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.

It's hard but if you have enough will power it will work. There is an American programme about morbidly obese people wanting weight loss surgery. The doctor won't do it until they lose a certain amount themselves, he sets a target and they don't get surgery unless they show they can achieve it, or at least close to it so he knows they can change their habits.

I've never had a weight problem although getting closer to overweight in my 70s but I know I'd struggle to lose weight as I don't have the willpower.

I am probably an ideal candidate as at 62 I lost 2 stone initially eating very healthily- I am still though 13 stone 12 and a bmi of 31 and despite carrying on eating very healthily and around 1300- 1500 a day I have remained static for 6 months. I can't help but wonder if this would give me a jump start again. It's not for me about underlying habits- I also don't eat loads of sugar, cakes or biscuits as am gluten free and am just on the pre diabetic borders.

The news, Dr Karan, Google Scholar - basically all free sources of health research.

I dont understand this. I made the choice during Covid to put on 30kg, would never have occurred to me to ask the NHS to help me lose it. I saved and bought the jabs myself.

It's really not that simple though. It could be thousands every year and then millions in compensation claims and subsequent treatments to treat side effects. This drug is really in it's infancy, no one knows the long term effects.

Simply being fat is not an illness and for most people, the answer is in their own hands and they need to take responsibility for that. The NHS hasn't enough resources to go around.

Agreed! This is what bugs me about threads like this. Always people saying private buyers are taking it from the diabetics etc.

Mounjaro gets prescribed to diabetes but they need to meet criteria to get it. I.e. they have had tried a few different diabetic drugs first and only prescribed MJ if they are still struggling with their blood sugar. Also, MJ is only available to diabetes that are type 2 diabetic and are obese. So a majority of the diabetes that gets mj are on it because they got diabetes by being obese, eating too much bad food etc. So surely the fat phobic should be applauding obese people making the decision to go private before they get diabetes themselves and then would quality for mj on the NHS!

What happened to the days of people taking responsibility for their own actions rather than forcing society to fund it…

Is it not because we don't know what the long term implications of these medications will be? I agree that if nothing else has worked for obesity, the risks of long-term obesity are probably higher than the risks of the medication, but it is sensible to explore other options first.

read up about the weight set point. Your body has a weight that it will fight to maintain. Dieting wrongly raises the weight set point, so your body will divert more calories away from other functions to raising your weight.

Why do you think so many people eat such different numbers of calories and maintain the weight they are on?

Of course if you don't eat at all you will eventually starve, but there are so many survival mechanisms that fight against that, so you can put on weight with fewer and fewer calories. Your metabolism slows down more and more

To lose weight permanently you need to lower the weight set point, and to do that you need to NOT trigger the survival mechanisms that help you survive more on less calories. You need to LOWER your weight set point. And to do that you need the right diet, which means avoiding sugar, avoiding margarine, avoiding HPF and eating a lot more veg, and high fat and protein food.

This is mainstream science. Not new or faddy, the consensus from all robust research over the last decades. The trouble is so many people still believe the warped information coming out of the sugar industry decades ago, claiming that fat was the enemy, and sugar is harmless in moderation.

Read "why we eat too much" by Andrew Jenkinson. He explains it really well

Neither.

So anyone who has ever sunbathed should pay for their skin cancer treatment?

If you trip up because you have had too much to drink society shouldn’t pay to treat your injuries?

As for anyone who have ever smoked, used illegal drugs, drunk alcohol to excess, engaged in unsafe sex, forgotten to put on a seatbelt? Clearly society shouldn’t fund treating the consequences of any of those things? Why weren’t all there people more responsible?

No I didn't put on three stone whilst waiting for the injection. I put on three stone whilst waiting for, the referral to the obesity clinic to pick up my referral.. then 9 months of 6 weekly entirely pointless and infantile 'healthy eating workshops' where I was taught that pork pies contain more calories than an omelette - and that protein keeps you fuller for longer .. all of which only a complete imbecile would already know. Add to that the 6 month wait for surgery .. that's 2 years of GP, NHS admin, Nurses, Dietitian and Surgeons time . Not to mention mine. I lost nearly 7 stone and maintained that weight for 4 years. The thing is that NOTHING except the surgery contributed to my success - and a simple referral to the surgeon would have achieved the same outcome (Jabs were not an option 4 years ago. ) and cutting out all the tier three stuff would of saved ££££ to the NHS .

However

Fat people aren't stupid. Obese people are almost certainly more knowledgeable about nutrition and healthy eating than most people - having spent most of our adult lives battling weight.

The jabs are a game changer . I have never encountered any issue getting hold of them. I am on MJ. I pay my money and take the medication and have lost another 19lbs and for the first time in nearly 20 years are no longer obese. Just over weight with 10kg to go until 'healthy' .

What happens when I am at healthy is as yet unknown. But on the basis that I cook from scratch, never eat UPF and managed to maintain my weight for 4 years post op.. go to the gym 4 -6 times a week and am no longer on mirtazipine .. (a drug that is given to the elderly to encourage them to eat - but given to me for insomnia) .. I am hopeful that I will succeed in keeping 'in the zone'

What I find so incredibly unfair is that I have access to this jab for one reason only ... money ! I can afford it. Wheras £149 a month is an absolute unaffordable luxury for many who would benefit - with the long term consequences of arthritis, high bp, cancer, heart disease and if course diabetes.

Just seems so short sighted .

For those saying. 'We don't know the long term affects of.. ' sorry but a drug doesn't just appear . It has been tested, developed and trialled for YEARS before getting approval from NICE .

It doesn't require you to

WTF does that even mean when we live in a country that has health care free for all at the point of need '

If you don't like that concept (one of the few things that makes me proud of this country) you need to bog of to the states and enjoy the cash register at every hospital..

So jaw surgery and sleep apnea takes up 65% of the nhs budget does it ? What a ridiculous argument.

If the fat people were thinner you would have all that money spent on diabetes, heart disease, arthritis clinics to channel into jaw surgery and sleep apnea .

It's not a race to the bottom ! How about a bit of prevention? and thereby saving money for the stuff that's not so fixable ?

Thank you @combinationpadlock for summing up what I wanted to say earlier but didn't have time too. Totally agree and am very frustrated by those on this thread who trot out the tired old trope about willpower.

Then you have never been obese and have never tried the jabs.

Get to the place of health and then do this stuff. Save the NHS £££££ on the way ..

Well depends what you think 'point of need' means?
I'd be alot happier if I had laser eye surgery, but can't afford it so wear glasses. Should the nhs pay for me?
I'd be happier if I had a nose job for my broken nose, I could pay, but maybe the nhs should?

i'm type 2 diabetic and bmi is 30. but no the NHS does not want to know - 'try to eat less' was the treatment. so after a tough menopause and a chronic migraine I am unable to exercise other than do my 10,000 steps and some stretching. I am going to fund mounjaro myself. prevention is better than a cure so lose the weight every so often and keep my BMI lower than type 2 symptoms

2 things.

1. I don’t agree with the jabs and don’t think the NHS should be funding them at all.

2)My dd has been battling Anorexia for years, she is now lucky enough to be having treatment that has saved her life. The pressure on ED services is huge and wait lists for life saving treatments such as therapy and inpatient are massive. People die from Anorexia and the sooner you treat it the better. Funding for this should be the priority.CAMHS and CMHS are hugely under funded funded and under big pressures. All EDs involve needing mental health treatments. Funding for that should come first too as it would help stop EDs from developing.

Also trying to get well well from any ED is excruciating. My dd has tried to kill herself several times.She is winning the battle now. There is no quick fix or jab for Anorexia. You battle or you die. Those struggling with obesity do need to take some responsibility for it themselves.

There can't be many people in this country who really do not know what to eat or not in order to lose weight. But yes it's an effort and take willpower, been through it myself. These drugs should not be used as an easy solution for those who are not willing to lose weight by their own efforts. As there is a shortage, and given the cost, these drugs are surely restricted to diabetics and those whose obesity is caused by underlying conditions. As already pointed out taking these drugs does not change nutritional knowledge or habits.

I agree with you OP.

There are so many other non-medical interventions that the NHS could provide that would save so much money - better physio, more counselling, better elderly care. All of these things would cost, but they would save more money in the long run.

How about a bit of reading comprehension ? I do pay for it because I can afford it. My AIBU is that it's only available to those with money .

No this is wrong thinking.

The most cost effective solution is to get people to not be obese . Due to the huge number of co morbidities related to obesity.

In my mind - if they gain then put them back on it . A ridiculously amount cheaper than heat bypass/ knee replacement/ diabetic management..

Well they do change habits - while a person is taking them - because they change what and how that person eats. People keep insisting that the jabs are an easy option but they come with side effects (some pretty unpleasant!), they come with risks and they require the person taking them to change their diet. It still takes effort, but it makes success more achievable. People can't lie around eating junk food and then do a quick injection that magically reverses it, that's not how they work.