The medical treatment regulator for England has approved a second drug to combat obesity, giving patients and doctors what it says is a more effective alternative to semaglutide. The National Institute for Health and Care Excellence (Nice) issued draft guidance on Tuesday recommending that very obese people should be prescribed tirzepatide, which is marketed in the UK as Mounjaro. Doctors can give it to people in England who have a body mass index of at least 35 and at least one weight-related comorbidity, such as heart disease, type 2 diabetes or sleep apnoea. Nice’s draft guidance said: “Clinical trial evidence suggests that tirzepatide with diet and exercise support is more effective compared with diet and exercise support alone. “Indirect comparisons suggest it is more effective compared with semaglutide alongside diet and exercise support.” Semaglutide, which is better known as Wegovy, was the first anti-obesity drug that Nice approved, back in 2022. Novo Nordisk makes Wegovy while Mounjaro is made by Eli Lilly. Experts said patients should find it easier to obtain Mounjaro, and it is likely to become more widely used than Wegovy, because GPs, rather than just NHS weight management services, will be able to prescribe it. Nice’s move will probably increase the number of people taking obesity medication. Clinical trials have shown that tirzepatide has helped users shed 22.5% of their body weight over 72 weeks compared with 16% over 68 weeks with Wegovy. Dr Nerys Astbury, an associate professor of diet and obesity at Oxford University, said: “The introduction of more pharmacological options to help healthcare professionals outside specialist weight management settings treat people living with obesity can only be seen as a good thing.” Nice said a four-week supply of pre-filled pens of Mounjaro would cost between £92 and £122, depending on the size of the dose, but this would be a good use of NHS resources because it would reduce the chances of patients suffering other serious health complications. People prescribed Mounjaro will be able to take it for as long as necessary, whereas Nice has imposed a two-year limit on the use of Wegovy. Dr Simon Cork, a senior lecturer in physiology at Anglia Ruskin University, said that, despite Nice having set a threshold BMI of 35 for receipt of Mounjaro, meaning that “very few patients” will be given it, other people will try to get it as they have done with Wegovy. Prof Sir Stephen O’Rahilly, a professor of clinical biochemistry and medicine at Cambridge University, said that given increasing rates of dangerous weight gain, “medicines such as tirzepatide will become a central plank of how we help people living with obesity to live longer and healthier lives”. However, Nice also said that doctors should stop prescribing Mounjaro if the patient has lost less than 5% of their body weight within six months.