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.

And how exactly do you propose that will work ?

I take in 960 calories per day at 5' 6 and previously 13 st + gym (weights 5 x a week ) with personal trainer. X 1 per week .. ?

I apparently need 1760 calories per day to maintain.. and yet 2IBs in 3 months..

@thefishingboatbobbingsea

960 calories a day at 5ft 6lb is terribly low. I'd be feeling rotten surviving on that!

Are you still on 960 calories on MJ?

So how is MJ working for you OP?
Are you now consuming even less calories due to not being hungry?
If you get to a weight you are happy with and you stop it what then? If all it's doing is suppressing your appetite what happens when you stop it?

Also if you already live a super healthy lifestyle then I think you are atypical of most obese people

Did they ascertain the underlying cause of not losing weight on such low calories? Obviously not a question to answer on here, but there's something going on if that's the case and hopefully they've got to the bottom of it for you.

Having looked it up it seems like slowing gastric emptying is the mechanism of feeling less hungry on these drugs rather than some mysterious 'hormone rebalancing' that people on this thread are taking about

Obviously they do cause more insulin release too but if you're not diabetic I'm not sure how that would be helpful.

So I need to understand your argument.. most fat people don't understand nutrition. ?

They don't know that protein fills you up far better than beige carbs ? That all-bran is chocked full of hidden sugars ?

And that an omelette would be far better sprayed with a minimal amount of olive oil to cook in ?

I am sorry but that is just bollox .. fat people know so much about nutrition that it would blow your mind .. we live this life ..

We know the best foods are legumes and fish (preferably oily) we know not to eat too late in the evening..

BUT most of us are on medication: have medical conditions that counteract the 'norm' ..

In my particular case (v outing here ) I had a condition that destroyed my platelets in the blood .. with the glorious title of idiopathic thrombocytopenia.. it required a massive dose of steroids whilst I waited for my spleen to be removed.. the hunger was unimaginable.. I was 43 and had been 67 kg most of my life . Within 4 years I was 110 kh literally twice my body weight..

I would literally wait outside the bakery for the shop to open .. am I lazy and unknowingly eating for the sake of it ? (The answer is no - that's why the nhs gave me weight surgery ) .. but it wasn't enough.

I am terrified of getting cancer , heart disease. .. I was diagnosed with type 2 diabetes which I am so thankful has been reversed .

My reason for this AIBU is simply to say that I want everyone to have the opportunity I have had to get to a good weight and avoid those potential life threatening issues.. not just because they have or don't have the money to do it ..

You've missed the point. Lots of fat women know lots about nutrition. Lots don't. How do you separate the good fatties with complicating factors from the bad fatties who got fat and never did anything about it?

Hormones are involved in most of what goes on in the body, including gastric emptying.

Well yes but I'm a scientist so I wanted to know what was the exact mechanism. What is the connection with GLP? HOW does it make people lose weight? Rather than just vague hand waving explanations about hormones

That's not surprised the GLP cost the US so much. The pharmaceutical companies charge the US a fortune for the drugs. Possibly more than 5 times what we pay for it privately. They probably do this because the cost is covered by insurance, but if insurance has to pay this for say half the population of the US, they aren't going to be financially viable for much longer.

Until there is a cheaper version, seems like the NHS will be very careful with the amount of people they prescribe to

If you were a scientist you'd have looked it up and figured all that out!

This. Having an injection isn’t a cure-what would you do? Stay on it for life? Or on and off it over and over again doing damage to your body by yo-yo ing? It doesn’t address the issues of why people over eat. For some it’s poverty, for some ease, for some lack of knowledge etc etc. obesity is a very complex issue that is multi factoral but at the end of the day, people who are overweight, eat too much. So clearly education must be part of it. You say you know everything that was told you, but it still had no impact despite your gastric surgery.
IMO giving people an external locus of control (a jab), doesn’t help. It’s like everything else-you need to control to it to make a difference.

Because why should taxpayers with nutritional knowledge be paying for all these jabs for people who are simply not able to control their eating? They’ll get a jab and then get fat again.

better to let them discover the weight loss journey themselves, to help them understand food, calories, food processing, cooking from scratch, and their bodily rhythms. Jabs aren’t an easy fix.

I am not sure that you really are representative of 'most' people with obesity OP

I am not convinced that no obese people can benefit from diet and exercise advice because they already know it all or that most obesity is quite so clearly medication induced as yours. Yes lots of overweight people will be on meds but often as a consequence not a cause.

I meet a lot of people who really don't know anything about healthy diet or nutrition having been brought up without that knowledge.

Or they have a tonne of socioeconomic barriers that prevent them implementing the advice eg too poor to buy healthy food or join a gym, don't even have a cooker in their bedsit just a microwave.

These were clearly not the case for you but there are a lot of people living on takeaways and crisps and feeding their kids takeaways. Really there are.

This leads to kids already obese and with no knowledge of how to live healthily, not exercising because it's uncomfortable and having poor self esteem. This is a really really common issue in deprived communities and weight loss injections alone are not the answer.

A lot of people struggle to lose weight because of insulin resistance. I think this is one of the reasons that mj works for a lot of people as it helps with releasing insulin and reverses the insulin resistance.

You’re assuming every overweight person is the same as you - they’re not.

If all overweight people know all this and everything else then why are they still overweight? Because as we all know it’s far more complicated so aside from cost, best we understand what some of the roots causes are first else you’re only ever treating symptoms. What will happen to you when you stop taking the medication?

I'm sure the amount of people who get gastric surgery is tiny compared to the number of people injecting ?

you were a scientist you'd have looked it up and figured all that out!

And I'm saying to you that I just did!
It's not my day job field and I have never considered taking a weight loss injection so I had never looked it up before but now I have and it appears delayed gastric emptying is the most plausible explanation

But there are similarly long waits for many NHS services. I don't think this is weight/nutrition-specific. You hear of people waiting an awful long time for cancer treatment which should surely be a priority. And, while you might feel it's clear that this treatment would benefit you, it would be negligent to explore less invasive ones first. Plus lots of people might not be as clued up about nutrition etc so they would benefit from teaching. You don't go to the what is effectively the last resort straight away, unless it's so time sensitive (e.g. terminal cancer) there's no other option.

So I need to understand your argument.. most fat people don't understand nutrition. ?

As lots of PP have pointed out it's complicated. Some fat people are very well educated - when I was overweight I knew the calories in nearly everything but still had a blind spot when it came to chocolate.

But not everyone does have that knowledge and an important driver of obesity is lack of interest in food and cooking. When people don't have the resources, either financially or the mental energy to prepare healthy foods, they eat badly. Not because they are thick but because it's too high a mountain to climb.

It's also possible for people to be knowledgeable about food and next to clueless about portion control. Food manufacturers have a big responsibility too. Arguably, cocoa pops are a low calorie food if you only eat the 30gs that Kelloggs claim is a portion. In reality, people eat 3 times as much and that portion is 500 calories of nutritional rubbish. The bottom line is that most people who say they can't lose weight on a calorie controlled diet, underestimate what they consume.

So even with GLPs to help people learn to manage their appetite, education is still important.

Well you can’t treat cancer or liver failure yourself. You can’t put your mangled self back together if you’ve been in a car accident nor can you self abort a child you have conceived regardless of whether you should have or not so the situations aren’t the same.

You can however loose weight yourself. For free.

Is this a drug people won't die without ?

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

But the difference between weight loss drugs snd something like insulin, which T1Ds will die without, is that there is a free alternative: eating smaller, healthier meals.

If you are obese OP I don't understand why you can't try and lose some weight to try and avoid cancer, heart disease, stroke....

People who genuinely need medication to stay alive are a greater priority to the NHS.

weight loss jabs and surgery only address the symptom, not the cause.

I know they won't, but I'd rather the NHS spent the money PROPERLY trying to help people deal with the root causes so that when they lose the weight it stays off.

It is, it does need an overhaul but no one will do it. My DB died waiting for a place in rehab after getting tangled up in county lines before it was well known. He was targeted as he was vulnerable, and although offered methadone this causes more issues than it solves in many ways. Pretty much like many people being adverse to better support for people struggling with their weight many aren't keen on investment in junkies, sadly.

Why will they have to? Mounjaro is intended for long term use. I started taking it with the knowledge that I will likely need to commit financially to paying for them for life. It's like people want there to be a gotcha because deep down, they think fat people deserve to be punished for poor willpower.