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.

Do we ? Please tell me your source for this statement !

I'm guessing you have never suffered medication induced obesity..

What an ignorant post . No more to say .

Sorry to hear about your DD, glad she's been able to access support now. The wait lists and the thresholds for being able to access care are ridiculous at the moment.

Not directly comparing the two, but investment in therapies (actual effective ones not group chats or quick generic presentations) would help so much with this too; lots of people who over eat do so because of BED or because food is an emotional crutch. If the NHS invested in more support perhaps in addition to or maybe instead of jabs and all sorts then people would be more likely to address the underlying issues and lose weight. People generally don't eat themselves into a myriad of health problems or have food affect every faucet of their life and lower the quality of it often unless there's other things going on.

I think the reason why u go throu different tiers is to perhaps make sure u are on board with eating healthier before and after the procedures ! U can’t just carry on gaining weight !
you actually said u gained weight whilst waiting and you had been on workshops ? And now u want the injections if u take on board the things that u know and put the effort in you will lose weight !
losing weight is not something u do for a few months it’s a whole lifetime of being healthy and making healthy food decisions .
At some point you have to make sure u have the knowledge to stay healthy because u can’t take weight loss injections forever !
Im not trying to be horrible btw I’m just being upfront and being honest ! What I do think we need it help understanding is why we should make changes in our diets as we get older especially when we hit perimenopause there is so much conflicting advise .
Best advise I got told cut down on your carb portions ! Eat lots of proteins and veggies . I have lost nearly 3 stone since October but if I hadn’t been advised on what would work I’d still be 3 stone heavier ! X

Really should there be ? So you are happy for obese people to fill the clinical time of heart specialist,, diabetic clinics , orthopaedic wait lists ?

How about getting fat people thin and their being much faster access to all the above for people with those conditions that are not caused by obesity ?

How about personal responsibility?!

Yes I agree about needing to test any medication properly.

The point I’m making though is that obesity plays a big part in the reasons why people end up with extremely serious conditions.

We should jump on early interventions wherever feasible - starting with schools not feeding children the nutritional equivalent of McDonalds using public money, proper PE and healthy lifestyles provision.

I’m not saying the government and public funds should do everything, not at all, but prevention is better than cure. And cheaper for the gov and the individual.

The OP’s story sounds like a ridiculous and inappropriate waste of resources that we are all paying for and nobody gets any benefit from.

Most of my family are doctors and they literally wouldn’t believe this story as they’d never put a patient of theirs into a lengthy limbo with no benefit.

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

That doesn't mean that over prolonged use serious side effects don't appear. There are many that have gone through drug trials (Phase 1-5) received FDA/NICE approval and long term have resulted serious life threatening side effects in some patients. Drug trials only target a few thousand people in a sample group to prove their efficacy.

Once released to the wider population, side effects can start to appear.The UK government has the yellow card system to report such incidents.

Multiple law suits against the big pharmaceutical companies have resulted in drugs being pulled because risks have emerged that negate approval.

There really isn't the long term data over millions of patients yet in place to really determine what the long term side effects could be. It would be too risky versus reward at this stage.

Also, it's no guarantee of long term success. It really isn't.

1. they can't afford it
2. They are worried people would abuse them. What's the cut off going to be and why? BMI is awful. People can be a size 8-10 and in the overweight BMI category. I was in obese category and I was a size 12-14.
3. Would it encourage obesity and bad eating habits? Knowing they can just get the NHS to give them a jab should they put on weight so not putting in effort to learn good nutrition and eating habits. What about when you lose 'enough' weight? How will we help people maintain without being on these drugs for life?
4. They're new. It's not like a new cancer drug where people would die without it. Should, God forbid, we find out this drug causes X, Y, Z 20 years down the line what then? People are obese even as teenagers. They could be on these drugs for decades. We may not know for many years the full side effects of the drugs long term and NHS certainly can't afford that lawsuit.

Probably because dieting and exercise are cheaper and shows willingness of the part of the patient to be responsible for her own wellbeing.

I say this because I have recently dropped 10kgs (ongoing) cause the doc said I should and if I can do it anyone can.

What are the tablets you've been prescribed?

@WhereIsBebèsChambre
Personal responsibility?
OK let’s not treat:
Alcohol related conditions or injuries;
Smoking related conditions;
Skin cancer from tanning;
Any illnesses or injuries from illegal drug use;
Any STD where safe sex wasn’t practised;
Any injury from dangerous sports like boxing, rugby, skiing and horse riding;
Any injuries obtained during the commission of a crime;

Arguably all of these were preventable and so the doctrine of personal responsibility says the patient is to blame?

I am not advocating for this approach I am merely pointing out the utter hypocrisy of lecturing obese people about personal responsibility if you don’t then do the same to people who require treatment for all other potentially preventable conditions.

I think @1BodyProblem was making a fat joke.

So I pay £149 per month. Let's say there is £20 per script added for profit as they are a business not the NHS ..

Are you honestly going to tell me that my previous costs to the NHS per year of :

GP x 6 visits a year . (Reception , phlebotomist, pathology, GP ) Blood pressure meds and statins

3 x Diabetic clinic (Metformin , admin, receptionist, registrar

3 monthlly cortisone injections in knees by GP

Sleep Apnea referral, overnight studies and medication..

All of which are no longer required. I now only take thyroid medication..

Costs less than 12 months worth of Mounjaro ? £1788

and without the profit element.. £1578 ?

I think your maths don't add up .

Well yes - it's regular use of emollients and then a weak steroid cream, and protecting your skin from irritants / using gloves. I've had dermatitis from hand washing - protecting the skin and emollients are key, otherwise it will just come back in the future. Jumping straight to strong topical steroids for everyone going to the GP with eczema or dermatitis is totally inappropriate. Problem is the GP can't tell at the start who will respond and who won't- you have to try first treatment and see what happens.
It's the same with obesity - first line is advising calorie restriction by dietary advice. That's all these drugs do by reducing your appetite, you could still maintain or gain weight on them if you eat too much.

I have issue with one point you make ..

Is this a drug people won't die without ?

The answer is YES.. obesity is directly related to cancer , heart disease, stroke ..

Because otherwise too many people would go straight for the jab which is inappropriate. It’s a medication, there are side effects. Better if more people can lose the weight naturally rather than through medication 🤷🏻‍♀️

To be fair a lot of that list could be avoided with effective prevention measures which aren't currently widely accessible. Alcohol and drug abuse for example, many people who struggle have underlying MH conditions or trauma etc that the NHS doesn't provide support for in big numbers- many people die or tear down their lives before being able to receive help. These should be invested in, as should support for people who eat themselves to an early grave.

@Sunlime
Absolutely. The NHS is too often currently a crisis management service rather than a crisis prevention service. In the longer term in many cases prevention would be better than cure.

I was 13 st 8. 5ft 6

I go to the gym 5 times a week and am a hello fresh cook (healthy food from scratch ) as there are only me and DH now ..

I have a massively under active thyroid since my middle child 27 years ago.

I looked fit as weights improved my body shape and firmed me up .. there are never any white/beige foods in the house . I have an egg on whole meal sour dough for breakfast at 11 am.. I have fish and veg at 5pm.. (I'm a faster so nothing after 5:30pm .. ) nothing changed ... I got a personal trainer to help me up my training.. I lost 2lbs in 3 months .. I don't drink alcohol. I don't eat sweets.. no biscuits or chocs in my home ..

The only thing that has made my weight change is Mounjaro .

I have lived this life for four years. I am super happy with my intake . But hungry . MJ took away my
hunger .Before basically just maintained . Now I lose .

Thought so.

Not all diabetics are overweight. But if your insulin dependent it doesn't matter what size you are you need insulin or you will be dangerously ill and could die.

To answer the question the OP posed, the reason the NHS make access to fat jabs almost impossible is because it’s just too expensive - I quote from the Spectator - “Wegovy is only available in a handful of European nations, such as Germany, Denmark, the UK and Switzerland. Everywhere demand outstrips supply. Last month, the Danish government, where the manufacturer of Wegovy and Ozempic is based, announced that it would restrict prescriptions for Ozempic and will start putting patients with type 2 diabetes on cheaper drugs first. This came after the bill for the GLP-1 agonists topped $200 million last year, double 2022’s expenditure. In total, it accounted for a staggering 8 per cent of all Denmark’s medicine costs.
In the US, a report published last month by the Senate’s Health, Education, Labor and Pensions Committee claimed high GLP-1 drug prices, coupled with high uptake, could ‘bankrupt our entire health-care system’. The report warned that if half the adults with obesity in the US start taking Wegovy or similar drugs, total spending on these medications could reach $411 billion – more than Americans spent on retail prescription drugs in 2022. In an attempt to cure obesity, could we end up killing the NHS?” Max Pemberton, 1st June 2024

Part of the reason you won't get fat jabs straight away is that thinness does not necessarily equal health. If you are a woman who is a thin drinker who doesn't do resistance exercise then you're not as a healthy as you could be. If you went straight to that from fat you'd still be likely to cost more in the long run. But if they make you think about nutrition and movement you might be more healthy than you were.
Fat women who don't drink, eat well and workout can be healthy in every metric except weight. I wish there was some way to measure those things so we could qualify for useful help in all our conditions. Want to see me lift weights? Row 5km? Nope, just stand on the scales 🙄