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.

One of the big external factors in Japan is very low social acceptance for obesity. Under the Metabo Law employers and the public sector are responsible for monitoring health of the employees/local population and take action when someone is at risk of the metabolic disease.

Given the level of denial of the link between personal food choices and weight on every thread like this, I don’t think the Japanese model would be warmly received in the UK.

I am a registered nutritionist who had weightloss surgery because I was morbidly obese. I knew every single mouthful of food, everytime I didn’t go for that walk, everytime I ate until I was bursting was contributing to my obesity. Could I stop? Nope. I knew what UPFs were doing to my guts and my brain. I knew that I was making wrong choices. But I was still fat. Sorry but I was fat. I had a degree in nutritional biochemistry and a masters in nutrition but I was fat.

As a weightloss professional I chose weightloss surgery to physically help me to lose weight. However, I think we need to be very careful prescribing surgery or weightloss jabs on the nhs. These methods are NOT permanent and need to be treated as such. A person needs to be very educated on how these aids (and that’s what they are, aids not cures) can help them with a LOT of will power and commitment. The NHS can not fund these jabs forever as well as the counselling I feel needs to go alongside them. As soon as the jabs are stopped most people will put weight back on if they are not careful, same with surgery. Which is a waste of money.

Obesity is a very complex disease. And whilst I agree we need to stop treating it differently to any other disease I also think we need to be careful and realistic with our approach to tackling it.

were you a registered nutritionist with patients when you were morbidly obese pre surgery?

As a weightloss professional I chose weightloss surgery to physically help me to lose weight.

I mean you do see how that reads don’t you?

Yes I was. I was advising people on how to prevent diabetes and I was going home and eating dominos. I was harming myself physically whilst trying to help other people.

did no one ever say or make a joke “why are you morbidly obese?”

That’s not all I’m saying though. In my experience most very obese people have underlying issues. I don’t know one person who’s got to 40+ BMI simply by eating too much. Of course eating too much is a major part of it for many, but it’s what causes this in the first place, what other factors are present.

To my main point though: Once past a certain BMI our physiology changes, the way our bodies and brains react is different.
Past that point it’s very unlikely, whatever the cause, that we can successfully lose weight and maintain it - because of the physiological changes, not because we’re stupid. Studies back this up. Yet so many people insist on carrying on beating us with the shitty “greedy and lazy” stick despite there being the information out there that proves that’s not the case.

You presumably were used to people doing s but if a double take when you said you were a registered nutritionist?

@persistentyes you’re coming across as unnecessarily nasty right now.

oh i hope not and sorry if i am

So many on this thread want the overweight punished more than they want a healthy society

All that matters is that obesity and all the related conditions are conquered

Once past a certain BMI our physiology changes, the way our bodies and brains react is different.
Past that point it’s very unlikely, whatever the cause, that we can successfully lose weight and maintain it - because of the physiological changes, not because we’re stupid.

Where does that point start, between say a size 8 and a size 30 or whatever other range? And where does personal responsibility sit before that point?

Well of course you are, and deliberately so - it's extremely disingenuous to pretend otherwise.

It seems vitally important to you to insist that some people are obese due to laziness and greed - why is that? Does that make people more or less deserving of these injections in your opinion? I asked you earlier, what if if was the case that a person in that situation took the jabs and found themselves unable to eat junk and so learned healthy recipes and developed a taste for nutritious food? What if their improved diet gave them more energy and they became more active? What if these jabs could actually help people to conquer greed and laziness? Is that still a problem for you?

You just need to read the threads here to see that people taking these injections frequently are discovering they don't enjoy chocolate or greasy food or pizza etc while taking them. It's not just an appetite suppressant, but it's actually - for a significant number of people, not all of course - changing their tastes and their mindset.

Someone experiencing that may revert once off the injections, but I don't think we can dismiss the effect of several months of healthy eating. There will be people who learn that they like this kind of diet, that they enjoy how it makes them feel and that their other health issues are improved by the lifestyle they experience on the medication. That could really help to keep someone motivated to continue.

But you only seem interested in asserting that greedy, lazy, fat people don't deserve any help or any compassion. You don't think they deserve a job as a nutritionist because you can't accept that they can understand and in fact be extremely well informed and qualified in how to lose weight and be healthy but still be unable to put it into practice themselves. It doesn't mean that poster couldn't help other people, she just couldn't help herself. The injections are a tool by which she can help herself - why do you hate that fact so much?

Great post 👏

I can’t remember the BMI, but if memory serves it’s beyond 35, but I imagine it’s an individual thing.

In regards to personal responsibility, that can happen any time, but let’s take into account the deliberate addictiveness of certain foods - literally designed to make humans want more and more - not everyone is susceptible I imagine, just like not everyone has the propensity to be an alcoholic. The way humans are evolved behaviourally means that the response for some with food would have kept us alive once upon a time, but those instincts now and adrenaline response are impossible to change without help, and (as I’ve been saying) the other circumstances around many cases of obesity which limit our power in controlling it - the mental
illness, the medications known to cause weight gain but often underestimated (particularly once the patient has gained weight).

Let’s also consider the personal responsibility around alcohol, smoking, certain sports, taking drugs, driving, and other risky things. None of these things are treated with the same disdain as obesity when they require costly NHS treatment. Alcohol and drug addicts are usually treated with respect as it’s known that addiction doesn’t just come from nowhere. Food addiction isn’t really that different, in terms of the effects on the brain.

We all have personal responsibilities, but at the moment society is actively pushing more people to being obese. There is more diabetes than ever before, and the societal causes need to be addressed, changing this and preventing obesity in the first place is ideal (start young, food and budgeting lessons from a young age, changing how we eat, stop pushing cereal as a healthy start for children - my dc breakfast club only offered sugary cereals as an option, and that’s how it starts - get them addicted young!), and offering safe ways for people to help manage their weight, which would in turn make the nation healthier. This can all be done for the good of everyone without beating obese people so much for being obese.

@WorkingForCunard What an insightful post. Thank you very much for sharing all that.

Well, what if someone has neglected to take personal responsibility for themselves and ended up in a mess? Do they not deserve any help? Should we just berate them for their poor choices forever?

Do we have to carry out an assessment on every obese person to decide of they are 'worthy obese' or 'shameful degenerate' before we agree to treat them? If found to be insufficiently responsible and without a good enough excuse for their weight, do we just sneer and judge and withhold any help? The 'good obese' can have medical treatment, but the feckless can be denied it?

I feel like that would be more of a waste of NHS resources than just prescribing the drugs, honestly.

I've been thinking for a while now that on these threads you always get people saying "losing weight shouldn't be easy" and everyone nods along in agreement.

But why? Why shouldn't weight loss be easy if it is safe and possible?

It's just endless shame/punishment/guilt messages.

In what version of reality are alcoholics and drug addicts not treated like shameful degenerates?

There’s help available but the significance of personal responsibility in getting sober and clean is enormous and the common advice is focused on things like accountability and admitting to having a problem. All groups helping recovering alcoholics and drug addicts evolve around accountability.

Overeating is about the only harmful behaviour where denial and external circumstances such as poor MH, stressful lifestyle etc are perfectly socially acceptable.

Well, exactly, I agree. There are a lot of wildly unqualified and ill-informed people who ascribe a moral worth to weight and cannot bear the idea that anyone might get to skip a gruelling penance for the sin of being obese (ignoring the fact that the injections are not, as so often asserted, the 'easy option' - easier, yes but easy no).

Someone like @persistentyes gleefully anticipates a future whereby fat people who use the injections have not only regained all the weight and more but are also suffering terrible unforseen consequences of the medication so that she can say 'I told you so' and reaffirm her belief that fat people are lazy, stupid and undeserving.

Someone like that can't bear to contemplate the alternative future whereby fat people successfully lose weight. Where the drugs are developed and improved, the prices come down and the NHS is relieved of the burden of rapidly increasing diabetes and other expensive comorbidities. Where people learn healthier habits on the jabs and pass these on to their children. That's a possibility here, but if it doesn't involve maximum pain and suffering for the obese then some people don't want it.

I think it should be made as easy as possible! The problem is these drugs are at the moment a significant cost and the evidence suggests that the weight is regained after they are stopped. If they were the same price as for instance statins, the regain would not be a problem.

I agree with you @cortietat that drug addicts and alcoholics are not treated with respect either and that their treatment comes with a lot of judgement and disapproval.

Obesity is strongly correlated to poverty though in the UK and I think a lot of the sneering at the obese on here is about class snobbery. It's about poor people being thick and lazy and disgusting more than anything else - if anyone is actually interested in public health and improved NHS outcomes, they would welcome medical developments in combating and reversing obesity.

And the drug prices will come down as patents expire in the next few years.

But if there was an injection or a pill that would help alcoholics and drug addicts to recover, I’d like to think it would be made available to them. Personally, I’d be all for that. I mean, who wouldn’t?

Funnily enough there is speculation that the weight loss injections could help with reducing addictive behaviour and actually be useful to treat alcoholics and drug addicts at some point - imagine if the reviled fat jabs had even more beneficial effects for other groups, how would the naysayers cope?!