Weight expectations

As demand for GLP-1 receptor agonists (GLP-1RAs) surges, fragmented prescribing practices threaten patient safety. A coordinated response from regulators, prescribers and patients is urgently needed to facilitate the ongoing monitoring of the safety of these products.

Media coverage of GLP-1RAs for weight management has intensified, reflecting both growing public interest and the expanding clinical relevance of these therapies.

Originally developed for type 2 diabetes, GLP-1RAs are now widely used for the extended indication of weight loss, often accessed through online platforms that bypass National Health Service (NHS) care pathways.

Additionally, there are increasing reports of patients using GLP-1RAs outside the licensed indications. For these patients the benefits and risks of these medicines have not been studied, and the safety profile remains unknown (BNF, 2025). This presents new challenges for clinicians, regulators and patients alike.

The appeal of these products is understandable: they offer a non-surgical option for weight loss, with evidence of metabolic benefits and cardiovascular risk reduction.  Semaglutide, for example, has demonstrated significant efficacy in reducing body weight in trials such as STEP-UP.

However, the rapid uptake, fuelled by celebrity endorsements and social media, has outpaced the development of safeguards to ensure safe use. The result is a prescribing landscape that is increasingly fragmented, opaque and difficult to monitor.

GLP-1RAs demonstrate clear efficacy in clinical trials when used as part of a structured weight management programme. However, their use outside structured clinical environments raises significant safety concerns.

Although there has been an attempt to strengthen prescribing practices in recent months (General Pharmaceutical Council, 2025), online prescribing platforms may still lack comprehensive patient assessment, continuity of care and integration with NHS records.

This disconnect increases the risk of inappropriate prescribing, missed contraindications and delayed recognition of adverse events (MHRA, 2025).

In traditional settings, clinicians assess patients holistically, considering comorbidities, medication interactions and psychosocial factors.

Online platforms, by contrast, often rely on self-reported data and algorithmic decision-making, and therefore may be at greater risk of misuse and/or may overlook critical nuances. For example, a patient with a history of pancreatitis or severe gastrointestinal disease may be prescribed a GLP-1RA without adequate screening.

GPs are often unaware of prescriptions issued online, making it impossible to correlate reported adverse events with specific drug exposures. Moreover, healthcare professionals may inadvertently prescribe medications to patients without recognising concurrent use of GLP-1RAs.

This lack of visibility can lead to contraindicated prescribing or clinically significant drug–drug interactions, thereby elevating the risk of medication-related harm.

Such discontinuity in prescribing oversight undermines post-marketing surveillance efforts and obscures the true safety profile of these widely used agents.

Local Medical Committees (LMCs) have called on the General Practitioners Committee UK of the British Medical Association (BMA) to urge the MHRA and the Care Quality Commission (CQC) to conduct an “urgent and thorough review” of online prescribing practices for GLP-1RAs. This review must go beyond surface-level surveillance and include a robust drug utilisation and safety study.

Key policy recommendations could include:

• Mandatory reporting of all GLP-1RA prescriptions (both private and NHS) and associated adverse events by the prescriber and/or the recipient
• Integration of private prescribing data with NHS electronic health records
• Clinical governance standards for online platforms equivalent to those in primary care
• Clear guidance on off-label prescribing and patient eligibility criteria
• Public education campaigns to inform patients of risks and encourage disclosure to their GP.

To enable meaningful pharmacovigilance, a national prescribing registry should be established, capturing all GLP-1RA prescriptions regardless of origin.

Alternatively, or in addition to this, access to online/private prescription data should be available to conduct appropriate drug utilisation and safety studies. These data sources must be interoperable with NHS systems to allow clinicians to access complete prescribing histories and link them to adverse events.

Private prescribing platforms should also be required to submit anonymised data to a central surveillance system, enabling real-time monitoring and early detection of safety signals.

Importantly, the data must be accessible to researchers conducting drug utilisation and drug safety studies.

Without reliable data on who is receiving GLP-1RAs, in what context and with what outcomes, it is impossible to evaluate their real-world safety and effectiveness, especially in populations not traditionally included in clinical trials (GPhC, 2025).

The responsibility for addressing these challenges does not lie with regulators alone. Online providers must commit to transparency and clinical accountability. General practitioners need support and tools to manage patients who present with complications from medications they did not prescribe. Patients themselves must be empowered to make informed decisions and encouraged to disclose all medications they are taking.

Pharmaceutical companies also have a role to play. As manufacturers of GLP-1RAs, they should also invest in independent post-marketing studies that reflect the realities of current prescribing patterns, including online access and off-label use.

Collaboration across sectors is essential. The rise of digital health is not inherently problematic, but without coordination, it risks creating silos that compromise care.

The rapid expansion of online prescribing has outpaced existing pharmacovigilance frameworks. The absence of robust data integration between online prescribing platforms and NHS records may compromise regulatory oversight, leaving critical gaps in patient safety and drug surveillance.

As GLP-1RAs continue to rise in popularity, healthcare surveillance systems must adapt to ensure that therapeutic advancement does not come at the expense of safety.

We urge regulators, policymakers and healthcare leaders to prioritise a comprehensive review of online prescribing practices, underpinned by a clear mandate to safeguard patient well-being and uphold the integrity of clinical care. This review must encompass provisions for a drug utilisation and safety study, supported by robust data infrastructure and strengthened oversight mechanisms.

Without decisive action, blind spots will continue to widen, undermining the quality and safety of care. The time to act is now.

Dr Kathryn Morton is Drug Safety Research Physician and General Practitioner at the Drug Safety Research Unit