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.

What are people saying obesity is caused by other than eating too much?? I mean that is literally the case isn't it?

Other contributing factors to obesity operate by increasing appetite (and/ or reducing movement ) and therefore causing people to eat too much. That could be medication, hormonal conditions like Cushing or PCOS or an emotional cause. Genetically I am sure some people are more or less disposed to eat too much but fundamentally these all operate via the end mechanism of eating too much.

In an environment where there is not the food available to eat too much like Subsaharan Africa or a concentration camp then no one is obese. If there was some other cause then people would be obese in resource poor situations but they aren't.

Also some people prescribed medications that classically cause weight gain don't experience that effect presumably because they consciously compensate

In our world the way it is set up with very sedentary lifestyles and easy widespread availability of calorie dense food then you don't have to have much susceptibility to start to gain weight and once that has got to a certain point it's hard to reverse

So I understand that the predisposition can vary but saying there is some whole other mechanism not involving eating too much that I don't understand

But I wasn't referring to people with health conditions that pre disposed their obesity. Hence me putting the caveat about being obese due to existing health conditions - if you have chronic pain because of an accident, have to take daily analgesia etc obviously you are more likely to become overweight.
I didn't mean to be patronising but apart from education what do you suggest? Apart from medication?
And why is it more complicated than that? Obesity has soared in my lifetime as has upf, fast food, portion size and inactivity so it doesn't look that complicated to me.

@ThePure I don't think anyone would dispute that obesity is caused by eating too much, the question is what causes people to eat too much.

aren't there serious side effects ?

There can be

If that's the case, it is secondary; the gym was established first some time ago.
I am not defending at all. I don't even agree with the injections - would frighten me to death (as someone who has done risky things to herself in the name of vanity - and regret it), and who knows, at this point, what the longer term consequences might be. How much can the digestive and endocrine systems be tampered with without there being a knock-on effect on other systems and parts of the body?

I am not saying this as a smug slim person either. The only time I was thin was in the grip of a hellish eating disorder, which has also caused some longer term issues. But I do have a lot of interest in health and nutrition, and agree when it is mentioned by PP that there is a lot of patronising towards people with obesity problems, as though the size of the body and the brain have an inverse relationship.

(Happens with age/being female too.)

This. Weight loss takes time, effort and changing how you eat/exercise. But, it can be done.

Lots and lots of genetic, psychological, social and environmental causes js the answer to that

Most of them will not be solved simply by a mass programme of obesity injections

I am not at all against people who need them getting them but I don't want people to be blinded to the urgency of addressing the wider societal causes so that we don't get into this situation. Childhood obesity is a public health emergency and the causes are to do with changes in our exercise and eating habits not some mass epidemic of genetic or hormonal diseases

No more serious than the side effects of morbid obesity. 🤷‍♀️

I’d report anyone selling it on FB. It needs to come from a pharmacy prescriber! Not some random on FB.

But I wasn't referring to people with health conditions that pre disposed their obesity.

Neither was I. You said @BloodyHellKenAgain that 'surely it can't be good to take medication for life.' I was simply pointing out that lifelong medication is essential for some people, even though they aren't about to fall off their perch.

There has actually been quite a lot of research on GLP1 medicines…

Right. They are 20 years old. The only difference now is that Eli Lilly & Novo Nordsk are now marketing them.

I’m fat with a BMI of 40 and my husband is a diabetic. He’s on the jabs on the nhs and at one point he had a life threatening bowel obstruction because of them and spent several days in hospital.
the thing is - you mention cost saving but if people don’t address the reasons they need the jab in the first place…you’ll need to be on the jab for life to maintain your lost weight and that is in itself an expense that needs to be considered. Not to mention is there any research of people using it for long term? If you put on that much weight waiting for the gastric band…I am guessing a huge reason you are maintaining your weight now is because of the surgery.

If that's the case, it is secondary; the gym was established first some time ago
@LighthouseTheme Is it a bodybuilding type gym?
They tend to be frequented by doormen who are also recreational drug dealers (by which I mean people who sell recreational drugs not people who deal drugs for recreation- although the two may overlap)

The research increasingly suggests that being obese damages some of the feedback mechanisms that are intended to keep your body weight stabilised. Issues such as leptin resistance, insulin resistance and damage in the hypothalamus can affect the ability to lose weight effectively.

Leptin resistance can mean that your brain doesn’t recognise that you have sufficient fat stores. Consequently, it increases hunger signals to encourage calorie consumption to solve a problem that doesn’t actually exist. Your brain is constantly telling you to up your calorie intake at the time when you are trying to reduce it. You feel hungry most of the time. My leptin levels were really high but I felt hunger almost constantly.

CICO may work for preventing weight gain in someone who has never been overweight but it becomes far more complex once people have gained weight, especially if they have multiple gain and loss cycles. Being obese alters your metabolism and so you need to tackle the metabolic issues. Once of the reasons bariatric surgery works is it appears to trigger a hormonal reset, it’s not simply about volume reduction.

Unpopular opinion but if the obesity isn’t caused by a medical condition then why on earth should the taxpayer pay for it. Pay for it yourself or lose weight the old fashioned way. It’s odd to scoff at the nutritional advice given when you must be unaware of some things at least in order to become overweight in the first place. You say you’re on thyroxin which tells me you have an underactive thyroid. If you’re struggling to lose weight then that would imply they don’t have your thyroxin dose correct. I am also on thyroxin and it is tricky to get it right but I’ve always been listened to if I felt my dosage wasn’t right for me. There’s a huge range of normal with thyroid function and if you’re eating well, exercising and still fat then I can almost guarantee that your thyroxin just needs adjusting. If you’re eating junk and not exercising then that’s why you’re fat.

For their intended purpose surely?
Isn't the weight loss aspect jut really a side-effect that has not been capitalised on.

There are all types; even I joined for a little while as, being very small, they managed things quite well at the start of/during the pandemic.
I stopped when everything reopened, not becuase of the doormen types, but it became overrun with Instagrammers, and is too small (in sq m) to get any elbow/breathing room.
I suppose it is the same as when gyms could get hold of T3 (thyroid med) as that too was purported to enable weight loss.
Not that I agree with it at all, and she has obviously taken it herself. The boobs are no smaller becuase they are implants. Very out of proportion now, and with some big scars - which I would hope could have some give in them in case some of the "weight" comes back.

The jabs have been approved for weight loss now though?

Ozempic is more for diabetes control I think. We have ones called Wegovy and Mounjaro both approved for weight loss given the promising results in trials.

I mean, "just" - and "not been capitalised on"

[Too late to edit.]

As a tax payer, would you rather pay £1,000 on prevention now or £100,000+ over the years for irreversible conditions?

Disclaimer: Numbers are examples to demonstrate scale rather than actual prices

Obesity is a more complex problem than just give the fatties (including me) an injection pen and let them to go off.

If GPs are allowed to prescribe to every person who sees it as a quick fix the NHS will be overwhelmed with requests as it will be seen as an easy fix which is it not. The NHS will not have the support services available to make sure they are not being misused or used unsafely which the NHS has a duty of care to ensure.

I am using MJ and some of the posts in the forums or facebook are shocking. One woman just yesterday accidently injected herself with double the dose and had horrendous side effects, another was questioning it affecting oral contraceptives because she had "heard somewhere it might" when it is clearly outlined when ordering, when approved, and in the patient leaflet.

I believe it will come from the NHS eventually, but it will take time to put all the processes and procedures needed around it to make sure patients are safe and they get the support needed too.

I don't dispute what you're saying as I've read the same. However, I'm referring to personal responsibility about what you eat before you get to the obese stage.

I think because it tends to be a gradual process it’s hard to spot.

I never thought I was as fat as I was, until I saw pictures. Then I’d want to curl up and die.

I freely admit I struggled to lose the weight without additional help in the form of bariatric surgery. It has been a lifesaver for me and worth every penny.

As a tax payer I'd much rather pay less for prevention for all sorts of things, obesity, alcoholism, drug addition, certain cancers, having children you can't afford (controversial!!), poor educational outcomes etc etc
The list is endless.

I believe prevention starts with good education, personal responsibility and necessary support though.