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

if someone wants to just eat crap and do no exercise on these drugs they will not work. They do not burn fat. They remove all the food noise, hunger, and the hit from food which makes it easier to eat healthy food and maintain a calorie deficit

Just to add that of course no-one should be calling anyone a fat lazy bitch - this should go without saying but as this is MN I expect to be jumped on unless I say so explicitly. But it's a straw man argument to suggest that the only options are 'fat lazy bitch' or weight loss drugs.

I think the NHS knows more about the pros and cons on this than I do. Although I also agree it is very poor at preventative medicine (but then obesity rates are in fact proof of that, and this medication will not treat people at risk of becoming obese, it will treat people who are already obese, so more proof of failure on the prevention front…). In all honesty, given rates of obesity, which have gone up massively in the last century, you do really seem to be asking for the NHS to deal with a problem that should not have arisen in the first place, rather than dealing with the fact that something is causing burgeoning rates of obesity (often accompanied by malnutrition in poorer sectors of society). It’s not just overeating that is causing an obesity epidemic, so imvho, it’s not just drugs that will cure all associated health problems caused by an obesogenic environment and it is dangerous to give the impression that a drug will make everyone slimmer, fitter, healthier and live longer. Too often, people look for medicine as a cure, not an aid. I can very much see the NHS letting lots of people stay on medicines for a long time without helping them to make the other necessary changes to their lives and thus not fixing the real problem, just medicating lots of people.

"So is it more cost-effective to support Jemima in losing weight through these drugs alongside a programme of dietary advice and exercise? Or will we just tell her she's a fat, lazy bitch and then spend the next thirty years treating her diabetes, knee replacement, cardiovascular drugs, cancer, blindness and ultimately dementia?"

If you're genuinely interested in trying to answer this rather than in rhetoric, then the analysis based on current evidence and current drug pricing suggests that if she already has a weight related comorbidity (and taking into account other factors such as BMI and ethnicity) then it is more cost effective, but if she doesn't then it's not. Which is why NICE have recommended reimbursement for these drugs in patients who satisfy certain criteria, where it is predicted to be cost effective, but have not recommended it for a broader population.

No they don’t. They just enable people to carry on eating the same crap( just less) alongside getting zero exercise.

Going to preface this by acknowledging that if I read what I'm about to say at my heaviest I would have been full of excuses and "it's easy for you to say that.." but it's important to note they were definitely excuses. I say this as someone with a disability and an exhausted parent of ASN children (those were my excuses at the time!):

I'm someone who stayed morbidly obese for a long time. At my heaviest my BMI was 44 and I weighed 244lbs which given I'm short really wasn't good. I had a health scare myself last year and rather than wait for the NHS to give me injections etc I gave myself the kick up the arse I clearly needed. I stopped with the excuses and sorted out my diet. I'm 300 days into my weight loss and down by 81lbs and I'm still going. Another 28lbs to go but it's doable. I feel a massive sense of accomplishment that I wouldn't feel with an appetite suppressant. I feel less of a drain on the NHS than I would if I'd had to use an appetite suppressant. Ultimately the biggest appetite suppressant should be the reality of risk we are putting on our own lives by remaining obese, if that doesn't suppress your appetite then as others have said it's time to look at the actual root cause rather than sticking a proverbial plaster over the problem.

The problem is, food companies want us to be addicted to food so will keep finding ingredients which makes it hard to quit. Pharmaceutical companies want us to be ill - lifetime chronic illness (so we’re unwell but not dead) is what is driving their profits. And these food and pharmaceutical companies have so much influence over our university research centres (paying for “studies”), our media and our politicians that society doesn’t ever really stand a chance of becoming healthy.

I don’t know how that loop is broken, unless the government really to want to change things and bring in much stricter regulation of these industries.

Absolutely it is. WL injections support people to do that.

Aldo - other than the costs at the moment I wouldn’t be too fussed at remaining on it long term. If you frame it as a drug to treat a health problem then why not. I have recently been diagnosed with a couple of conditions that require lifelong medication. I would rather that than suffer unnecessarily

No, the best way to lose weight, and keep it off, is to change your eating habits/lifestyle.

All drugs can have base side effects, and the NHS shouldn’t be funding it on demand anyway.

I agree but I think it does need to happen alongside lifesfyle changes, which are hard to achieve. I am 6 stone overweight. In January I began crossfit classes and running.

I have kept up 3 classes a week consistently since then. In June I started WL injections. I have remained on the lowest dose but have lost 2 stone in that time. It is coming off quickly but I think the fact that regular exercise is ingrained now will help keep it off if I have to stop. I have also changed what I eat and the hope is feeling fuller on healthier foods will also remain.

I do feel it is unfair that I am able to achieve this because I can afford to pay for it. I think once you get to tier 2 wl management on the nhs it should be offered.

Yes - it’s because it acts on the hormones and whatever other physiology that causes disordered eaters like me to eat as we do.

I now feel I eat more like a normal person- the person I was before the events that triggered my comfort eating to commence. Do I get hungry and am I ready for my meals - yes. Do I now feel when I get hungry - pain, distress and like my body is hollow and that my brain will literally scream at me to keep until the hollow is filled - no

so yes once you stop the meds which change how you react to hunger I guess old behaviour can just come back

The online sites have really tightened up their procedures recently. They’re asking for photos plus proof of ID and have software in place to identify photoshopped pictures and ensures the ID matches the full body shot. They also now insist on letting your GP know. Of course there are ways around it but it’s much harder now than just lying about your weight

How does Mounjaro work?
This medication works by activating two receptors called GLP-1 and GIP to increase the level of incretins – hormones - in the body.
It works by helping your body to produce more insulin when needed. It also reduces the amount of glucose, or sugar, produced by the liver, and slows down how quickly food is digested. This all helps to lower blood sugar levels and HbA1cc*.

I was so big for so long that I was actually offered bariatric surgery on the NHS (or rather they suggested putting me on the waiting list for it, but they said I shouldn’t have to wait that long) but I refused it as I was determined to get there by myself. It’s definitely been tough - I have lots of loose skin, am still medically a couple of stone overweight and still crave sugary and fatty foods everyday - but its helped that I had a good reason for wanting to loose the weight ( I wanted to have children).

I couldn’t do it with exercise - I have back problems that make that very difficult, so had to rely on diet alone. I have PCOS and I think sugar is the major culprit for my weight gain ( including “hidden” sugar in carbs) - so I have focused on limiting my carbs like potatoes/bread/pasta etc to one meal a day and also limited my treats like crisps, choc, ice cream etc to again only once a day (or twice if I’m having a bad day). I won’t lie and say it’s not tough- there is still the odd time I can’t stick to it ( feeling especially unwell and need the boost or on holiday and temptation too much etc) but I try to think of them as a day or even a week long blip and then get back on track. You’d think after nearly 8 years of keeping the weight off it would get easier but I’ve had to accept it’s a lifelong struggle for me.

I hope you manage to find something that works long term for you, that you can stick to as well 🤞

I think that's how slim people normally view food, along with restraint like @Grumpy12345 suggests.
I don't actually think about food between meals but after about 5/6 hours without eating I an hungry and enjoy a meal, just stop when full.

So it sounds like the drug mimics normal appetite and yet there must be more to it if people go back to old eating patterns when they stop taking it.

Yes. Since hitting the menopause I have had to be so strict with my diet. It is definitely less fun restricting yourself. I tend to be v v careful in the week and have a more relaxed weekend. It’s not easy but I don’t want to be overweight and increase my cancer risk etc. I am in no way ‘naturally’ slim sadly!

I don’t want injections though…

I can’t get it even though I’m overweight and type 2 diabetic too.

Very well put and I couldn't agree more.

I shouldn't open these threads because the attitude of some people makes me despair.

What about sports injuries? My dd broke her foot doing gymnastics?presumably thay shouldn't be funded either

How do you know what level of interest a “normal” person has in food? I am a healthy bmi and always have been but that’s not because I have less interest in food than over weight people. I also get a hit from eating. Pretty much every mammal alive on the planet does. It’s not that slim people don’t like food as much as overweight people, it’s that slim people deprive themselves of too much food or unhealthy food to stay slim. I would love to be prescribed something to make that easier (i.e suppress my appetite) and if overweight people are prescribed it on the nhs then so should non-overweight people if they want it.

These threads are always depressingly full of people who don't have a fucking clue that other people's lives are not exactly like their own.

There's a difference between say Jenny who is naturally slim but put on half a stone in perimenopause and Jemima who comes from a family where:

• one side of the family is slim and birdlike and the other have large builds and store fat just by looking at it.

• food trauma started young because it was embedded in poverty and hunger.

• neurodiversity and poor impulse control around food and substances are a thing (dopamine driven)

• the family are living in a time when food is literally engineered to be addictive as fuck and Jemima has yoyo-ed up and down with her weight for the last 30 years

• throw into the mix that Jemima is a working mum with a physical disability and three young kids to care for.

Now tell me: is it going to be easier for Jenny or Jemima to lose weight? Answers on a postcard. I'm quite sure the occasional Jemima manages to shed those stone and OF COURSE she is justifiably proud BUT those Jemimas are the exception NOT the rule.

So is it more cost-effective to support Jemima in losing weight through these drugs alongside a programme of dietary advice and exercise? Or will we just tell her she's a fat, lazy bitch and then spend the next thirty years treating her diabetes, knee replacement, cardiovascular drugs, cancer, blindness and ultimately dementia?

Indeed
But I think that many people in the west are obese and simultaneously malnourished due to their poor food choices. And I firmly believe it's upf that is driving obesity in most cases.

• most private health insurance policies do not cover bariatric surgery

• all diets basically have very high regain stats sadly

I think if people actually engage the healthy living type courses are great and effective. I have a relative who has reversed being diabetic over a 9 month course. She's now very low carb and doesn't miss anything, says she's not hungry but has lost quite a bit of weight and taken up more exercise than she's ever done. On the other hand another relative (also pre diabetic, miracle they're not fully T2) has said they'd engage in an online course but they have absolutely no intention of changing their ways. A friend has been told they're pre diabetic only in their 40s and really not that over weight and don't seem to have any intention of doing a thing about it! This is the problem.