Three years ago, a fashion editor friend returned from Milan Fashion Week bursting with a story to tell.

Most fashion editors stayed at the same hotel, she explained, and each bedroom had its own mini fridge. After checking out, en route to the airport, a stylist in her party cried out that he'd left "an important package" in his fridge and telephoned the hotel, pleading with them not to throw it away.

"Turns out he'd forgotten his Ozempic," my editor friend whispered. We were baffled. Ozempic?

Back then, Ozempic was not part of the common lexicon. But quietly, in certain circles, this injectable drug, which is licensed for the treatment of type 2 diabetes, was being prescribed privately and off-label for weight loss.

Flash forward to today and the picture is vastly different. "So many fashion people are on it," she tells me today. "And now they're very vocal."

Serena Williams, Elon Musk and Whoopi Goldberg have all spoken about using weight-loss injections. Some are now prescribed by the NHS, including Wegovy and Mounjaro, generating scores of headlines.

Really, this should have made it a great leveller. In theory, anyone struggling with obesity can - without the expense of a private doctor - get help to manage their weight.

Only that's not the full picture.

Thousands of NHS patients are believed to be missing out. And with the NHS tightly restricting access, some working in the field warn a two-tier system around weight-loss drugs is developing - one that's benefitting the most well-off.

Martin Fidock, who is UK managing director of Oviva, which provides Wegovy and lifestyle support to NHS patients, claims that thanks to varying thresholds of eligibility in different regions, NHS prescriptions are a "postcode lottery".

An estimated 1.5 million people in the UK use these drugs - but more than nine in 10 are believed to pay privately. Prices vary but it generally costs between £100 and £350 a month, depending on the dose and lifestyle support.

Then, last month, it was reported that pharmaceutical giant Eli Lilly was expected to increase the list price of Mounjaro by as much as 170%.

They have since done a deal for UK distributors, meaning rises are likely to be less, and the rises don’t affect the cost to the NHS - but it has still caused concern in some quarters.

"It's scary," says Brad, a tech company worker in his 40s. He has been taking Mounjaro for a year and worries he may not be able to afford to continue.

"I've lost 20kg and want to keep using it, but it's a lot of money. It's unfair."

Nutritionists and GPs I spoke to have also expressed concerns about the broader system, and in particular whether existing health inequalities could worsen.

"We cannot allow good health to become a luxury for the wealthiest by limiting access to weight-loss drugs to those who can pay privately," argues Katharine Jenner, executive director of Obesity Health Alliance.

So could it really be that weight-loss injections - for all of their benefits - are turning obesity into a wealth issue?

Weight-loss drugs have been available on the NHS for some time, but the landscape changed significantly with the introduction of some newer medications - among them, semaglutide, marketed under the brand name Wegovy, and tirzepatide, sold as Mounjaro.

Wegovy was first prescribed for obesity by the NHS in 2023, while Mounjaro followed earlier this year. They work in part as an appetite suppressant by mimicking a hormone, which makes people feel fuller.

Studies have suggested patients can lose as much........

© BBC