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However, NICE technology appraisals for weight management medications provide the framework for NHS access: Semaglutide 2.4 mg (Wegovy) – NICE TA875: For adults with BMI ≥35 kg/m² and at least one weight-related comorbidity, or ≥30 kg/m² with specific risk factors, in specialist weight management services, typically for up to 2 years Liraglutide 3.0 mg (Saxenda) – NICE TA664: Similar criteria with specialist oversight and duration limits Tirzepatide – Subject to current NICE guidance for weight management The British Obesity and Metabolic Surgery Society (BOMSS) recommends that any pharmacological intervention after bariatric surgery should be: Individualised based on patient circumstances, weight trajectory, and comorbidities Evidence-based where possible, acknowledging the limited but growing research base Delivered within a multidisciplinary framework involving bariatric surgeons, dietitians, psychologists, and specialist physicians Accompanied by lifestyle modification support, including dietary counselling and physical activity guidance Medical supervision requirements for post-bariatric patients using weight loss injections include: Baseline assessment : Comprehensive evaluation of nutritional status, including blood tests for vitamins, minerals, protein levels, renal function, and HbA1c/glucose Regular monitoring : Follow-up appointments every 4–12 weeks initially to assess tolerance, efficacy, and side effects Nutritional surveillance : Ongoing monitoring of protein intake, hydration status, and micronutrient levels with appropriate supplementation Medication review : Assessment of concurrent medications, particularly diabetes treatments that may require adjustment Pregnancy status : Confirmation of effective contraception in women of childbearing potential Diabetic eye screening : For patients with diabetes, particularly if rapid improvement in glucose control occurs Psychological support : Evaluation of eating behaviours, body image concerns, and mental health Prescribing should typically occur through specialist weight management services or bariatric teams rather than primary care alone, given the complexity of post-surgical patients
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