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.

There is a lot of evidence that losing weight isn't simple because humans evolved to retain weight incase of famine. But, we live in a world with excess food, not famines (well most of us). Some of us are lucky that we were slim teenagers who fitted whatever body type was popular at the time and therefore never to tried diet to change our body shape. I found it quite hard to resist the pressure, because though I looked very slender, I had quite a high weight for an 18 year old due to height and broad shoulders (swimming) and was never the 60kg that my friends were. However, I did manage to resist that pressure and therefore never did a diet. Once you start dieting, it seems that you are on the route to yoyo dieting all your life, which triggers this 'reset' of the weight that your body tries to hang on to. So, this judgement on people with obesity is terrible, tbh.

Because "fat jabs" do not address the source of the problem - people who over-eat and dont take enough exercise.

People need to take accountability for their own health (and that of their children) rather relying on the NHS to fix a situation they've created themselves!!

That's why.

Before judging, I myself have been grossly overweight for the majority of my life and then along came Michael Mosley with his 5:2 diet. This is the easy sustainable way to address it, in my experience.

Yes. I entirely agree

And if NHSE want to fund GPs to do it, we'd be happy to.

But what tends to happen is people call for us to do something significant and new with no new resources. It's up to NHSE and the equivalents in the devolved nations to fund this, not for individual GPs to squeeze it into already full days. That way lies rushed consultations and mistakes.

So no personal responsibility? GPs and NHS just to do whatever to meet demands?

Our whole society/culture needs a shift to make moving more and eating less a more built in part of most people's lives. It should be easier to walk/cycle short journeys that to use a car/public transport, but it often is more difficult, for example. Cheap convenience food is high fat/high sugar, for another. Walking and cycling routes to new builds should be considered, whether new housing or new business space, and so on and so on.

So it's not just the NHS's problem to solve, it is a whole-culture issue.

ALL medication has side effects and is a risk-benefit decision when prescribed by a doctor. There is simply no easy route of a magic injection to make you thin. It doesn’t exist.
The NHS used to prescribe Thalidomide as a morning sickness remedy before it emerged that it was teratogenic (damaging to foetus).
There is not enough data yet on the safety profile of these drugs.

Just your regular private healthcare. I'd never considered it before, thought it would be too expensive. But it really wasn't, for me at least. It was via the support and advice groups and 121s you get with the jab supplier e.g. Boots and ukweightloss that we discussed long term maintenance and coming off the jabs and one of the nurses suggested going private and getting a weight loss referral - she herself worked for private providers. So I did that, I am with Vitality. I got a std package - so GP appointments, referrals etc and was referred immediately and I just said I'd like to continue this type of support, like I got with Boots. Plus I get the added benefits of a private healthcare package for anything else that crops up where I'd have normally gone to a GP for.

And to summarise my previous post - what's the difference between the jabs and doing it the old fashioned way of more exercise and calorie counting...

• Sustaining a limited amount of calories long enough to break the addiction of sugar from ultra processed foods. This has never happened to me before using traditional methods.
• Lack of appetite and food noise that makes the length of limited calories actually sustainable. This changes your messaging, that won't happen using traditional methods.
• Losing enough weight to drop your weight point so you cannot physically go back without dire consequences and side effects. I've never been able to sustain a 800 calorie diet to lose enough weight to lower this, it is not possible. And for my height, 800 calories was too many!
• The mental changes that happen when you finally see yourself achieving weight loss, meeting goals, being healthy for the first time in your adult life. I've never been able to get myself there - they've given me the opportunity to see it, feel it and want to stay motivated.

I think it's obvious by the obesity crisis that the majority of people are struggling with a traditional method, these are different and do work.

We don’t know the long term effects of these drugs yet. If the NHS dished them out like smarties and then it was found later on that they caused serious harm, everyone would turn round and sue, claiming they’d been pushed into taking them. So it’s reasonable that the NHS only prescribes them after all the safer options for weightloss have been explored.

Once they are better established then they will likely be much more widely available.

@3CustardCreams you cannot compare the situation around thalidomide and any current UK-approved medication. There were no safety trials or proper research done on thalidomide until after it was in widespread use for a variety of ailments. Now, all medicines are scrutinised and subject to safety studies before being made available. They are then monitored and any side effects recorded and investigated. Furthermore, they are only made available for specific treatments for patients with specific qualifying criteria. Mounjaro for instance is not prescribed to anyone pregnant, trying to become pregnant or breastfeeding.

Of course there are drugs that are subsequently withdrawn as the side effects are shown to be more severe than previously found, or limited in their uses. But that is because they are monitored and controlled more tightly than in the past.

I work in medicine and poly-pharmacy is a problem. No medicine is universally safe and if you can achieve results without drugs- that is the safest route to take. Even the contraceptive pill comes with thrombosis risk- pulmonary embolism and DVT from which you can die. Anticoagulation with novel agents like Apixaban, Edoxaban etc for stroke risk in atrial fibrillation - they still come with a risk of bleeding/haemorrhage from which you can die. Safety profiles and testing are not a guarantee. If you can achieve the same results with hard effort of diet and exercise - that is what I would always advocate for.

@SofieM0 it sounds like you're doing really.

I completely understand the food noise.

Can I ask how much weight you lost and what your typical food intake looks like now?

Yes, as you say, safety is an issue for all medication, not just these specific treatments.

I would agree that the first line "treatment" for being overweight is diet and exercise. GPs telling patients to do that is obviously not very effective in our current society!

Sure, I don't want to hijack this thread with jab pushing but in the context of giving an answer to 'what happens long term'...

I now use intermittent fasting. It is, for my measurements, the only way I can maintain such a low calorie count. I plan it in advance around my life so I don't miss out on a breakfast date for example and can go on holiday without worry. This was something the GP wouldn't recommend when I first went to them but have been able to get support via the private route in abundance. Typically I will eat between 2pm and 6pm, all my daily calories that cover all nutritional needs. I do not touch UPFs and on the occasion I have had processed sugar or been stuck in a situation where I've been at a party and there was only pizza for example, I have been ill. So I agree that skinny does not = healthy but being fat, then skinny absolutely = healthy! My naturally skinny friends are ticking time bombs so I'm grateful for my fat journey!

I have lost a total of 5stone and 9lb over 3 years - 4stone of that being on the jabs and over 1 year. I would have lost more if I continued on the jabs, I'm certain but I also don't agree with the BMI scale. I'm happy at a UK female size 8-10.

@SofieM0 thank you and well done

Not just the NHS, this is true of a lot of services, they just don't have the spare money lying around to save money longer term.

We need to do more ourselves. Look back 40 years, there were nowhere near as many fat people in 1984. Why? Portion sizers were smaller for a start. Grab bags of crisps and sharing bags (nobody shares) of minstrels did not exist. More people cycled to work or walked. We didn’t endlessly snack during the day either (apart from a couple of Digestives with a cuppa).

The biggest thing however, no internet/smart phones, As a 21 year old in 1984, we were always out, disco, swimming, darts in the pub (or Aunt Sally), we’d go ‘up town’ shopping on a Saturday - walking for ages etc. We made our own entertainment, stopping in scrolling on a screen didn’t exist.

I say this as a 12st 6lb 5ft 4 overweight 60 year old who has lost 2 stone since January by changing my dinner plate and exercising daily.

My naturally skinny friends are ticking time bombs so I'm grateful for my fat journey!

What?

Baffled me too. Going against all recognised medical data

As in, they don't think twice about UPFs, sugar, alcohol. They consume in excess but because they remain skinny, they don't see an issue. They all have various issues ranging from gut problems, skin disorders and hormone imbalances but because they aren't overweight, will not hear that any of it is associated to they are what they eat - only I was what I ate because I was fat. Of course this isn't true of everyone but in my group, it is. Hope that clarifies.

I checked out of curiosity what was available in my country. In my region (highly regionalised healthcare and different services available to people depending where they live) there’s liraglutide that can be prescribed but must be fully paid. So normal appointment fees plus 100% cost of the drug.

These drugs are currently so expensive that I expect that most free healthcare services wait for 1) long term data on how sustainable the weight loss is, say, 5 years after the jab; 2) the drugs going off-patent.
Funding something extremely costly that might result in the same outcomes as free interventions would be a waste of public resources.

They might well eat unhealthy diets, but bar some people who have metabolic disorders the vast majority of 'naturally' slim people eat within their calories relative to their physical activity levels- even if it is junk. Whilst it might be true in your friend group, most people of a healthy weight are well aware of what constitues a balanced diet and are consciously active. Carrying excess weight regardless of what else is going on in someone's body elsewhere is a risk in itself. It's great you're now eating foods that nourish and benefit your body, but let's not fool ourselves about the reality.

I too do intermittent fasting (either 5:2 or a 16:8 or a combo). It's really sustainable and has a whole host of other benefits besides weightloss. I lost 5 stone over a course of a year and a half very easily and have maintained the same weight ever since (that was 5 years ago now).

Read what you can about intermittent fasting. Our GP surgery now does recommend it for obese people because it is really straightforward to do, costs nothing, no side effects (apart from better health!!!) and completely sustainable for the rest of your life.

My tuppence is that I think the NHS wants to discourage the use of these injections by people who are just lazy, and not have medical disorders that cause weight gain, like you clearly have had (underactive thyroid/etc).

Plus rapid weight loss comes with it's own problems (excess skin - that I understand you also cannot get rid of on the NHS) and also - keeping the weight off is supposed to be tougher if you have rapidly lost the weight.

Trouble with weight - for people where it is not a medical condition causing it - it is all about mindset, so not only do you have to treat the body you also have to treat the mind.

I've struggled with my weight my entire life. Lost half my body weight in a year and then 10 years later put some back on due to a medical condition and losing the will to live with calorie counting. Have recently taken up the gym and keeping my diet in check again but I know it'll take me a year to resolve.

Plus, I might be incorrect here, but I thought the injections were for diabetics first and foremost.

100% agree. Had I fully understood this and not been given the 'it's too dangerous' message by my GP at the time (could have changed since), I think I could have made more progress 'naturally'. However I still question, for myself at least, whether it would have broken that sugar addiction for me or if I would have still eaten junk but just less and in a smaller window of time - thus using all my calories on junk?! Knowing what I know now and finally getting out of the sugar cycle, Im grateful for the jabs for doing that for me. Literally couldn't eat junk or sugar on the jabs and can't look at it now - a revelation! With that on top of intermittent fasting, it's a life-long plan I can follow.