Jump to: Quick comparison | Clinical evidence | Programme structure | Support differences | Pricing | Who should choose each | FAQs | Take home message
When choosing between Piko and Second Nature for medication-supported weight loss, the most important difference is clinical evidence and track record.
Second Nature has delivered NHS-commissioned weight management programmes since 2017 and has published peer-reviewed research in journals such as JMIR and the British Medical Journal.
Our approach combines GLP-1 medication with support from registered dietitians and a structured behaviour change programme.
Piko is a digital health company that originated in Portugal and recently expanded to the UK.
They offer GLP-1 medication alongside blood testing and doctor consultations, but have no published clinical outcomes or NHS partnerships.
Both services prescribe Mounjaro and provide ongoing support. The difference is in the evidence behind the programme that comes alongside the medication.
This guide was written by Second Nature, so it naturally reflects our perspective, but we’ve aimed to present Piko’s strengths and limitations as fairly as possible.
Important safety information: Weight-loss medications like Mounjaro and Wegovy are prescription-only medicines. This article is for informational purposes only. Always consult with your healthcare provider before starting any new medication or weight-loss programme.
Piko vs Second Nature: quick comparison
| Feature |
Second Nature |
Piko |
| Company focus |
✓ Weight management specialist since 2017 |
✗ Digital health startup, recently expanded to UK from Portugal |
| NHS partnership |
✓ Commissioned across 43 ICBs and Health Boards |
✗ No NHS affiliations |
| Clinical evidence |
✓ Published peer-reviewed research in JMIR1 |
✗ No published outcomes; claims reference general GLP-1 trial data |
| Professional support |
✓ Registered dietitians and nutritionists |
? “Doctors and health professionals” (specific credentials not listed) |
| Trustpilot reviews |
✓ 4.5/5 from 7,800+ reviews |
✗ 4.3/5 from 14 reviews |
| Behaviour change model |
✓ COM-B framework with 4-phase structured programme |
✗ No named methodology |
| Blood testing |
✗ Not included as standard |
✓ 100+ biomarker panel available |
| Programme options |
✓ With or without medication |
✗ Medication-focused only |
| Money-back guarantee |
✗ Not offered |
✓ 30-day guarantee on programme fee |
| Founding team |
✓ Publicly identified leadership and clinical team |
✗ No founders or medical directors named on the website |
Clinical evidence and NHS partnership
Second Nature: published outcomes since 2017
The NHS has commissioned Second Nature since 2017, with 43 ICBs and Health Boards across the UK now using our services. Over 250,000 patients have been supported through our programmes.
Our published research in JMIR Formative Research shows specific outcomes for our medication-supported programme1:
- 19.1% average weight loss at 12 months
- 77.7% achieved at least 10% weight loss
- 22.1% average weight loss among those reaching the highest medication dose
Separately, NHS England’s evaluation of the Digital Weight Management Programme found that Second Nature achieved substantially higher weight loss compared to other providers at 12 months2. This is independent validation from the NHS, not our own marketing.
Second Nature is also partnered with Vitality Health to support their members on our non-medicated weight-loss programme.
Piko: general GLP-1 data, not programme-specific results
Piko makes several weight-loss claims on its website, including that 92% of customers lose weight in the first few weeks, that members lose an average of 36 lbs in their first year, and that 74% keep their ideal weight after treatment.
These are notable figures. However, Piko’s own website carries this disclaimer: “Results Are Not Guaranteed. Based On Published Clinical Studies Of GLP-1 Medications; Individual Results Vary.”
This means the outcomes Piko presents are drawn from published GLP-1 clinical trial data, not from results measured within their own programme. Clinical trials are conducted under controlled conditions that don’t always reflect real-world experience.
Piko does not appear to have published any peer-reviewed research examining their own patient outcomes.
Programme structure
One of the most practical questions to consider when choosing a weight-loss programme is what happens when you stop taking medication.
Research suggests that around two-thirds of people regain weight after stopping GLP-1 medication without adequate behaviour change support4. This makes the programme around the medication just as important as the medication itself.
Second Nature: structured behaviour change
Second Nature’s programme is built on the COM-B model (Capability, Opportunity, Motivation, Behaviour), an evidence-based framework developed at University College London3.
The programme runs across four phases:
- Core: Building foundational knowledge about nutrition, movement, and sleep
- Grow: Developing personalised habits and routines
- Maintain: Strengthening habits while adjusting medication as needed
- Sustain: Transitioning off medication with ongoing support (some members choose to stay on medication for the long term)
This structure is what allows participants in our research to sustain weight loss after stepping down or stopping medication1.
Second Nature also offers non-medication programmes from £33/month for those who prefer a lifestyle-only approach.
Piko: doctor-led with a technology focus
Piko structures its programme around medical assessment and diagnostics:
- Online health questionnaire and doctor consultation
- Optional blood testing with 100+ biomarkers
- Medication is prescribed where clinically appropriate
- Follow-up consultations and in-app tracking
- An AI-powered copilot for day-to-day questions
The blood testing component is Piko’s main differentiator. Having a detailed view of metabolic markers, hormonal balance, and nutrient status can provide useful insights into health.
However, there’s no published evidence that this approach leads to better weight-loss outcomes compared to programmes without it.
Piko describes their support as “coaching-style guidance” but doesn’t reference a specific behaviour change framework. Their website mentions a maintenance plan, though specific details on what post-medication support looks like are limited.
Support and professional qualifications
Second Nature: registered dietitians and nutritionists
Second Nature provides UK-registered dietitians and nutritionists, available five days a week through both group and private messaging. These professionals are:
- Registered with the Health and Care Professions Council (HCPC) or the Association for Nutrition (AfN)
- Trained specifically in GLP-1 medication support
- Supervised by senior dietitians
- Supported by in-house psychologists on behaviour change coaching
You’re also placed in a small peer group with others on similar programmes. Research consistently shows that peer support improves weight loss maintenance5, and this is built into every Second Nature membership.
Piko: doctors and AI
Piko offers doctor consultations, 24/7 in-app messaging with their clinical team, and coaching calls on certain plan tiers. They also provide an AI agent for answering day-to-day questions.
Doctor-led medical oversight is valuable for the prescribing and safety monitoring aspects of treatment.
However, Piko describes their team as “doctors and health professionals” without specifying qualifications or regulatory registrations for their broader clinical team.
Weight management is largely about changing your relationship with food and building sustainable habits.
Registered dietitians specialise in exactly this, while doctors typically focus on diagnosis and prescribing.
Piko doesn’t appear to offer peer support groups as part of their programme.
Pricing
Both programmes are priced comparably for medication-supported weight loss.
Second Nature:
- First month: from £129 (introductory discount at any dose)
- Subsequent months: £229–£299 depending on Mounjaro dose
- Includes: medication, delivery, registered dietitian support, app access, 300+ recipes, peer groups, and all educational content
Piko:
- Mounjaro from approximately £199/month
- Separate programme fees of $60–$100/month listed in US dollars on their UK site
- Includes: doctor consultations, app access, coaching on certain tiers
At similar price points, the difference comes down to what’s included. Second Nature bundles medication and comprehensive support into a single transparent cost. Piko lists programme fees in US dollars on its UK site and separates programme and medication costs, which can make total monthly cost harder to estimate at a glance.
Piko offers a 30-day money-back guarantee on their programme fee. Second Nature does not offer a money-back guarantee, but provides NHS-validated outcomes and 7,800+ Trustpilot reviews as a different form of confidence.
Who should choose each programme?
Choose Second Nature if you:
- Want a programme backed by published clinical research
- Value NHS-validated approaches and institutional trust
- Prefer support from registered dietitians and nutritionists
- Benefit from peer support communities
- Want a structured plan for life after medication
- Want the option of a non-medication programme
Choose Piko if you:
- Want detailed blood testing as part of your programme
- Prefer doctor-led consultations over dietitian support
- Are happy to try a newer provider that is still building its track record
- Like the idea of an AI-powered health assistant
- Want a 30-day money-back guarantee
Frequently asked questions
Is Piko or Second Nature better for Mounjaro?
Second Nature offers more specialised support for Mounjaro users through registered dietitians trained in GLP-1 medications. Our published research shows 77.7% of participants achieved at least 10% weight loss at 12 months1.
Piko provides Mounjaro with doctor consultations and blood testing, but has no published data on their own programme outcomes.
Does Piko have NHS approval?
No. Piko has no NHS partnerships or commissioning. Second Nature has been NHS-commissioned since 2017, with 43 ICBs and Health Boards using our services across the UK.
Is Piko a UK company?
Piko originated in Portugal and has expanded to the UK. Their UK pharmacy services are provided through a GPhC-registered partner pharmacy. Their website does not publicly identify founders or a medical advisory board.
What qualifications do Piko’s clinicians have?
Piko describes their team as “doctors and health professionals experienced in weight, metabolic health and preventive medicine.”
They reference a UK-based GP on their editorial pages. Beyond this, specific qualifications and regulatory registrations for their broader team are not detailed on their website.
Are Piko’s weight loss results based on their own data?
No. Piko’s weight loss claims carry the disclaimer that results are “Based On Published Clinical Studies Of GLP-1 Medications.”
This means the figures come from general GLP-1 research, not outcomes measured within Piko’s own programme.
Can I switch from Piko to Second Nature?
Yes. We’ll review your medical history and current medication to ensure a safe transition. Many members join Second Nature after starting with medication-only or less comprehensive services.
Is Piko’s blood testing worth it?
Blood testing can reveal useful health information, including nutrient deficiencies and hormonal imbalances.
However, there’s no published evidence that adding 100+ biomarker testing to a weight loss programme improves weight loss outcomes compared to programmes without it.
Which programme helps with weight regain after medication?
Second Nature’s programme is specifically designed to support the transition off medication. Our four-phase structure uses the COM-B behaviour change model to build habits that last beyond medication1.
Research suggests that around two-thirds of people regain weight after stopping GLP-1s without behaviour change support4.
Piko references a maintenance plan but provides limited public details on what this involves.
Take home message
Second Nature brings eight years of specialist weight management experience, NHS commissioning across 43 health boards, published clinical research, and support from registered dietitians.
Piko offers an interesting approach combining medication with blood testing and doctor consultations.
Their biomarker focus is a genuine differentiator, though they are a newer provider with no published outcomes data and a limited review base in the UK.
Both prescribe the same medications at comparable prices. The difference is in the programme that supports you alongside medication, and the evidence behind it.
Second Nature's Mounjaro and Wegovy programmes
Second Nature provides Mounjaro or Wegovy as part of our Mounjaro and Wegovy weight-loss programmes.
Why choose Second Nature over other medication providers, assuming you're eligible?
Because peace of mind matters.
We've had the privilege of working with the NHS for over eight years, helping people across the UK take meaningful steps toward a healthier, happier life.
Our programmes are designed to meet people where they are, whether that means support with weight loss through compassionate one-to-one health coaching, or access to the latest weight-loss medications (like Mounjaro and Wegovy) delivered alongside expert care from a multidisciplinary team of doctors, psychologists, dietitians, and personal trainers.
At the heart of everything we do is a simple belief: real, lasting change comes from building better habits, not relying on quick fixes. We're here to support that change every step of the way.
With over a decade of experience, thousands of lives changed, and a long-standing record of delivering programmes used by the NHS, we believe we're the UK's most trusted weight-loss programme.
We hope to offer you something invaluable: peace of mind, and the support you need to take that first step.
References
- Richards, R., et al. (2025). A Remotely Delivered, Semaglutide-Supported Weight Management Program: 12-Month Outcomes. JMIR Formative Research, 9(1), e72577.
- Ross, J.A.D., et al. (2022). Uptake and impact of the English National Health Service digital diabetes prevention programme: observational study. BMJ Open Diabetes Research & Care, 10(3), e002736.
- Michie, S., van Stralen, M.M. & West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.
- Wilding, J.P.H., et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide. Diabetes, Obesity and Metabolism, 24(8), 1553-1564.
- Lemstra, M., et al. (2016). Weight loss intervention adherence and factors promoting adherence: a meta-analysis. Patient Preference and Adherence, 10, 1547-1559.
