AIBU to think it's time for the NHS to do itself a favour and make WL injections readily available.

What's not useful about her source?

@Errors I think you've got a good grasp of it! That's my hope and intention, to use Mounjaro in my case, to get to a healthy weight and use the time and mental freedom to work on not putting it back on.

Interesting
I wonder if Ozempic can be used along side other therapies, in the same way anti-depressants are used along side CBT for example.
So, the ozempic tells you that you are full and don’t need to eat
You lose tons of weight, all while exploring the triggers of emotional eating and how to listen to your body when it tells you you feel full
You get to a healthy weight, come off it and then as your stomach is smaller you will feel full after less food than you did before you had the WL injections and you’ve hopefully developed new habits and behaviours around your eating (as well as getting therapy) that makes it a long term solution??

Ive never been overweight so maybe I shouldn’t have an opinion, but I would imagine that the double burden of trying to lose tons of weight as well as dealing with the emotional issues of why you eat would feel insurmountable

Kind of like with depression - if even brushing your teeth feels like a mammoth task how are you supposed to find the will and energy to get better? That’s where medication comes in. Gives you just enough of a boost to help yourself get better.

I might be talking shite here though!

Please cite someuseful source for this…. 🤣

There is a lot of evidence it causes long term issues. Did you not want to read that bit?

People are skinny in Japan partly because it's a very socially conservative society where no one wants to stand out. There are all sorts of fattening foods available but people don't gorge on them as that's not socially acceptable.

School dinners have soup, veg and pickles, breakfast is soup and fish, dinner will be rice pickles etc. there's a lot of veg.

t giving injections reminds me of giving someone infographics to make decisions because they can't read.... if they can learn to read, teaching them to read would be so much better for them. It could be argued as unethical to not try very hard with obese people to encourage them onto a better pathway to recovery than medication for life

I think this analogy is really flawed. Firstly, what does teaching people to reverse obesity look like? We don't have a successful strategy - there is no Phonics for Fat People here. There is weight management education on the NHS already and it's not working. Nothing is working - any diet, any change of lifestyle or programme, anything currently available - no one has come up with something that works long term to keep formerly obese people at a lower weight. The statistics are overwhelmingly dispiriting. If 95% of kids in school never learned to read, we wouldn't keep bashing phonics into them would we? But that immense failure rate for long term weight loss doesn't discourage people from insisting that we need to educate fat people slimmer - because that assumption is so baked in that fat people are stupid and they just haven't tried hard enough. I think that's what they used to tell kids with dyslexia years ago, and it didn't help them learn to read any better than it's helping obese people lose weight and keep it off.

Then, the analogy is also based on something we just don't know, which is the long term success or failure of these injections. At the moment, there is a theory that people may be on them for life. It's also possible that someone might take them for say two years and manage in that time to resolve some of the issues around binge eating. Maybe weight set point theory will turn out to be true and people could use the injections to reset their body weight, making it more likely that they can maintain over time. Maybe the injections will be like every other means we have right now of achieving weight loss and people will gain it all back and more - and we will be in the same position as we are today.

But there is no point saying 'we shouldn't use WL injections because other means of weight loss are better or more successful' because that's just not the case. Once someone is obese, it is very unlikely they will successfully reverse that long-term because of physical changes in the body that make it near enough impossible. The percentage of people who do that is absolutely tiny. So it's not a helpful solution when so many people are obese and the numbers are rising. We do need something better if we actually want to change that. That might be the injections, it might not - but it definitely isn't a case of teaching people not to be obese anymore because that is not working.

Er how do we encourage asthamatics to avoid medication?? (asthmatic since childhood and parent to an asthmatic - only ever heard how important it was to keep up the preventer. What "lifestyle" leads to asthma??)

As to why some ppl get obese...
My esp. large friends who struggle with their weight, admit that they binge & comfort eat. It's not that they don't have full signals, it's that they have conditioned themselves to ignore the full feelings. Which habit comes down to emotional crap in their lives, some of it very historical.

I perceive that if there was an effective treatment that dealt with those emotional legacies, that would be a route to them being happier overall, not just smaller.

As long as the injections are cost-effective then I don't care if they are offered by NHS. But giving injections reminds me of giving someone infographics to make decisions because they can't read.... if they can learn to read, teaching them to read would be so much better for them. It could be argued as unethical to not try very hard with obese people to encourage them onto a better pathway to recovery than medication for life. Same as trying to get T2 diabetics, people with CKD or asthmatics to avoid chronic medication.

Unlike other addictions or behaviours we’d rather hide from others, obesity is very visible and seemingly many (on MN) think they can start commenting on other people. Unusually with little prior knowledge of the individual.

You can smoke, drink, take prescription and illegal drugs, gamble etc without anyone knowing. Become overweight - god help you.

I know there is a bias that greater weight = lower IQ points but actually there are plenty of obese people who are really well educated about nutrition, to whom there is little anyone can suggest that they aren't aware of or haven't tried.

Some of this comes back to education - for years people have been told to eat salad or cabbage soup to lose weight but it’s not sustainable and not particularly effective.

I’m on about 1600 calories a day which should average 1lb per week weight loss. Today I’ve eaten porridge with pecans and chia seeds, a protein shake (protein powder and water), a portion of leftover sausage jambalaya, Greek yoghurt with blackberries, pumpkin seeds and a bit of honey and then lamb Tagine with couscous and roast veg.

Yes it means weight loss takes time, but I don’t feel like I’m restricting myself, I’m rarely hungry and I know I can stick with it.

Absolutely. And it must be exhausting, to always be so aware of food, of having to fight against your body every day, dealing with the guilt and shame because a lot of people make judgements about you as a person. Many people will have spent a large portion of their lives losing and regaining weight, and that's both hard work mentally and physically. Fighting against yourself is just very hard to win and it gets to a point where you have lost that connection and trust with what your body is doing.

But there seems to be this need to further punish obese people, this belief they need to do things the 'right' way instead of there being an easier, more realistic way for them to lose weight. If these jabs can help people lose weight and enjoy life and be more healthy then surely that's exactly the kind of thing technology should be working towards. Many people won't need them or want them, but for those who do, it could totally redefine their life and relationship with food. It's a very exciting step I think, and I think once you sever that connection that is giving you constant appetite and food chatter, it becomes easier to make better decisions about type of food too and to make longer-term changes about eating well.

I think as well @moppety there is something really pertinent about the role that restriction and shame plays in hunger. Obese people have often tried to restrict food, to fight their body's signals, to cut out food groups and diet over and over again, and the body reacts in a primal way with a hunger that is greater than before. You end up locked in a constant battle with your own body that you can never win and it becomes soul-destroying. The more you try to diet and restrict, the worse it gets - it's very well documented that diets lead to greater weight gain in almost everyone.

Great post @moppety ❤

A lot of people see being slim as some sort of virtue and being fat as a moral failing. They think that fat people are lazy, gorging themselves, and lack willpower. But I think the issue is that some people just have totally different biological responses to food and satiety. People who are naturally slim and have never had to diet and go on willpower probably don't have half the willpower some obese people have who have fought to lose weight for years and years, but having to have willpower every single day for the rest of your life is really hard v people who can eat a normal portion and just feel full. Some people just don't get full signals or their brain doesn't understand them and they always feel hungry.

A lot of people say MJ and the like turn off the 'food chatter', and I think a lot of naturally slim people just dont have that chatter in the first place. It's not moral superiority or willpower that stops a lot of people overeating, it's that they eat a normal portion and feel full and don't want any more. To some obese people, that's a marvel (and that's what the jabs allow them to feel). Nobody wants to be fat, and obese people certainly aren't necessarily lazy or even gorging on takeaways every night.

There seems to be this feeling that fat people have to suffer to become slim again and that's their own fault because they are fat, but if there's a solution to give obese people the same feelings around satiety and cravings as naturally slender people have, then why not?

As the price goes down in future, I hope it becomes available to more people. Being obese is not a character failing.

This. 100% this. Yes it’s true that some will put the weight on because they don’t change their habits and don’t retrain the way they eat and live. But that is true of any diet or weight loss method. The WL injections simply stop the food chatter in your head. You literally won’t feel like eating at all and struggle to get your calories in for the day. I think for those that have at least 4 plus stones to lose, that have tried everything but don’t want surgery, should have this available to try. For people today I did it through diet and exercise etc, good for you, I’m genuinely so happy for you. But everyone is different and has different stresses, pressure, responsibilities and above all health needs. To say everyone else you be judged by what I think is quite frankly ignorant. Whilst I do think it should be available, as many have said it’s mainly a supply issue. Because the NHS are able to prescribe some of these WL injections in certain areas, but very few do because they can’t get the supply. Above all else, I think unless you’ve been in the position of being overweight for many years and desperately trying again and again to lose weight and failing for whatever reasons, you can’t really relate to those that do struggle. The food is simply a crutch for other things that we aren’t dealing with. And until we can feel what an average person feels like about food, it’s honestly an absolute lightbulb moment.

Agree with you op. Its about time these were available. I maybe think at £50 a month via nhs gp prescription. I do agree that if people paid vs free, they would take it more seriously and not as a lazy way out. Where are you getting it so cheap? Please tell me your secrets!

Yes our food culture has been Americanised. Its a simple as that

Huge portions of mainly carbohydrate based foods, either fried or with fried things on top.

The more we have drifted from a European alignment (and we werent that aligned food wise), the worse it has got

We dont have any more ND or trauma, or medical conditions than other people around the world with lower obesity rates (and Europe is soon catching up with us because of their own Americanisation of food)

We snack, we eat on the move, we have massive portions, we dont exercise as a nation, we sit in front of the telly alone eating meals. We have an isolationist and individualistic society, self centred and self absorbed, this doesnt bode well for thinking about the impact of our actions on society.
We have special offers on massive portions of junk food but no lobbying or promotion of fruit and veg. Same in America.

We also dont smoke anymore which is a good thing but people move on to something else when they give up usually.

And we are animals, which we do share with the rest of the world, we are designed to eat and preserve calories, we are a cold country usually, our food heritage is of heavy meals because of the need to eat enough, our make up is designed for this.

All those things combined mean it is very difficult to lose weight and for those that do have conditions like depression, ADHD, trauma who use food it does add to the difficulties

Tools are helpful to help people lose weight, some people find SW or WW a great tool, some find medication or surgery a tool. No one should judge anyone else for how they do it or how they maintain their weight. Many horrible posts on this thread (as is usual here)

I say this on a lot of these threads, fat people are wrong for being fat, they're wrong for losing the fat in the wrong way.

Wrong!

These drugs may well cut cancer rates, as being obese for a long time increases your risk of various cancers...

There is a serious hatred and contempt for fat people on this site and the way people speak about them would appal everyone if it was directed at any other group. It's excused because they consider fat people as having brought it all on themselves and being a worthless drain on society but it's double-edged because if a fat person does something to address their weight, it brings about another slew of judgement and blame because any interventions eg injections are considered the wrong way to do it.

It's true - I do IF and was starving for the first few days
Now I don't get hungry and get fuller more quickly.

Hormones, as opposed to stomach capacity, play a major role in appetite, hunger and satiety. It's how these drugs work - they make the person feel more full by regulating insulin and blood sugar, not by shrinking the stomach, though they also slow the passage of food so it's also the case that the stomach is not empty. I always think of how powerful pregnancy hormones were in changing my tastes and hunger - the nausea, strong cravings and insane aversions to certain foods and drink. We are more at the mercy of our hormones than we realise!

This might be a lot of nonsense because (being honest!) science/biology is not my strong point, but is it not the case that people who over-eat expand their stomachs over time and then it takes more food to feel full? I've been on a diet for the last month and I feel like now my stomach is used to smaller portions and I feel full sooner, like my stomach has "shrunk"? So it's not quite as simple as slim people are lucky and they feel full sooner, slim people feel full sooner because they are slim and don't generally over-eat?