Online pharmacies operating in the UK are approving and dispatching prescriptions of controversial slimming jabs for people of a healthy weight, a Guardian investigation has found.
Some pharmacies appear to be issuing prescriptions of such medications to people who lie about their body mass index (BMI) on an online form. In one case a reporter was issued a prescription after accurately saying their BMI was about 20. A healthy BMI lies between 18.5 and 24.9.
The findings have raised alarm among eating disorder charities, which have warned that weight-loss medications should only be sold under the strictest conditions. Their concern has prompted calls for online pharmacies to employ stronger health checks and screening for eating disorders.
Drugs originally developed for diabetes have recently been hailed as “gamechangers” after they were found to help people reduce their weight by more than 10%, making them a potential alternative to stomach surgery. While available to some people on the NHS, they can also be bought on prescription through online pharmacies.
However, the medications, which are administered by injection, are controversial because they can cause side-effects such as nausea and fatigue, and it is thought weight loss will reverse when the drugs are stopped.
Saxenda, a brand of the drug liraglutide, has been approved for use in the UK for certain groups of people with obesity – meaning a BMI of 30 or greater – or who are overweight with a BMI of 27 to 30 and have weight-related health problems.
Ozempic, a brand of a similar drug called semaglutide, is licensed for diabetes but is increasingly being prescribed “off-label” for weight loss by online pharmacies. While legal, “off label” prescribing is done at the discretion of the prescriber.
To investigate the availability of the slimming jabs, the Guardian approached a selection of online pharmacies from the top search results returned by Google.
On two occasions an online consultation for Ozempic – accurately filled in by a 1.7-metre (5ft 7in) female reporter weighing 57kg (9 stone), resulting in a BMI of about 20 – was immediately approved and dispatched by the online pharmacy Daily Chemist.
This is despite the form stating the drug should be discontinued once a patient’s BMI fell below 27. The medication arrived by post within days.
A number of other online-only pharmacies contacted, including Click2Pharmacy, Pharmacy2U and Simple Online Pharmacy, refused a prescription to the same reporter based on her BMI, as did the online websites of the high street chemists Lloyds and Superdrug.
Daily Chemist did not respond to a request for comment.
The investigation also found that other online pharmacies have authorised prescriptions and sent medication to individuals who deliberately submitted incorrect information in order to get slimming jabs.
Jenny*, who has a history of disordered eating, meaning she has irregular eating behaviours, said she had sought out the jabs after gaining 4.5kg to 6.4kg after an operation.
“I definitely am not in the weight category to qualify for any kind of weight-loss drug really. But I decided I really wanted the quick fix,” she said. “I could afford it.”
Searching online, Jenny found a huge range of online chemists and that to obtain a prescription for Saxenda it was only necessary to answer a few simple questions. “One of them is: ‘What’s your weight?’ So I just added two and a half stone to my weight, kept my height the same, my age [and] everything else the same,” she said.
To proceed with the order, applicants must allow the company, Chemist4U, the option to contact the patient’s GP and see their summary care record. As a teenager, Jenny had an eating disorder that was discussed with her family doctor but is not known whether her GP was contacted after she filled out the form for Saxenda. Despite this, the prescription arrived in the post within a couple of days.
Sasha* said she sought out Ozempic online in order to lose 6kg to 7kg of weight to reduce her BMI to the lower end of the “healthy” window and cut her risk of diabetes – a disease that was common in her family.
Like Jenny, she submitted an incorrect weight to obtain a prescription from the Mayfair Weight Loss Clinic. “I had to boost my weight to make me up to 30 BMI on this online weight loss clinic to get it,” Sasha said. Mayfair Weight Loss Clinic did not respond to a request for comment.
In 2019 new safeguards were introduced by the General Pharmaceutical Council (GPhC), the independent regulator for pharmacists and pharmacies, to protect people from the risks of buying inappropriate drugs through online providers.
In guidance for pharmacies acting at a distance, including online, the GPhC says: “Some categories of medicines are not suitable to be supplied online unless further safeguards have been put in place to make sure that they are clinically appropriate – these include medicines liable to abuse, overuse or misuse or when there is a risk of addiction and ongoing monitoring.”
The GPhC confirmed this category included medicines used as weight loss treatments.
The guidance goes on to say medicines in this category should not be prescribed unless the pharmacy has been assured “that the prescriber has contacted the GP in advance of issuing a prescription, and that the GP has confirmed to the prescriber that the prescription is appropriate for the patient and that appropriate monitoring is in place”.
Tom Quinn of the eating disorder charity Beat expressed concern at the findings. “The fact that weight loss injections are apparently available online without stringent health checks in place is very alarming,” he said.
“It can feel incredibly tempting to order weight loss injections like Ozempic as they seem to promise fast results, but these medications can be extremely dangerous for those with eating disorders.”
Quinn said rapid weight loss could contribute to eating disorders developing for the first time in vulnerable people. “You can never tell if somebody has an eating disorder based on their BMI, and it’s crucial that thorough health checks and eating disorder screenings are in place to ensure that nobody unwell with an eating disorder is able to access weight loss medications,” he said.
The Guardian passed its findings to the GPhC. The regulator’s director of insight, intelligence and inspection,, Claire Bryce-Smith, said: “We take all concerns that are raised with us very seriously and part of our role is to inspect pharmacies to ensure they are meeting the standards we have set to protect patient safety.
“We have recently taken action to stop a small number of online pharmacies supplying medicines being used for weight loss to potentially vulnerable people. We’ve also reminded all online pharmacies that they need to follow our standards and guidance at all times.
“These include the requirement for pharmacies to ensure they have all the relevant patient information before making a prescription and carrying out a risk assessment to consider the person’s wellbeing, particularly as eating disorders, body dysmorphia and mental health issues can play a part in the reason for requesting these medicines.”
Bryce-Smith said pharmacies should verify the accuracy of the information patients provided them, for example through the use of video consultations. She added that those accessing healthcare services should also always provide truthful and accurate information about their health and medical history.
* Names have been changed.