Weight-loss drug semaglutide could be prescribed to people with a serious form of fatty liver disease under new guidance announced today.

The medication – sold for weight loss under the brand name Wegovy – has been approved by the MHRA to treat metabolic-associated steatohepatitis, or MASH.

MASH develops when excess fat builds up in the liver, triggering inflammation and scarring. It is more common in people who are obese, have type 2 diabetes or have high levels of fat in the blood.

Under the new guidance, semaglutide can be prescribed to adults with MASH who have moderate to advanced liver fibrosis – scarring of the liver caused by the condition.

Julian Beach, Executive Director of Healthcare Quality and Access at the MHRA, said: ‘The available evidence indicates that semaglutide is a safe and effective treatment option for patients with MASH.

‘As with all GLP-1 receptor agonists, this is a prescription-only medication and should only be taken in consultation with a doctor.’

However, patients with MASH cannot currently get semaglutide on the NHS specifically to treat the condition and will need to obtain a private prescription.

NICE is still assessing whether the drug is clinically effective and cost-effective enough to be offered routinely as a treatment for MASH and until that decision is made, it will not be available on the NHS for this use.

Fatty liver disease is now one of the fastest-growing health problems globally

The approval is also conditional, meaning regulators want more evidence before granting full marketing authorisation. Further results are expected from an ongoing study in adults with MASH and moderate to advanced liver scarring.

Semaglutide is a GLP-1 receptor agonist and is prescribed alongside diet and exercise. It works by mimicking a hormone released after eating, helping people feel fuller for longer, reducing cravings and supporting weight loss.

It is already authorised for weight management in adults and adolescents, and for reducing the risk of cardiovascular events in adults.

Treatment usually starts at a low dose of 0.25mg once a week, before gradually increasing to 0.5mg, 1mg and 1.7mg, with patients spending around four weeks on each dose. The usual maintenance dose is 2.4mg once weekly.

For patients with obesity, defined as a BMI over 30, the dose may be increased to 7.2mg once weekly after at least four weeks on the 2.4mg dose.

The MHRA said it will review new information on semaglutide at least once a year, and update the product information if needed.

As with all medicines, the regulator will continue to monitor the drug’s safety and effectiveness. The most common side effects are gastrointestinal problems, including nausea, diarrhoea, constipation and vomiting.

Anyone who thinks they may be experiencing side effects is advised to speak to a doctor, pharmacist or nurse, and report them through the MHRA Yellow Card scheme.

Liver disease is one of the fastest-growing causes of death in the UK, and often develops silently, leaving many unaware until serious and sometimes irreversible damage has already occurred.

 Incidents of the disease have soared in recent decades, with deaths increasing more than fourfold since the 1970s – even as outcomes for many other major illnesses have improved.

While it is often linked to alcohol, experts warn growing numbers of cases are being driven by obesity, diabetes and poor diet – meaning millions of non-drinkers could also be at risk.

One of the biggest challenges is that symptoms can take years to appear. By the time the condition is diagnosed, patients may already have significant scarring of the liver, known as cirrhosis, or even liver failure or cancer.

The announcement comes shortly after a tablet form of the medication became available in the UK. 

Today Superdrug announced it would be selling the pill for a little as £79 per month.

Around 2.5million adults in the UK are thought to be using fat-busting jabs such as Wegovy and Mounjaro, but the arrival of the new pill has opened the door for millions more.

On average, the lowest dose of the once-weekly injection – 0.25mg – costs between £80 and £140 per month in the UK.

Trial results of the new pill, which is taken daily, found that patients lost around 17 per cent of their body weight after 64 weeks on the highest dose, 25mg. 

This means it is slightly less effective than the jabs, which tend to trigger up to a 20.7 per cent reduction.

Superdrug is currently stocking the pill at doses of 1.5mg and 4mg, with higher doses at 9mg and 25mg coming soon. 

The sun is out – and that means feet are out too.

The heavy boots and thick socks of winter have been swapped for sandals and flip flops, and suddenly toenails are on display.

And for many of my patients, that’s a problem. They look down, feel embarrassed, and come to my surgery asking what on earth can be done about their thickened, crusty, yellowing nails.

If that’s you, you are far from alone. About one in ten of us has a fungal toenail infection – and by the age of 70, it’s roughly half of all adults.

The culprit is usually a family of fungi called dermatophytes, the same bugs behind athlete’s foot. They invade the nail and the skin underneath it, and left untreated the nail becomes thickened, discoloured – often yellow, white or brown – brittle and, in some cases, painful.

So why do so many of us get it? Fungal nail infections become more common with age, as nails grow more slowly.

You’re also more at risk if you have a weakened immune system, poor circulation – perhaps due to diabetes – or a nail that’s been damaged in the past. And walking barefoot in communal areas such as gym changing rooms and swimming pools increases your exposure to the fungi in the first place.

But here’s the surprising bit: it’s often your footwear that triggers the problem.

About one in ten of us has a fungal toenail infection – and by the age of 70, it’s roughly half of all adults

Fungi thrive in warm, dark, moist environments – which makes the inside of your shoe the perfect breeding ground.

Synthetic trainers worn for hours on end, rubber-soled boots and tight shoes with no ventilation all trap the heat and sweat that fungi love. This is why Crocs – the plastic sandals – or other sandals are some of the best anti-fungi shoes, as they have holes that circulate air and evaporate sweat, so moisture doesn’t build up.

Your socks matter too. Synthetic sports fibres or merino wool pull sweat away from the skin so it can evaporate.

Cotton, on the other hand, acts like a sponge – absorbing moisture and holding on to it, leaving your feet constantly damp.

Change your socks daily (and no, that isn’t obvious advice to everyone), and try alternating your shoes so each pair gets 24 hours to dry out fully.

However, this advice only helps those who haven’t got the infection yet. So what do you do once your nails are crusty and yellow?

The good news is that antifungal nail lacquers, such as amorolfine, are available over the counter. But this is where most people go wrong – and I see the same mistakes again and again.

Take my patient Lucy. She noticed athlete’s foot – a scaly, itchy rash – between her toes a few months ago and didn’t treat it. A while later, her pharmacist diagnosed a fungal toenail infection and recommended an antifungal lacquer. She used it for a month, then came to see me complaining she’d wasted her money because it hadn’t worked.

Do you have any of these conditions?

The problem is that a month is not nearly enough time for the lacquer to take effect.

And it’s the most common reason I see for these treatments ‘failing’: people simply haven’t given them long enough.

The reason it takes so long to work is because toenails grow slowly – very slowly in fact.

Depending on the nail, it can take 12 to 18 months to grow out fully.

Amorolfine needs to be applied once or twice a week for at least nine to 12 months. The infected part of the nail may never look better – instead, crucially, treatment has worked if new, healthy nail grows in from the base.

There is a second mistake I also see. Patients not filing the nail first.

The lacquer has to penetrate the nail to reach the fungus underneath, and if the infection has made your nail thicker, the medicine simply can’t get through.

That’s why the packs come with disposable nail files. Patients are supposed to file the nail down every time before they apply the lacquer, or the treatment is far less likely to work.

The third mistake is Lucy’s original one: ignoring athlete’s foot. If you have a fungal infection on the skin of your feet, the same fungi may be causing both problems. 

Treat the nail without treating the skin and you’ll simply reinfect yourself. Athlete’s foot creams are also available over-the-counter and should be used alongside the nail treatment.

If you’ve done all of this properly, for long enough, and it still hasn’t worked, see your GP.

We can send nail clippings to the lab to identify the fungus, and if appropriate prescribe potent terbinafine tablets.

These are more effective and work faster, but they can cause liver side effects, need monitoring, and aren’t suitable for everyone.

Laser therapy to burn away the fungus is also offered by some private podiatrists, but it can be expensive and have mixed results.

There are also alternative – and potentially effective – treatments that many patients might not have heard of.

There is some evidence that tea tree oil, applied undiluted to the affected nail twice daily after filing, might help – especially if the infection is caught early.

Again, it takes time, and it’s less likely to work on a longstanding or severe infection, though it can be used alongside antifungal nail lacquer.

GP, author and broadcaster Dr Philippa Kaye advises patients to act quickly if they spot a fungal toenail

Apple cider vinegar, on the other hand, is often promoted as a toenail fungus cure but has no good evidence to support it – save it for your salad.

One thing I’d urge you not to do is reach for the nail varnish. I understand the temptation to paint over the problem, but varnish traps moisture, stops antifungal treatments from penetrating the nail – and hides what’s going on underneath, which all may well be getting worse.

Instead, keep it simple. Dry your feet thoroughly after washing, including between the toes. Keep your toenails trimmed straight across. Don’t share towels, nail clippers or footwear as this can spread the infection.

And if you spot athlete’s foot, treat it promptly with an over-the-counter cream before it spreads to the nails.

And if you’ve only just spotted a fungal toenail? Start treatment now. The honest truth is that you probably won’t see the results this summer – but, if you follow these steps, you could well do by the time next year’s heatwaves roll around.