Semaglutide for managing overweight and obesity
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1.1 Semaglutide is recommended as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and increased physical activity in adults, only if:
a body mass index (BMI) at least 35.0 kg/m2, or
exceptionally, a BMI of 30.0 kg/m2 to 34.9 kg/m2 if they are referred to tier 3 services based on the criteria in NICE's clinical guideline on obesity: identification, assessment and management.
Use lower BMI thresholds (usually reduced by 2.5 kg/m2) for people from south Asian, Chinese, and Black African or Caribbean family backgrounds.
1.2 Prescribe semaglutide as part of a specialist weight management service with multidisciplinary input (such as a tier 3 or tier 4 service).
1.3 Only use semaglutide for a maximum of 2 years.
1.4 These recommendations are not intended to affect treatment with semaglutide that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.
Why the committee made these recommendations
Management of overweight and obesity in adults includes lifestyle measures alone or with orlistat, or referral to weight management services (such as tier 3 or 4), which might include liraglutide or bariatric surgery.
Clinical trial evidence shows that people lose more weight with semaglutide alongside supervised weight management support than with the support alone, and people lose more weight with semaglutide than with liraglutide. The evidence also shows that semaglutide with lifestyle measures reverses prediabetes more frequently than lifestyle interventions alone, and may decrease the risk of cardiovascular disease.
People from some minority ethnic family backgrounds have an equivalent risk from obesity at a lower BMI than people from a White ethnic family background. Also, NICE's guideline on BMI recommends using lower BMI thresholds for people from south Asian, Chinese, and Black African or Caribbean family backgrounds when identifying the risk of developing type 2 diabetes and providing interventions to prevent it. So, a similar adjustment in the BMI threshold is appropriate when considering using semaglutide.
It is appropriate to use semaglutide alongside intensive lifestyle interventions that are provided in specialist weight management services because this is in keeping with the clinical trial.
For people who have at least 1 weight-related comorbidity and a BMI of at least 35 kg/m2 or exceptionally a BMI of 30 kg/m2 to 34.9 kg/m2 and also meet the NICE criteria for referral to a tier 3 service, the cost-effectiveness estimates for semaglutide are likely to be within what is normally considered a cost-effective use of NHS resources. For these groups, semaglutide is recommended alongside intensive weight management in an appropriate multidisciplinary setting.