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.

If you have no appetite @purplepentagram I’m not sure the injections are for you as they work by suppressing appetite. If you’re gaining weight despite eating very little, there must be something else going on. It must be very frustrating for you not to be able to get any answers.

The pharmacy's find them incredibly hard to get hold of. I too did ozempic, 0.25, 0.5, then 1mg, but in end it was impossible to get hold of, I work in a pharmacy too.

Not in the UK
They are easily available from online pharmacies

The quick answer is the NHS refuses to pay for it. I was on Ozempic from the GP, with agreement by the hospital weight management team I was referred to, and lost over 7 stone when it was stopped due to availability. I've since been told it's who you know, not what your needs are. Apparently many patients are still receiving it in my area, but my diabetes nurse tells me it's not available. The hospital based dietitian told me they were awaiting NICE to give the go ahead for the hospital team to issue Wegovy directly to patients, instead of via GPs. They got the agreement last year, then the NHS refused to fund it. I've waited a year to be switched to Wegovy, as the weight is slowly creeping back on, as I need to lose a few stone more to get hip replacements, so I can do adequate exercise to keep it off. It's gutting after all the hard work I put in with the Ozempic to lose so much in the first place.

YABU.

NHS nurse here. Your GP can prescribe both. There was no reason they couldn’t. Likely didn’t have the confidence.

Ozempic is not licensed for weight loss. It’s licensed for type 2 diabetes. The same drug but known as Wegovy is licenced for weight loss prescribed by the tier 3 weight management team. Which have not stopped prescribing and GP’s are advising to prescribe if meets criteria of bmi.

Mounjaro is licensed for both type 2 diabetes and for weight loss for those with a BMI >30.
Again, no reason Gp cannot prescribe. Many in my area already starting to prescribe both now more on the drug and it’s become familiar to them

“Again, no reason Gp cannot prescribe. Many in my area already starting to prescribe both now more on the drug and it’s become familiar to them”

I’ve been told that there isn’t the money for it, and that some areas (North Yorkshire for example) don’t prescribe it at all, and the only tier 3 service is out of area.

For all saying it’s a quick fix, there is now so much research showing that over a certain BMI any weight loss is very unlikely to be maintained. Bodies retain fat in different ways when obese, and the way hormones work means weight loss is much more difficult to sustain. Injections like ozempic or Mounjaro change that, and there’s evidence that they improve your gut biome (a problem that helps maintain obesity - google faecal transplant).
It’s not a quick fix, it’s possibly the only way that someone who is morbidly obese can lose weight.

Some people feel better though if they can consider fat people as stupid and lazy.

@cauliflowercheeseplease, you have zero understanding of pharmaceutical R&D. Many drugs are developed for one issue, to be then found useful for other conditions. In this case it's not surprising as the mechanisms are intimately linked.

Inform yourself:

www.sciencedaily.com/releases/2016/11/161129150501.htm

Maybe that is their intention. Offer people high risk surgery or alternatively suggest that they pay for their own drugs to fix their self inflicted problem.

@chipsaway, technically GPs can prescribe, but it would be against national guidance so understandably not many are prepared to. ICBs get jumpy.

apart from glp1s have been around and used long term by people for 20+ years so all this " we don't know the long term side effects" is either ignorance or scaremongering and you don't see the same degree of outcry over other new medications hitting the market.

we do absolutely know about the long term effects of obesity. People choosing to take glp1 drugs have the same degree of risk-appraisal as the rest of the population. I know the drug I'm taking is increasing my insulin sensitivity and therefore reducing my chances of developing type 2 diabetes. I know that I am therefore reducing risk of metabolic disease, cancer and cardiovascular issues. I'll take the risk of future know and unknown side effects of the medication as for me the risk is worth it.

Exactly the same as when I chose to have my covid vaccine (moderna) with the emerging vary rare risks.

Gp absolutely cannot prescribe gpl1 for wt loss in someone without DM
Read the NICE guidance.

because it isn't working?
more than 50% of all UK adults are overweight or obese.

The issue is systemic.
People who haven't struggled with weight are going to have to come of their high horses soon enough as you are literally the minority

I actually work in the field and prescribe both for a living in NHS!
Yes they can now! Look at Mounjaro BNF.

Also As I said Ozempic ISNT licensed for weight loss. It’s licenced for type 2 diabetes therefore can be prescribed by GP. Wegovy it’s the alternative name and that it what is licensed for weight loss. Both Ozempic and Mounjaro are being initiated by GP practices in my area.

Sometimes it's because it's a diabetic treatment - people are already buying it and so there's already a supply issue for diabetic. If more people had it for weight loss then demand goes up and manufacturers can't keep up

NICE is only a guidance and yes they can prescibe. I actually prescribe both drugs for a living within the NHS. The OP reports she had diabetes. Both are licenced for type 2 diabetes. GP’s are initiating both drugs within the area of the Uk where I am now that they are more familiar with them.

I would qualify for Ozempic but I have kidney damage, caused by diabetes, so it won't be prescribed.

That’s a gross oversimplification back the other way. My FIL is overweight because he is lazy, ears rubbish and drinks too much. If he just changed one of those things it would make a huge difference. Exercising more and eating better doesn’t mean salads and running 10k everyday. People these days are inherently lazy, nobody walks anywhere, food is often the easiest (and not cheapest) option etc. I appreciate I’m oversimplifying too by the way. A huge problem the NHS faces is everyone just assuming it will solve their problems rather than taking steps themselves. There’s plenty of cases where the extra help is needed of course, but that’s the minority, not the majority in an example like this.

@brunettemic

what have I over simplified?
50+ % of uk adult population is overweight% or obese- that's a fact.

That fact in turn must mean the issue is systemic

if 50+% of the population was illiterate of course we would be looking at system change.

our food system is broken and education and healthcare on obesity is woefully inadequate.

you cannot chalk 50% of the population up as 'lazy' as the route cause. it is so much more complex than anyone on this thread cares to admit. just look at obesity trends across the developing world..

I’d love to think the NHS was that strategic but we both know that’s not the case.😂 Every phone call I had this year cost you - and me - three times what a month of GLP-1 costs. Not to mention the 3 months of meal replacements I was sent without requesting it.

(PM me if anyone wants it).

We can't afford not to deal with this. The fact is there are many reasons people are overweight. For me it is due to my medication. I'm taking personal responsibility by asking my GP for help!

Exactly - those with T2D is usually because they are a 'greedy, fat, lazy person' but because they got diabetes makes it all ok. Same person wants to prevent getting diabetes in the first place=wrong.

well from the day you posted 5 months ago to say that you were about to increase dose (but turns out you actually decided to stop taking it all together on that day!)

to yesterday when you posted on this thread

you didn’t post once.

so 🤷 who knows!

Every morbidly obese person I know is the way they are because of deep seated psychological issues (very often ND) or medication or both.

Antidepressants are a big reason for weight gain as are many other drugs. I don’t know one morbidly obese person who a) got there simply by eating too much, there’s always underlying issues, mental illness, chronic conditions requiring long term medication, and b) doesn’t know all about diets and nutrition and exactly how to lose weight, more than most other people.

Being obese is different to being overweight, and changes how our bodies works, and changes how we lose weight and the reactions our bodies/brains have to that. There’s so much information coming out about it that there’s really no excuse for anyone to trot out the predictable stupid and lazy comments that also often come from drs and people who really should know better.

Injections should be easily available. They are safer than surgery and safer (and likely cheaper to the NHS) than treating fat people like idiots who aren’t taking responsibility for themselves.

Every morbidly obese person I know is the way they are because of deep seated psychological issues (very often ND) or medication or both.

and not one because they just really really bloody like burgers, takeaway curries, chocolate, crisps and fries and can’t be bothered to walk more then a dozen steps from car to front door?

There will be some 👆 and daft to think otherwise

I know a few people who have been down the surgery route and have gained the weight back as they didn’t change their life style (pain privately for the surgery) and also ended up with health problems because of it.

I guess they want to see whether in a more group situation and the support of professionals people can change their habits themselves and therefore not need the medication or surgery. It’s morally right to give it a fair go.