The Dekagram: 12th January 2026

In this week’s Dekagram Linda Nelson explores an area likely to be of increasing interest to practitioners this year; liability for use and misuse of weight-loss drugs, whilst John Schmitt explains the recent decision of Mr Justice Poole in care proceedings regarding the question of the location of a newborn baby’s habitual residence.

Weight-loss injections: growth in litigation likely, as waistbands shrink

In recent years weight-loss drugs have revolutionised the diet industry. The brand names Ozempic, Wegovy and Mounjaro have become part of the common lexicon and an estimated 1.5 million people in the UK now use these drugs[1].

Ozempic is a prescribed medication for Type 2 diabetes, and Wegovy is prescribed specifically for management of obesity. Both contain the same active ingredient (semaglutide). The active ingredient in Mounjaro is tirzepatide: both those ingredients work by mimicking the hormone GLP-1 (glucagon-like peptide-1), which suppresses the appetite and gives a feeling of satiety.

Approximately 1 in 8 adults (12.5%) in America were using GLP-1 injections in November 2025[2] and such is the efficacy of the drugs that the effects are being seen in many aspects of society. In May 2025 Weight Watchers filed for bankruptcy in America and cited the rapid rise in popularity of GLP-1 weight-loss drugs as a key factor in its financial struggles. Its troubles were already evident in 2024, when Oprah Winfrey announced that she was leaving its board, having already revealed that she uses weight-loss drugs as a “maintenance tool.”[3] In the UK, restaurants are offering smaller portion sizes to cater for diners using the injections, with Heston Blumenthal (who also uses them) developing a taster menu for that reason,[4] and tailors have reported a 20% increase in business, with clients spending on new suits or alterations to existing clothing[5].

The injections are prescription-only medicines and therefore can only be prescribed by an ‘appropriate practitioner’,[6] namely a doctor, dentist, ‘supplementary prescriber’, nurse independent prescriber or pharmacist independent prescriber. The NHS prescribes the medications where the patient meets certain criteria. In December 2024 NICE published a Technical Appraisal[7] recommending Mounjaro as a treatment option for adults with a BMI (body mass index) of at least 35kg/m² (less for people from certain backgrounds, e.g. Asian) and with at least one weight-related health condition (e.g. high blood pressure). NHS prescription is carefully controlled: NHS guidelines state that patients should follow a diet and physical activity programme, and the drug can only be prescribed for a maximum of two years.[8] The Technical Appraisal and the MHRA (Medicines and Healthcare Products Regulatory Agency) confirm that structured wraparound care is a required treatment component: clinical support (including eligibility assessment, safe prescribing, dose management and referral to other clinicians where appropriate) and behavioural support (including advice and support with nutrition and acknowledging obesity as a chronic, relapsing condition shaped by biology, environment and psychology)[9]. NHS prescriptions can be issued by specialist weight management services (on referral from a GP) and (since June 2025) by primary health care providers (e.g. GPs).

Known side effects of the medications include nausea, stomach pain, vomiting, diarrhoea and babies (Mounjaro can inhibit the absorption of the contraceptive pill, so additional methods of contraception are needed). Patients who fail to ensure their body’s nutritional needs are met can experience hair loss (a common side effect of Mounjaro, affecting up to 10% of people[10]) and muscle loss. Additionally, when the patient stops taking the drugs, they will regain the lost weight if they have not made the necessary changes to their diet and exercise habits. It is therefore important to counsel prospective users of the injections on such points, to ensure that prescription is appropriate for them, and to provide the wrap-around care specified by the MHRA.

Many people who do not want to wait for an NHS prescription, or who do not meet the NHS prescribing criteria, legitimately obtain the injections on private prescriptions issued by independent prescribers (e.g. nurses, and pharmacists) and regulated online services (e.g. Boots/Asda Online Doctor). The GPhC (General Pharmaceutical Council: a statutory body and the independent regulator for pharmacists in Great Britain) tightened the rules for online weight-loss drug sales in 2025, introducing stricter requirements in respect of assessment of patient BMI and medical history. Regulated online pharmacies can no longer rely solely on simple questionnaires and must instead independently verify a patient’s weight and BMI e.g. via video consultations. Such regulation is required to protect people seeking prescriptions inappropriately (e.g. people with eating disorders). 

In the UK, more than 90% of people are believed to pay privately[11] and with private prescriptions costing hundreds of pounds per month, inevitably there is a growing and flourishing black market. Regulation 214(1) of the Human Medicines Regulations provides that ‘a person may not sell or supply a prescription only medicine except in accordance with a prescription given by an appropriate practitioner’. Despite this, products sold as weight-loss injections are readily available without a prescription online (advertised on social media) and in beauty salons on the high street.[12] The MHRA works to shut down such websites and social media accounts, but faces the ‘whack a mole’ problem of rampant proliferation. Unlicensed versions of the drugs present a health lottery to the user and can contain toxic ingredients. Obviously, any such medication would fall foul of the Consumer Rights Act 2015 requirement that products be of satisfactory quality. Users of unlicensed products will not benefit from the protection afforded to users of licensed products, which are subject to regulation and authorisation by the MHRA and must comply with the internationally recognised Good Manufacturing Practice (GMP) standards enforced by the MHRA, which cover various aspects of manufacturing and compliance with which is verified through regular inspections.

America has already seen numerous product liability lawsuits filed against Eli Lilly and Novo Nordisk (manufacturers of the weigh-loss drugs), for failing to adequately warn of severe side-effects. There is also the potential for issuing clinical negligence claims against authorised prescribers, for issuing prescriptions inappropriately (e.g. failing to follow requirements in relation to initial patient assessments, or failing to follow new guidance of which they should have been aware) or for failing to ensure the patient is fully advised as to the associated risks and wraparound care. So too will claims lie against sellers/manufacturers of unlicenced medicines/ injections  without prescription, but in such cases identification of a defendant with funds/insurance is likely to be an issue.

About the Author

Linda Nelson was called in 2000 and is ranked in both the Legal 500 and Chambers and Partners for her travel law work. Linda regularly advises in international personal injury cases with cross-border issues, particularly those falling within the jurisdiction of the Admiralty Court. She is well-versed in claims involving the international carriage conventions, the package holiday regulations, Merchant Shipping regulations, ship collisions and issues of jurisdiction, applicable law and limitation. She is a contributing author to Munkman on Employers’ Liability (writing the ‘Shipping and Workers on Ships’ chapter) and co-authored ‘Work Accidents at Sea’ (now in its second edition).

Casenote: Wirral Metropolitan Borough Council v (1) AZM [2025] EWHC 3366 (Fam)

The Facts

A newborn baby (“AZ”) was delivered in a hospital in England in October 2025 to a mother who is a Romanian national who has spent much of her life in Austria as well as in Romania. She also has three other children all in the care of Austrian authorities due to significant concerns of abuse and neglect.

The Local Authority were sufficiently concerned by the family history to apply for an interim care order on the first day of AZ’s life. She was then placed in foster care.

The Issue

The question arise as to where AZ could be said to be habitually resident aged one day.

The Hague Convention 1996 determines jurisdiction in this case as the UK, Austria, and Romania are all contracting states.

Under Article 11:

“In all cases of urgency, the authorities of any Contracting State in whose territory the child or property belonging to the child is present have jurisdiction to take any necessary measures of protection.”

Aside from cases of urgency, jurisdiction is determined under Article 5:

“The judicial or administrative authorities of the Contracting State of the habitual residence of the child have jurisdiction to take measures directed to the protection of the child’s person or property.”

The time at which habitual residence is to be assessed is upon the issue of proceedings.

In principle it is open to the court to find that AZ was habitually resident in this jurisdiction in which case the courts of England and Wales have jurisdiction over her welfare (Article 5) or that her habitual residence cannot be established in which case the courts of England and Wales have jurisdiction whilst she is present here (Article 6(2)).

In either event, a request can be made to the authorities in another contracting state with which AZ has a substantial connection for it to assume jurisdiction for protection of her welfare (Article 8).

Alternatively, in principle the court could find that AZ was habitually resident in another jurisdiction.

The Test

The Court of Appeal considered the concept of habitual residence in M (Children) (Habitual residence: 1980 Hague Child Abduction Convention) [2020] EWCA Civ 1105.

The following principles are extracted:

1. Habitual residence is an issue of fact. Lady Hale observed in A v A [2014] AC 1 at [54] that it is an issue which “should not be glossed with legal concepts which would produce a different result from that which the factual inquiry would produce.”
2. The correct approach to the issue of habitual residence is the same as adopted by the Court of Justice of the European Union. In A v A at [48] Lady Hale quoted from the operative part of the CJEU’s judgment in Proceedings brought by A [2010] Fam 42 at page 69, para. 2:

“The concept of habitual residence …. must be interpreted as meaning that it corresponds to the place which reflects some degree of integration by the child in a social and family environment. To that end, in particular the duration, regularity, conditions and reasons for the stay on the territory of a member state and the family’s move to that state, the child’s nationality, the place and conditions of attendance at school, linguistic knowledge and the family and social relationships of the child in that state must be taken into consideration.”

• Integration does not have to be full; it may occur quickly – per Lord Wilson in In re B (A Child) (Reunite International Child Abduction centre and others intervening) [2016] Ac 606 .
• Lord Justice Moylan noted at [49] to [53] that another relevant factor when analysing the nature and quality of the residence is its “stability” as can be seen from In re R (Children) (Reunite International intervening) [2016] AC 76 where at [16] Lord Reed held that it was:

         “the stability of the residence that is important, not whether it is of a permanent character … there was no requirement that the child should have been resident in the country for a particular period of time” nor was there any requirement “that there should be an intention on the part of one or both parents to reside there permanently or indefinitely.”

•  Lord Justice Moylan referred to Lord Wilson’s see-saw analogy from para. [45] of In re B , where he said:

         “The concept operates in the expectation that, when a child gains a new habitual residence, he loses his old one…”

The court went on to conduct a detailed review of relevant case law.

The Decision

The court had to consider AZ’s habitual residence at one day of life when she had not yet left the hospital where she was born.

At one day old, AZ had never lived anywhere other than in England and Wales. The court was unable to find that AZ was habitually resident in any country in which she had never lived. She was not habitually resident in Romania or Austria.

There was an absence of countervailing factors to suggest residence elsewhere (e.g. language, education, connection to friends, duration of residence) because AZ was so young.

What was in front of the court factually was a baby born in England, and deliberately planned to be so. The mother had been resident in England for two months before birth, and had links with the country through her grandmother and uncle living here.

Whilst there might have been a temptation to conclude that a child has no country of habitual residence, that was said to be only appropriate as a finding in exceptional circumstances.

In conclusion, the court held:

“There is no other country in which AZ could have been habitually resident at one day old. The only alternative to the finding I have made is that she had no country of habitual residence. In my judgement when one asks whether she had no country of habitual residence or whether she was habitually resident in England, there is only one answer. She was born here, her mother was living here at the time and not just on a very short term visit, the birth was planned to be here, and she was cared for by her mother and the National Health Service here.”

Comment

This case contained a very helpful review of the relevant authorities which will benefit practitioners.

The Local Authority attempt to swerve the question of habitual residence (i.e. to argue that the child had not acquired habitual residence in this jurisdiction) was addressed by the court in its decision to confront the issue squarely now, despite AZ being a newborn, and to stress that her “place of habitual residence is a key finding and it is important that the basis of jurisdiction is properly established.”

About the Author

John Schmitt was called in 2013 and now specialises in complex personal injury work. He is also experienced in representing families at inquests in a clinical negligence context and has done so through the AvMA pro-bono inquest service. Most recently he has represented a family at a four day jury inquest at the conclusion of which the deceased’s employer was ordered to produce a Prevention of Future Deaths report. He is described by the Legal 500 as having a ‘lovely manner about him’ but being ‘as sharp as a tack’.

[1] BBC News 29.9.25

[2] KFF Health Tracking Poll 14.11.25

[3] BBC News, 29.2.24

[4] Guardian 17.9.25

[5] Sunday Times 8.11.25

[6] Human Medicines Regulations 2012, SI 2012/1916, reg 214

[7] TA1026. Tirzepatide for managing overweight and obesity. 23.12.24

[8] www.nhs.uk/conditions/obesity/treatment

[9] https://www.england.nhs.uk/long-read/tirzepatide-in-primary-care-for-weight-management-information-on-wraparound-care

[10] ASDA online doctor

[11] BBC News 29.9.25

[12] BBC News 15.11.23