Why are the NHS making access to 'fat jabs' almost impossible.

[thefishingboatbobbingsea]

I cannot get my head around why the GPs are not being encouraged to prescribe the new weight-loss injections such as Mounjaro (MJ) . Instead, this NICE approved medication is only available via the NHS Tier 3 pathway for weight-loss .

I went down this road 4 years ago It is mostly a complete waste of time and smacks of making the 'fat people jump through hoops ' as a punishment for getting in that state to begin with.

Tier 3 for me , consisted of waiting 8 months for the referral appointment, driving an 86 mile round trip to the only hospital in the area with an obesity clinic. (Lucky I drive otherwise it's over 6 hours on the train).
Then being weighed. Then sitting in a 'workshop' where we are given amazing revelations such as (promise this is true) a pork pie has more calories in it than an omelette, that processed sugar laden food is worse for you than salad. That protein keeps you feeling fuller than a doughnut...(I can only assume that the NHS believe that old stereotype of Fat=Stupid. )

You have to do that every 6 weeks for about 9 months before you are eligible to go forward for your conversion with the surgical team to discuss the option of gastric sleeve, or gastric bypass. (Tier 4) then wait a further 6 months for the surgery.

I jumped through these hoops and had my surgery. I had gone from 19st to 21st while waiting to go /being on Tier 3/4.. so a complete waste of NHS time, my time and everyone's effort. Not to mention the massive cost of all the salaries of receptionist, nurses, dieticians involved.

I lost 7 stone. Which was obviously great . The difference in my health was astounding. Before surgery I was on medication for high blood pressure. A statin, metformin (type 2 diabetes) cortisone injections for painful knees. Thyroxine and associated clinics and monitoring.

Post surgery I am no longer diabetic. Have no knee problems. BP no longer high and the only medication I still take is Thyroxine. I was still 3stone 4lbs overweight. I go to the gym 5 days a week, I eat healthily, but I was only maintaining not losing. Probably due to being post menopausal.

However I am acutely aware of the health issues associated with obesity. (I was still obese with a BMI of 31 from 44 at my heaviest) and decided to investigate the new range of weight loss jabs. I settled on Mounjaro and am 19lbs down in 9 weeks. It's such an amazing tool for weight loss.

So my question is this. Given that obesity is the greatest single cost to the NHS why on earth are they not making MJ or Ozempic available from a GP. ? rather than the long winded and entirely pointless 'tier3 tier 4' nonsense. ?

Why is it that the wealthy are able to lose weight successfully without 'workshops' telling them that Pork pies are more unhealthy than omelettes. ? Or is it just an extension of that fat = stupid stereotype.. to poor=fat=stupid ?

AIBU fat loss jabs should not be available via the GP.

YANBU fat loss jabs work. The NHS will save a lot of money with fewer people suffering obesity related diseases. The benefit will far outweigh the cost.

You’d think so wouldn’t you. Along side some kid of actual genuinely helpful food training by a proper nutritionist.

Cheaper in the long run that all the issues and surgeries but this is bonkers Britain 😅

Someone will be along shortly who knows more than I do but I think in large part this is because the NHS can’t afford to pay for these drugs so it’s making people prove that they can’t lose weight without them? The NHS would collapse if everyone who needs them got access to them.

They’ve got to be cheaper than gastric surgery though?

I have no experience but you make a clear and very compelling case and I’d be interested to hear from anyone who works in the system why it is the way it is which seems costly, frustrating and counterproductive.

Some of these pens are diabetic treatments though aren’t they. So by prevents diabetes or reversing it for the same price saving future money.

I totally agree with you. After all the bleating about how obesity costs the NHS five bazillion quid a second, along comes a potential solution and, surprise surprise, not available on the NHS.

Being overweight if often a highly-complex issue, particularly the relationship with food often being about food addiction, or mental health issues, or poverty, or any other number of complex reasons.

You would have thought that drug-assisted weight-loss clinics would have been a very high priority.

Because the NHS just isn’t set up to save itself money. Right now there isn’t the flexibility to spend money on weight loss to save money on other treatments.

This is my huge hope for Labour. Take out some of the ridiculous layers and layers of policy people. Pivot the NHS to prevention. The NHS is not simply under funded, it’s the organisation of it which is a mess.

There are huge supply problems with these drugs at the moment so they have to prioritise.

I was considering a jab, but tbh the more I researched, the more I think that it isn't a life long solution. I do think that the NHS should wait another year. I've found doctor perscribed slimming tablets to work as the injection is supposed to.

I work in the NHS. Id say 7 out of 10 of my patients wouldnt need to be seen if they lost a large amount of weight. We are groaning with the sheer amount of patients overloading our services. The waiting lists for everything are horrific. This medication should be available to anyone who needs it.

YANBU but this model of 57 pre-appointments and hoops to jump through and 19 months of waiting before you get to actually have the treatment you need is ubiquitous across the NHS in all specialisms, not just weight.

Every appointment costs the NHS money, even if it’s less than the cost of the treatment they’re trying to gatekeep. I don’t know if anyone has ever done a cost comparison of cutting out the layers of touch with a human before a treatment is approved and comparing to a more efficient model of one or two appointments and then a yes or no. But they should, as I suspect it would be considerably cheaper in many respects, not least because it would free up NHS staff time. Obviously, the physical and mental health costs of long waits to patients would be massively improved too, though clearly that’s not something that the NHS considers a problem right now so probably wouldn’t be factored in.

In terms of your particular issue, they clearly feel they have to justify you’ve tried everything else before they prescribe Mounjaro or the like. Whether anyone has done any actual proper analysis on the cost-benefits of waiting and factored in the people whose weight will increase and health will worsen during the waiting game is unclear. I suspect not. I agree with you that the waiting game doesn’t make sense for either you or the NHS but it does things in its own peculiar way.

These are relatively new treatments and they can't yet be sure of longer term effects. Can you imagine the outcry if in 5 years time it turns out that they don't work long term, or cause other problems? You only have to look at the backlash about COVID vaccinations.

There are supply chain shortages across every pharmacy right now

Look up the issues with Creon as an example

People are paying privately for these jabs and they are bring diverted to the best paying sector, but these 'fat jabs' save the lives of diabetics, so their clinical need comes first

If these things were more freely available and a little cheaper, GPs might prescribe them

Agree totally. The NHS currently falls over itself to save a fiver now and ignores the situations where saving a fiver now costs it £50 down the line. Nobody takes a view across the piece/silos. It’s madness.

Every appointment costs the NHS money, even if it’s less than the cost of the treatment they’re trying to gatekeep. I don’t know if anyone has ever done a cost comparison of cutting out the layers of touch with a human before a treatment is approved and comparing to a more efficient model of one or two appointments and then a yes or no. But they should, as I suspect it would be considerably cheaper in many respects, not least because it would free up NHS staff time.

Absolutely this. I have sleep apnea. To have this diagnosed, my GP did the Epworth scale with me, he referred me to the specialist. Six months later a nurse phoned me and did the exact same exercise. That went to a consultant for review who agreed and referred me on for an overnight test. It is literally a scoring system that anyone can do, but this involved three professionals and over six months. Massive waste of time and money.

@OhmygodDont

Some of these pens are diabetic treatments though aren’t they. So by prevents diabetes or reversing it for the same price saving future money.

I agree but I think the NHS isn’t really set up to make that kind of investment in the future that requires a bit of short term capital investment for a longer term return. There just isn’t enough money to make the investment.

They are too expensive to prescribe.

My husband who isn’t particularly overweight, he was around 15 stone at 5’10 so a bit flabby around the middle, purchased one months worth from an online Chemist at £150.

They helped to kick start his diet by making him feel full all of the time and by the end of the month he’d lost around a stone and his cravings for junk had gone, so he’s been able to change his diet to a better one comfortably.

For most people though, they would need much longer than a month, and people would see them as a quick and easy fix. So there would be less incentive to try to look after oneself. Just my opinion of course.

I am currently in Tier 3

They won't prescribe Weight Loss Injections to anyone in my locality because the dietitians and exercise specialists who run the service aren't actually qualified to prescribe anything.

People like me are being sent there by the GPs being told they'll get the injections but they won't.

What happens when you stop taking the jab?

So besides the injection, what else has changed? Did you just start magically eating better because you were injecting yourself. Whilst waiting for the injection, you said you put on 3 stones.

Whilst I believe the injection is an aid, surely it's not the sole answer, what will happen when you stop taking the injection?

You are absolutely right. I have had an obese bmi for more than 20 years. I have lost over 3 stone on mounjaro so far, and it has reversed my type 2 diabetes, put my cholesterol in normal range, reduced my blood pressure into normal range and sorted my fatty liver too. I feel better than I have in years. I will 100% cost the NHS less with my new health status.

I am fortunate that I can afford to pay privately for these drugs, but it's wrong that people with obesity related issues can't access these meds via the nhs without the ludicrous tier 3 pathway. I think as time goes on this will change as economics tells you that this makes sense for the nhs.

Also to the poster who thinks these are new meds with unknown outcomes, they are not. They have been used successfully for more than 2 decades in the treatment of T2.

My understanding is that the failure rate of weight loss surgery is quite high so there’s a lot of work put in to ensure that the reasons for people’s weight gain is addressed alongside the surgery. Hence the “tiers”

it’s the same for a lot of things. I suspect my youngest had ADD. In order to get on the wait list for assessment I have to do a parenting course. He’s 16, I gave a 19 year old and a 22 year old with adhd and autism. I’ve done almost all the parenting courses and am actually qualified to teach one. But we can’t get on the waiting list here until I do there’s.

Or we could pay …

They don’t make it easy at all. I’m not allowed on the pathway at all due to have a wasting disorder as a teenage. I’m now in my 40s with no problems since- so not sure what they expect people like me to do…

Because the answer to everything isn’t that taxpayers have to pay.

Tier 3 should have involved seeing a psychologist to talk through food issues. Did yours not?
I found that part very helpful.
I think helping many people psychologically would be a better way to spend the money as it's more long term.
The weight loss jabs have to be taken forever to work and don't work at all on the persons relationship with food or nutrition.