‘Wild West’: experts concerned about illegal promotion of slimming shots in Britain

Weight loss injections are aggressively marketed to British consumers through often illegal promotions, in a practice that experts have described as a “Wild West” industry of drug sales.

The booming market for jabs like Wegovy and Mounjaro has led to a price war between online pharmacies, with even major chains benefiting from rising demand.

Last month, the pharmaceutical company Novo Nordisk unveiled Wegovy’s global sales reached £1.94 billion in the third quarter of the year, up 48% on the previous quarter and exceeding expectations.

However, a Guardian review of watchdog reports which regulates medical advertising in Britain shows that many online pharmacies are ignoring strict rules governing how prescription medicines can be marketed in Britain.

A study shows:

• Supermarkets are exploiting loopholes by advertising discount offers on weight loss ‘services’, including – and prominently – the injections.

• The Advertising Standards Authority (ASA) is preparing to launch an investigation into the marketing of slimming injections.

• The regulatory body responsible for drug advertising has upheld complaints about online advertisements for weight-loss drugs every month since April 2023.

In Britain it is illegal to advertise prescription-only drugs, such as weight-loss shots, directly to the public.

While the ASA states that consultations for weight loss “services” can be advertisedPOMs cannot be listed on a homepage, and information about them can only be provided elsewhere in the context of a possible treatment option following a consultation.

Price lists are allowed outside a website’s homepage, but the ASA says they must not contain claims about POMs, or actively encourage viewers to choose a product based on price, such as a discount offer.

However, a Guardian review of reports from the Medicines and Healthcare products Regulatory Agency (MHRA) has revealed that many online pharmacies are flouting the rules in a bid to attract customers looking for weight loss treatments.

The regulator has regularly written to online pharmacies advertising cheap and multi-buy deals on jabs to censor them over their promotions, reminding the retailer that the suitability of injections for weight loss “must be a professional prescribing decision based on a consultation” .

Despite the Committee on Advertising Practices issuing a writ of execution When it comes to advertising prescription weight loss treatments in 2021, such violations appear to be on the rise: although no complaints were accepted by the MHRA in 2019 and only four websites were reprimanded in 2020, the MHRA enforced 27 such violations in 2021. 2023 and 19 in the first nine months of 2024.

As of April 2023, not a month has gone by without the MHRA asking websites to change their advertisements for prescription medicines in the context of weight loss, including advertisements for medicines not licensed for such purposes.

The increase in such advertisements coincides with a rise in the number of prescription weight loss drugs approved by the MHRA, with Saxenda – which contains the drug liraglutide – being approved in 2017, and Wegovy – which contains the drug semaglutide – being approved in 2021 approved. and Mounjaro – which contains tirzepatide – approved in 2023.

Julian Beach, MHRA interim director of healthcare quality and access, said the MHRA takes concerns about the illegal promotion of prescription weight loss medicines to the public very seriously.

“We are considering complaints we receive about the alleged advertising of POMs to the public, examining each case on its own merits and working with other regulators where appropriate,” he said.

The MHRA’s official guidance states that failure to comply with a requirement imposed by a notice under the regulations is a criminal offence. “The penalty is a fine and/or imprisonment for a maximum of two years,” it says.

However, the MHRA told the Guardian it was not required to use legal powers to conduct advertising investigations into online pharmacies offering a weight loss service – and all voluntarily complied after being contacted by the MHRA.

The Guardian has also found examples of promotions that have raised concerns among experts about the use of 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 have images of the jabs next to the text offering the special discounted rates.

Superdrug Online Doctor has launched a web page with a promotional code that entitles customers to a 33% discount on the slimming service, with the prices of the prescription-only slimming pills Wegovy and Mounjarno listed below the offer.

Roz Gittins, head of pharmacy at the General Pharmaceutical Council, said: “Pharmacies are not allowed to create or use discount codes for prescription medicines (POMs) as this is a form of promotion of POMs. This includes creating codes for use in advertising, including on social media.”

A spokesperson for Superdrug said: “Our advertising for Superdrug Online Doctor is fully compliant with the ASA’s specific guidelines for weight loss services, which allow advertising of weight loss services provided no reference is made to medicines used alone are available by prescription. part of the treatment.

“The Superdrug Online Doctor discount code conflicts with the entire offering of the slimming service, including the expert time and consultation of the doctor, and does not conflict with prescription-only medicines.”

But Oksana Pyzik, associate professor of pharmacy practice and policy at UCL School of Pharmacy, said the aggressive promotion of weight-loss services targeting prescription drugs such as Wegovy and Mounjaro was a growing public health problem.

“While it is not technically direct-to-consumer drug advertising, the distinction is likely lost on most consumers. Patients will likely zero in on the ‘weight loss promotion’ and interpret these promotions as direct offers for Wegovy and Mounjaro at a discount,” she said.

“In this way, online pharmacy promotions effectively circumvent regulations by advertising ‘health services’ while prominently offering discounts on prescription drugs through the service. These advertising strategies are aimed at growing the number of patients using these products.”

She said current restrictions on drug advertising “become meaningless if drug price promotions can still reach consumers through obvious loopholes.”

Pyzik said an updated regulatory strategy was needed to address these new weight loss marketing tactics and ensure patient safety remained a priority.

“The line between promoting health services and prescription drugs has become increasingly blurred from the patient’s perspective. There is a duty of care for healthcare providers and regulators to protect themselves from this vague boundary,” she said.

Dr. Piotr Ozieranski, a reader at the University of Bath’s department of social and policy sciences, said: “This is like early 2000s drug marketing in the US, like the Wild West.”

A spokesperson for the ASA said advertisements for prescription-only weight loss drugs were firmly on their radar.

“We are about to launch eight proactive investigations into this type of advertising, some of which will include discount offers, as part of a project-based approach to identify and address issues and set clear precedents for advertisers,” they said.

“This will be followed by enforcement work. If and where advertisers are unwilling or unable to follow the rules, we will take further action.”

Novo Nordisk, the company behind Saxenda and Wegovy, told the Guardian it did not approve of the promotion of POMs to the public in Britain.

“As part of our work, we make providers aware of legal obligations, including regulations surrounding the promotion of prescription medicines,” a spokesperson said. “We are committed to monitoring providers who offer our medicines in the UK.

“When we become aware of providers promoting our medicines to the public, we address this directly with the provider and in many cases report this to the relevant authorities such as the MHRA and ASA.”

Experts say the situation surrounding advertising of prescription-only weight loss drugs is worrying, with rebukes from the MHRA and ASA over illegal promotions apparently having little effect.

Ozieranski said the MHRA must not only move faster, but also act proactively rather than relying on a complaints procedure, tackling gray areas and taking a more adversarial approach to prevent companies from breaking the rules – as is the case in the US .

“The current system is mainly based on reputational damage and issuing statements that indicate rule violations. And this is basically to name and shame the wrongdoers,” he said. “But what actually seems to work better are very significant financial sanctions.”