NICE backs Zepbound for obesity

Indirect comparisons suggest tirzepatide is more effective than semaglutide when combined with diet and exercise support

Tirzepatide (Zepbound) has been approved by the National Institute for Health and Care Excellence (NICE) for use in adults with obesity, provided their body mass index (BMI) is at least 35 kg/m² and they have a weight-related comorbidity. The guidance includes lower BMI cut-offs for certain ethnic groups. Treatment should be reviewed if less than 5% of initial weight is lost after 6 months on the highest tolerated dose.

What BMI thresholds apply to tirzepatide eligibility in different ethnic groups?

NICE recommends lowering the BMI threshold by 2.5 kg/m² for South Asian, Chinese, other Asian, Middle Eastern, Black African, and African-Caribbean backgrounds.

What should happen if tirzepatide treatment results in less than 5% weight loss after 6 months?

Clinicians should assess the benefits and risks before deciding whether to continue treatment.

Can patients continue tirzepatide if they started treatment before NICE guidance was published?

Yes. Treatment may continue under existing NHS funding until the patient and clinician agree to stop.

What does NICE say about tirzepatide versus semaglutide?

NICE reviewed indirect comparisons suggesting tirzepatide may offer greater weight loss than semaglutide when used with diet and exercise support.

Why did NICE limit tirzepatide use to people with a BMI of 35 kg/m² or more?

Because cost-effectiveness estimates for people with a BMI of 30 kg/m² were outside NICE’s acceptable range.