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.

These foods are readily available, easily ordered to your door and cheap.
Add in time pressures, depression, ND and the addictive brain changing properties of UPF bang there you have it.

I'm a stable, financially well off, healthy woman with no children at home.
I work PT and have time and money to spend on healthy food.
Others are not so fortunate.

It's very very complex and our current lifestyles predispose us to obesity.
You are all greedy and lazy just increases the shame, it doesn't help

Well here we go. The usual dismissal.
You don’t seem to understand that your response is typical, and offensive. You’re making assumptions that I’m guessing you’re not qualified to make.

It’s far easier to jump to these conclusions, because then the likes of you can never be obese, right? You’re disciplined, you take responsibility for yourself, right? Better take note of all the reasons people gain weight so you can avoid them eh? So if you have a long term condition that needs treating with steroids you’ll be disciplined enough to turn them down? Ditto certain antidepressants? If you develop a mental health condition that goes untreated/poorly treated for years you’ll have the self discipline to snap out of it? Jolly good, well done.

Every single morbidly obese person I know has underlying causes. Every single one. Whether it is genetic, or stems from mental illness (remember there’s also a mental health crisis going on and an NHS that cannot cope), or medication. You can’t see this, all you see is a fat person, deserving to be ridiculed and lambasted, which adds to the cycle - thanks for that.

Once past a certain BMI your physiology changes, which can be treated successfully with injections, more so than surgery or weight loss plans (which have been proven time and time again to not work long term). Injections to make our bodies work like non-obese bodies (and there are physiological differences) would not only help to make our lives better - by relieving certain chronic illnesses (that ironically have been made worse by the treatment for said conditions, I believe the term is iatrogenic), by preventing/reversing T2D and the complications arising from that. Even if someone has simply eaten themselves to obesity (and I’ve yet to meet one), they still deserve the chance to reverse this, and that’s unlikely without help, and remember, weight loss plans don’t work long term, unless you have plenty of money you can’t access decent and effective therapy.

But like so many ignorant fuckers you’d rather see obese people suffer and be punished for their sin of being fat and lazy. Go and educate yourself 🙄

I always wonder what people make of the fact that obesity and poverty are correlated in the UK if they're so sure that being fat = greedy and lazy. Do those people believe that the poorer a person is, the greedier and lazier they are? Do these people believe that British people are intrinsically lazier and greedier than eg Japanese people (where obesity rates are lower) or that greediness and laziness is on the rise across the world where obesity rates are rocketing all the time? Is this due to a moral decline in people's characters, a sweeping tide of degeneracy? Or could it possibly be that there are external factors influencing a person's weight, making it more or less difficult to achieve and maintain a healthy weight?

Oh and I forgot to mention night shift workers, they have higher rates of obesity too, the lazy fuckers am I right??

I'm a GP. I am happy to prescribe the GLP 1 meds for weight loss. I am however NOT allowed to. We get email reminders and queries of we do from our pharmacists/health boards. Wrist slapped if we do in a pt with no diabetes. In my area there is NO accesible tier 3 service. NICE guidance is that the meds need to be prescribed with psychological support hence referral to the service and no initiation via us with weight loss alone as an indication. (if we follow the guidance as it is set out) Lifestyle changes that mean the weight stays off when the meds are stopped. A hurdle yes, but nothing is straight forward in the NHS. Funding is an issue as is supply.

I have prescribed in exceptional circumstances where weight loss is a prerequisite for life saving surgery. Transplant etc. That I can argue. Weight loss helps long term health conditions and means people come see us less. Trust me we want to prescribe the meds!

7 stone is an amazing weight loss, well done, you must feel much better in yourself.
But if the weight is already creeping back on, will this need to be a lifelong medication for you?

Perhaps this is why the NHS is reluctant to prescribe, it will become unmanageable to keep prescribing.

I was morbidly obese because I ate too much food and did too little exercise. It aggrevated conditions such as sore knees, asthma and high blood pressure.
A lot of people are obese because of other reasons, but it's also true, for lots of us, we need to make better food choices and need help to do that.

If you read her post in full, she explains that she can't be active because she needs hip replacements (I think there is a typo and she means can't instead of can!) and is in a catch-22 whereby the problem with her hips is keeping her inactive and making it impossible for her to lose the weight she needs to lose in order to get the hip replacements. So this seems like a case where maybe the NHS would save money overall giving her the injections until she's able to have the hip surgery and then once her mobility is restored then perhaps she is more likely to maintain the loss rather than becoming more ill and requiring more health care long term.

The NHS spends a lot of money treating complications of obesity, it might well be cheaper overall to prescribe injections as a long term, even lifelong, treatment. Companies are working on pill forms, and patents will expire worldwide so that internationally these meds will become available in cheaper generic forms in a few years time. And they're constantly working on more effective ones too. So I don't think it would be unmanageable for them to become a long term treatment; I think it's likely that will happen.

I'm fat and I don't think this is something that should be funded. Therapy so that people can make better food choices on their own maybe. Not this.

and because of your insight and honestly, you have a MUCH greater chance of keeping off the weight long term

not “all”!!

NO where did i say or allude to “all”

quite the opposite

but daft to deny that some will be. or idly obese because they actively chose to eat loads of shit because they enjoyed it and didn’t like to move beyond sofa to car door

Every single morbidly obese person I know has underlying causes. Every single one. Whether it is genetic, or stems from mental illness (remember there’s also a mental health crisis going on and an NHS that cannot cope), or medication.

Every single morbidly obese person you know has told you this

Where's your evidence for that?

The creon issue is a real problem. I have had a whipple surgery and as a result most people who have this need creon as they have half a pancreas essentially so need help digesting food. I personally don’t as I produce enough still with my remaining pancreas but many people in the support group I’m a member of really struggling to get hold of them and needing to change to a different type. Using a diabetes group for weight loss will cause issues with people who genuinely need it for diabetes so I can see why the NHS are hesitant to provide it given there are supply issues.

Also of course we know that the funding for the NHS doesn’t work on the basis of let’s spend x amount on this patient as data tells us that in the next 10yrs they will develop x problems due to obesity and therefore there’s a saving of Y.

And what if someone like that takes these injections and loses their taste for junk food? What if, while taking it, they become more active and start to feel better? What if, unable to eat greasy burgers because that kind of food makes you sick on Mounjaro, they learn some recipes involving fresh, healthy ingredients and as the weight comes off they decide they prefer to be slimmer and healthier and keep it up?

Within groups, within meet ups, yes.
Are you also suggesting fat people are liars as well?

If you’re morbidly obese you may find that the differences in your body will make it nigh on impossible (and this is backed up by research) to lose weight and maintain based on making better food choices.

In the long run we need to make societal changes which should include removing food corporations input into healthy eating advice (remember the Change4Life campaign that was sponsored by nestle?), teaching children in school how to make healthy food, making healthy food cheaper and more accessible, having more hours of exercise in school, addressing the MH crisis that starts with very young children in school, changing the NHS diet advice which still harks back to the bad and corrupted science of the 1950s which arguably has led to the obesity epidemic both in the US and here.

Blaming people for being obese gets you nowhere, and has been shown repeatedly, doesn’t fix the problem.

I think some people (on this thread!) don't want the problem to be fixed @workingforcunard because all they're interested in is that fat people get punished. It's really important to them that fat people stay fat. They need them that way to keep boosting their own sense of smug superiority - fat people losing weight and keeping it off is actually the worst-case scenario for these people.

Yes I get that impression.

Not liars

but they may not be the most objective person on why they are morbidly obese

Just saying it’s “systemic” is an oversimplification. Some of it is down to that, some is down to people being lazy (physically or in terms of food), some is down to genetics/hormones etc (I’m not going to pretend to know anything about that), some is down to people not caring and “the NHS will fix me”. It’s a very complex issue with a multitude of factors, I’m not arguing with you so I’m not sure what you feel the need to be so defensive. Just blaming systems isn’t the answer…eg I’ve just looked at Tesco and a 4 pack of Mars bars is the same price as a pack of Royal Gala apples, that comes down to a choice. You can’t chalk 50% of the population up as not knowing what a balanced diet is and what isn’t. I agree it’s complex.

Yeah, again you’re assuming we’re idiots and that we have no ability to have insight on our lived experience. It’s rather gaslighty - are you meaning to come across like that?

I mean, you’re in good company as plenty of drs and health workers hold the same attitude.

Thankfully there are many drs who work in this field with years of experience and years of observations who thankfully are excellent advocates for obese people and understand that it’s not simply a matter of choosing not to be obese.

oh man alive

Do you seriously think that not one obese person is obese because they just really bloody enjoy eating shit day in and day out and have no inclination to walk further than to their car

I mean they may well be the minority

but there will be some!!

in fact from this thread alone we know some were obese because of this

why?

because they are open about it!