To think I should be allowed weight loss injections?

[Chalk111111]

Firstly, I think it’s a great thing that people are able to use this medication to gain control over their weight, and I think the bar set for getting them on the NHS is ridiculously high and it should be given to anyone who is obese. All those years people spent banging on about how much obesity was pressuring the NHS and then when we’re given a medication to tackle it they don’t make it available!

So I’m not confused about why I can’t get it on the NHS - I shouldn’t be able to - but why can’t I pay for it?

My BMI is 24 and I’d like to shift a stone and a half/two stone. I’ve fluctuated between this weight and a stone lighter for about ten years. I used to be able to shift half a stone at least but this time I’m really struggling.

I keep getting adverts about weight loss injections so I thought I’d have a look. Filled in the questionnaire and it says my BMI isn’t high enough for a prescription? But surely if my starting BMI was, say 35, I’d be allowed to stay on them until my BMI was 21/22, which is what I’d like? So why can’t I pay for them to lose a couple of stone?

It's really not that complicated. A person who was obese and loses weight isn't the same metabolically as a person who was never obese. They are far more likely to regain the weight than a never-obese person is to gain that much weight. You can't cure the disease of obesity simply by losing weight. For the formerly obese person, the benefits of staying on WLI at a healthy weight outweigh the risks of being on it because if they don't, they are likely to become obese again. For a healthy person who isn't obese the risks outweigh the benefits.

Wanting WLI to lose a stone is crazy. I'm in exactly that position, I know I've just got to get my arse in gear and be more disciplined about diet and exercise.

@Chalk111111 you are not wrong to ask. I am not in the UK (hence username) and my private doctor suggested ozempic when I went in to query my thyroid last year as I had been struggling to lose the last 2-3kg of baby weight and was exhausted all the time. I declined the ozempic as have no desire to be put off eating (or drinking haha) and sure enough a few weeks on thyroxine and the remaining weight dropped off. My bmi was 22 when I went in for the initial appointment so I suspect that private doctors will give you whatever you want if you are willing to pay! I suspect this explains why so many formerly average sized people are suddenly strutting around in size 6s.

I prefer diet and exercise since I actually enjoy working out and cooking from scratch but I don’t see any harm in someone who doesn’t enjoy this type of thing taking weight loss meds under medical supervision and certainly don’t begrudge anyone who finds a way to lose weight that works for them!

I think some slim people may be threatened by the idea that they aren’t special anymore if anyone can be slim. Same goes for elective cosmetic procedures. Provided that people pay for things themselves and don’t rely on the state to pick up the piece then I couldn’t care less - do what makes you happy is my mantra!

I’d be seriously questioning the judgement of a dr who would suggest WLI to someone with a BMI of 22, practically smack bang in the middle of the healthy weight range.

Why though? I was several kilos over my own normal weight (for me) even though I was eating cleaner and working out more than ever before. It gave me a great deal of compassion for overweight people who cant shift weight with diet and exercise alone.

Why would weight loss drugs be a worse option than the trainer who recommended 800 calories per day (I’m almost 6 feet tall)? It’s basically the same thing. In any case, I didn’t want to lose weight for it’s own sake but I did want to feel energetic again and I did question why diet and exercise wasn’t shifting the last few kilos. For me it was due to thyroid. For others maybe weight loss drugs will work. I think there is a lot of judgment from people about weight loss drugs being a cheat. If they help someone to look and feel better then why not? Arguably, my personal trainer and nanny allow me to “cheat” at staying in shape because I have time and resources that some people don’t.

When it comes to private prescriptions, I don’t know for sure what the rationale is, but I think it’s probably about the risks of the drug. Clinically you have to weigh up the risks and benefits. Doctors do take the oath of ‘first do no harm’ and they probably would not find it ethical to prescribe something where the risks of taking it so far outweigh the risks of not taking it. Private or not, they are meant to be still practicing medicine and upholding ethical practice. That applies even to the doctors working for say, a commercial pharmacy and assessing applications online.

No, the OP has repeated countless times on this thread that she would not be expecting the NHS to pay. A lot of people on here seem to have reading difficulties.

I think there is a lot of judgment from people about weight loss drugs being a cheat. If they help someone to look and feel better then why not?

Don’t get me wrong; I think WLI are absolutely incredible and necessary for those suffering with the disease of obesity yet they come with risks. Good doctors and even mediocre ones will weigh these risks up against the risks of one being obese and prescribe accordingly. My BIL has just started them: he’s almost 30 stone, has little quality of life due to sleep apnoea which keeps him up all night and sleeping all day (so no longer able to work), and he’s at risk of having a fatal heart attack or life-changing and debilitating stroke every day. Obviously WLIs will minimise these very real risks from happening so the risks of WLI might be a smaller list than the huge list of risks that come with his obesity.

You talk about one “looking and feeling better” - no, I don’t agree that people who do not live with obesity and with an already healthy BMI - especially one that’s quite far from away from the ‘overweight’ boundary - should be prescribed them to look and feel better, even if they’re willing to pay and are informed about the risks. For those living with obesity, sure they would like to look better too but their use of these drugs is primarily to live longer lives and avoid complications. You being a few kilos more than what you’d like to be is really not a concern for your health like it is for those who need to lose tens of kilos to even get into the top end of the healthy BMI range. And it really must be just a few kilos max to already have a mid-point healthy BMI.

A personal trainer or nanny don’t come with risks to your health like WLI do so that’s not the best analogy or comparison in that respect.

First of all, I didn’t ask for weight loss drugs. My doctor offered them. I treated a thyroid issue and immediately lost 3kg (well, within 4 weeks or so of starting the medications) without changing my already healthy diet or my usual exercise regimen. I only mentioned my own experience of having been offered them to tell OP that in other countries / private doctors are very willing to prescribe them to people who are already slim but want to lose a little more weight.

My experience of having a few pounds to lose and struggling with it (having been very slim for my whole life without particularly trying) made me feel sympathy for people who try but cannot get to their goal weight. Weight loss drugs have been used by diabetics for decades so I don’t understand the faux concern over potential side effects either. Then again, I haven’t looked into them in detail since I have no interest in taking weight loss drugs myself.

Your comments do have a whiff of the judgmental about them - if people want to be slimmer then what business is it of anyone else? As long as a doctor is monitoring them and they are paying for their own treatment then who cares? It doesn’t affect you or anyone else.

Do you think anyone should be able to have any prescription drugs that they want then, as long as they pay? So no such thing as controlled substances - it’s fine to use medications in circumstances where they haven’t been tested, in patients who don’t have the conditions the drugs are designed to treat? And patients decide whether that’s a good idea or not, instead of doctors and pharmacists?

Your comments do have a whiff of the judgmental about them - if people want to be slimmer then what business is it of anyone else? As long as a doctor is monitoring them and they are paying for their own treatment then who cares? It doesn’t affect you or anyone else.

If informed people want to pay for WLI when they are already a healthy weight and a doctor is willing to prescribe it, you’re right it’s none of my business. Outside my loved ones, not my circus, not my monkeys. But back to my original point, I am entitled to my opinion that I would be a bit dubious if my doctor prescribed them to someone with a mid point healthy BMI - with no history of obesity. As I am entitled to my opinion that I don’t think they should be accessible to anyone, regardless of weight or history of obesity. They can be addictive for a start. Mumsnet runs on opinions.

I quite clearly said under medical supervision. Why are people so upset by this? Bizarre. If you don’t like the idea of weight loss injections then don’t take them. I don’t like the idea of the possible issues with hair / skin / gastro complications so I wouldn’t take them. But why judge people who want to?

You seemed to think it’s fine for people to use drugs that are not tested or licensed in those circumstances, just because they want to, with no clinical need?

ADHD medication causes weight loss. Do you think someone without ADHD who wants to lose a few pounds should be able to have those if they want to? They’re not licensed for use in this way but that doesn’t matter, what business is it of mine etc etc?

But they are licensed for weight loss. I have no skin in the game as I don't use them and nor do I want to, but I do think that there is a lot of sanctimony around the use of weight loss drugs. Doctors happily prescribe them to already average-sized people who want to slim down. Do you know more than the doctors? I don’t.

In the UK, Mounjaro is licensed for type 2 diabetes and weight management in adults with obesity or who are overweight with weight-related problems. It’s absolutely not licensed for people with a healthy BMI who fancy being a bit thinner. It hasn’t been tested in that population and doctors here would not prescribe to those people.

Odd because I know multiple people in London having had it prescribed by private doctors. Even Harriet Walker in the Sunday Times wrote about having micro-dosed it under medical supervision. Weight management is literally weight loss…

If someone doesn’t have obesity, type 2 diabetes or weight related comorbidities, the medication is not designed or licensed for them. They might as well be asking for ADHD meds when they don’t have that either.

Off-label usage of medicine is common though. And letting an average weight person take a low dose of a medication that is licensed for weight loss in larger people isn’t a huge stretch. Anyway, we are clearly not going to agree so little point in continuing.

Weight management is weight loss, but adults with obesity or weight-related comorbidities does not mean everyone. That’s not difficult to understand, surely?

It’s not sanctimony, those are the terms of the prescribing licence here. So either people in London have weight-related comorbidities, or they have type 2 diabetes, or they have obesity (which doesn’t necessarily mean they’re grossly overweight), or they are not on Mounjaro but a different drug, or their doctors are prescribing off-licence on the quiet. I think the last is very unlikely but maybe there are doctors willing to risk their careers, I dunno.

Here you go: https://www.thetimes.com/magazines/the-times-magazine/article/ozempic-microdosing-weight-loss-before-after-7kfpm8g38

Lottie Moss who is 5'6'', 9st 6 with a bmi of 21 ended up in hospital.
She had bought it through a beautician.
No way is this lady overweight but 8st is the magic number in modelling circles. I modelled as a teenager and I was thought curvy at 9st 4. I'm 5'10.

Some people have constant food noise and their whole day is taken up with what to eat and what not to eat. We also don't celebrate normal! I've lost six stone over three years. For once in my life I eat exactly what I want. I'm lucky I wfh and can make myself a separate meal. I'm a size 16 but at my height wouldn't want to be smaller than a 14. I'm also nearly 60.
I had therapy for food and drink addiction and that worked when forty years of diets and quack pills didn't.

Your comparison is a bit like saying that someone who is a bit down for a few weeks should be given anti depressants to cheer them up rather than small lifestyle changes/address the cause of feeling down. Medication that carries risks (so basically every medication) shouldn't be prescribed for issues that are not health conditions and which can be addressed through lifestyle changes. Obesity is rarely able to be addressed though lifestyle changes - certainly not long term. Being a few kilos over your preferred weight absolutely IS.

If it was that easy for most people to lose weight then they wouldn’t need weight loss drugs though. For me, weight loss is easy (at least it became easy again once I fixed a thyroid issue after my youngest child was born) but for so many people it isn’t that simple. I repeat: if a doctor is monitoring and the patient is fully informed then what is the issue?

We don’t police plastic surgery and all of the attendant risks of that so why is weight loss such a divisive topic? I am genuinely interested by the way because even when I was carrying extra weight (for me) I was still objectively slim so this is not a sore point for me (before I’m accused of taking it myself).

@NormaMajors1992coat prescribing off label would not in itself lead to a loss of medical license immediately.

For example, many prescriptions of SSRIs to 16-18 year olds were off label because for a long time there were very few drugs that had been tested paediatrically (clinical trials on minors obviously more difficult) - however, practices spring up regarding prescription along with close monitoring of older children needing treatment for depression. It should always be done knowingly and carefully.

We don’t police plastic surgery and all of the attendant risks of that

it is not unregulated though! Surgeons absolutely should spell out the risks, understand what the patient is seeking, check that they aren’t being coerced etc.