?Wild west?: experts concerned by illegal promotion of weight-loss jabs in UK
Weight-loss injections are being aggressively marketed to British consumers through often illegal promotions, in a practice experts have described as a ?wild west? industry of drug selling.
The booming market for jabs such as Wegovy and Mounjaro has triggered a price battle among online pharmacies, with even high-street chains cashing in on the soaring demand.
Last month, the pharmaceutical company Novo Nordisk revealed global sales of Wegovy hit ?1.94bn in the third quarter of the year, up 48% from the previous quarter and outstripping expectations.
However, a Guardian review of reports by the watchdog that regulates medical advertising in the UK shows that many online pharmacies are flouting strict rules that govern how prescription-only drugs can be marketed in Britain.
An investigation reveals:
Supermarkets are using loopholes in the rules by advertising discount deals for weight-loss ?services? that include ? and prominently feature ? the injections.
The Advertising Standards Authority (ASA) is preparing to launch an investigation into the marketing of weight-loss injections.
The regulatory body responsible for drug advertising has upheld complaints against online ads for weight-loss drugs every month since April 2023.
In the UK, advertising prescription-only medications (POMs) such as weight-loss jabs directly to the public is illegal.
While the ASA states consultations of weight-loss ?services? can be advertised, POMs cannot be referenced on a homepage, and information about them can only be given elsewhere in the context of being a possible treatment option after a consultation.
Price lists are allowed outside the homepage of a website, but the ASA says they should not include claims about POMs, or actively encourage viewers to choose a product based on the price ? such as a discount offer.
However, a Guardian review of reports by the Medicines and Healthcare products Regulatory Agency (MHRA) has revealed many online pharmacies are flouting the rules in an attempt to attract customers looking for weight-loss treatments.
The regulator has regularly written to online pharmacies who advertise cut-price and multibuy deals on jabs to censure them for their promotions, reminding the seller that the suitability of weight-loss injections ?should be a professional prescribing decision based on a consultation?.
Despite the Committee of Advertising Practice issuing an enforcement notice on the advertising of prescription-only weight-loss treatments in 2021, such breaches appear to be on the rise: while no complaints were upheld by the MHRA in 2019, and only four websites were reprimanded in 2020, the MHRA upheld 27 such breaches in 2023, and 19 in the first nine months of 2024.
From April 2023 onwards, not a month has gone by without the MHRA asking websites to amended their advertising of prescription-only medicines in the context of weight loss, including advertisements for medications not licensed for such purposes.
The increase in such adverts coincides with a rise in the number of prescription weight-loss medications that have been approved by the MHRA, with Saxenda ? which contains the drug liraglutide ? approved in 2017, Wegovy ? which contains the drug semaglutide ? approved in 2021 and Mounjaro ? which contains tirzepatide ? approved in 2023.
Julian Beach, the MHRA?s interim executive director of healthcare quality and access, said the MHRA took concerns about the illegal promotion of prescription weight-loss medicines to the public very seriously.
?We consider complaints we receive about the alleged advertising of POMs to the public, looking at each case on its own merits and, where appropriate, working with other regulators,? he said.
The MHRA?s official guidance states that a failure to comply with any requirement imposed by a notice served under the regulations is a criminal offence. ?The penalty is a fine and/or imprisonment for up to two years,? it states.
However, the MHRA told the Guardian it had not been required to use statutory powers for any advertising investigations of online pharmacies offering a weight-loss service ? with all voluntarily complying after the MHRA contacted them.
The Guardian has also found examples of promotions that have raised concerns among experts for using what some describe as loopholes in the rules.
These often advertise a weight-loss ?service? or ?consultation? at a special price or discounted offer, as opposed to the drug itself, although many feature pictures of the jabs next to text offering the special discount rates
Superdrug Online Doctor has run a webpage offering a promotional code entitling customers to 33% off its weight-loss service, with the prices of the prescription-only weight-loss jabs Wegovy and Mounjarno listed below the offer.
Roz Gittins, the chief pharmacy officer at the General Pharmaceutical Council, said: ?Pharmacies should not create or use discount codes for prescription-only medicines (POMs), as this is a form of promotion of POMs. This includes the creation of codes for use for advertising, including on social media.?
A Superdrug spokesperson said: ?Our Superdrug Online Doctor advertising is in full compliance with the ASA?s specific weight-loss service guidelines which allow for advertising of weight-loss services, provided no reference is made to any prescription-only medication that might be provided as part of the treatment.
View image in fullscreen Examples of online promotion of ?weight-loss services? in the UK. Composite: Various
?The Superdrug Online Doctor discount code is against the entire provision of the weight-loss service, which includes the healthcare clinician?s expert time and consultation and is not against the prescription-only-medicine.?
But Oksana Pyzik, an associate professor of pharmacy practice and policy at UCL School of Pharmacy, said the aggressive promotion of weight-loss services centred on prescription medications such as Wegovy and Mounjaro was a growing public health concern.
?While technically not direct-to-consumer drug advertising, the distinction is likely lost on most consumers. Patients will likely zoom in on the ?weight-loss jab deal? and interpret these promotions as direct offers for Wegovy and Mounjaro at a discount,? she said.
?In this way, online pharmacy promotions effectively sidestep regulations by advertising ?health services? while prominently featuring discounts of prescription drugs through the service. These advertising strategies aim to grow the number of patients using these products.?
She said current restrictions on drug advertising ?become meaningless if price promotions for medicines can still reach consumers through obvious loopholes?.
Pyzik said an updated regulatory strategy was needed to address these new weight-loss jab marketing tactics and ensure patient safety remained a priority.
?The line between promoting health services and prescription drugs has become increasingly blurry from a patient?s perspective. There is a duty of care for healthcare providers and regulators to safeguard against this blurred line,? she said.
Dr Piotr Ozieranski, a reader in the department of social and policy sciences at the University of Bath, said: ?This is like early 2000s type of drug marketing in the US, like the wild west.?
A spokesperson for the ASA said advertisements for prescription-only weight-loss medications were firmly on their radar.
?We are about to launch eight proactive investigations into ads of this nature, some of which include discount offers, as part of a project-based approach to identifying and tackling problems and setting clear precedents for advertisers,? they said.
?This will be followed up by enforcement work. If and where advertisers appear unwilling or unable to follow the rules, we?ll take further action.?
Novo Nordisk, the company behind Saxenda and Wegovy, told the Guardian it did not condone the promotion of POMs to the public in the UK.
?As part of our work, we make providers aware of legal obligations, including regulation around the promotion of prescription-only medicines,? a spokesperson said. ?We are committed to monitoring providers offering our medicines in the UK.
?When we are made aware of providers promoting our medicines to the public, we address this with the provider directly and, in many cases, report this to the relevant authorities such as the MHRA and ASA.??
Experts say the situation around advertising of prescription-only weight-loss medications is concerning, with reprimands by the MHRA and ASA on illegal promotions apparently having little effect.
Ozieranski said as well as acting more quickly, the MHRA must move proactively rather than relying on a complaints process, clamp down on grey areas, and act more adversarially to prevent companies breaking the rules ? as is the case in the US.
?The current system is based on, primarily, reputational damage and issuing rulings which point out to rule breaches. And this is intended to, basically, name and shame the offenders,? he said. ?But actually, what seems to be working better is very significant financial penalties.?
