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.

@persistentyes it won’t let me quote you for some reason

No the majority of people aren’t that much of a tw*t that they’d comment on my weight. However I did received good feedback from clients who knew I was very qualified to do my job but pleased I also understood how they felt being overweight. They used to see slimmer nutritionists and feel judged or silly when they spoke about their eating habits. Your comments are just confirming their concerns were justified.

Absolutely and these injections and tablets are available. Still the success is heavily dependent on personal responsibility. The whole AA is based accountability, first for yourself and also for another person as a sponsor. I have several alcoholics in my extended family who have been sober for years. The amount of willpower, personal growth and lifestyle changes required is enormous.

Well at the moment, the drugs available to treat alcoholics and addicts aren't very good. They might get more effective - the research into tirzepatide might actually help this - and work better. Would you think this is a bad or good thing?

A lot of obese people get there through years of yo-yo dieting. Immense willpower and effort to change habits and lifestyle to lose weight only to relapse and regain. Because your body and brain strive to reach that high weight again. They send intense hunger signals and switch off satiety signals to try to gain it back - it's a primal survival instinct that has been distorted by dieting and weight gain and so it gets worse and worse. A great predictor of a person being overweight or obese is if they have dieted.

If someone uses medication to try to correct what the body is doing wrong, it doesn't make them less worthy, and maintaining weight loss will always require effort, willpower and hard work too. I think anything that helps someone to be more successful with that has got to be a good thing.

It seems vitally important to you to insist that some people are obese due to laziness and greed - why is that?

It is important surely if the issue is to be addressed fully.

How does repeatedly telling people they are lazy and greedy help them?

who said telling people that repeatedly ?

but as has been identified on this very thread… some were obese because of the above

and with acceptance can perhaps lead to an understanding of how to be addressed ie mental health support not necessary but maybe free gym membership and nutritional advice.

different causes have different remedies

but if you aren’t willing to accept one type of cause… then no chance of long term resolution

But what if laziness and greed can be helped by injections as I've asked you quite a few times?

I don't really care if someone is obese because they're lazy and greedy, or if it's because they live in poverty, or if it's due to trauma, or if it's a result of medication - the point is, can we find ways to help people in all categories to reverse obesity and improve public health?

It seems that all you're interested in is moral judgements, rather than practical strategies. Unfortunately, while I do believe there are strategies to help people overcome laziness and greed I'm not so sure anyone has come up with a way to treat spite and ignorance so I guess there's no help for you, @persistentyes

because i think that’s just throwing up hands and saying…. let’s spend a fortune on medicating.

Look we will have to agree to disagree

I have no skin in the game so i’ll bow out

It's not a cause though, is it. Why are people lazy or greedy? How did they get that way, is it just around food, or are they lazy/greedy in all aspects of their lives? If you give them a gym membership and nutritional advice, why would they go to the gym and why would they follow the nutritional advice? They're lazy and greedy!

Prices will go down as patents expire and pill versions are developed.

The NHS spends a lot on obesity right now, so if injections can reduce that burden they will save money.

Injections are not 'giving up' or 'taking the easy way out'. They still require effort from patients. But they are increasing people's chances of success, far more than the already available gym membership and nutritional advice that has been handed out for years - all while obesity rates rocket. We need something else - I'm so sorry for you that what we need isn't shame and judgement as clearly that's the strategy you favour. Unfortunately, it doesn't work, so try not to be so bitter about other interventions which might.

I think it’s the same with alcoholics, there are many relapses and some people never get sober.

I would absolutely support a drug that works better than the current ones for alcoholism, but at the same time I don’t agree with excusing away personal responsibility and accountability. It’s about the only thing that works long term.

I am not against weight loss drugs, quite the opposite. I just think the combination of weight loss drugs with denial and lack of personal responsibility is not going to work long term. This includes taking these drugs for a long time (lifetime). I think our bodies can adapt and the hunger cues would eventually return, because our survival depends on feeling hungry.

I think we agree then - to be clear, I don't view the injections as denying personal responsibility though, I think taking the injections is a step of personal responsibility - taking a medication that requires significant changes to your life and comes with risks and side effects is not an abdication of responsibility at all.

Well I'm pretty confident that they will soon be widely available and more affordable and many brands/types that will be used by people similarly to statins and blood pressure medication. Pills rather than injectables. Taken long term and for preventative treatment. And the dosing will be smarter to allow for that.

Although I can see pushback from the fast food and dieting industries. Dieting industry is huge and relies on people falling.

Mind you if the dieting industry relies on people falling then, surely, that doesn't apply to the NHS diet & healthy eating programmes.

Tirzapetide (Mounjaro) is not yet approved by NICE for obesity in those who aren't diabetic, guideline expected in Oct 2024 and will almost certainly be the same as the others, only tier 3 if company provides it as per agreed commercial arrangement, Likely to be at least yellow if not red in primary care in most areas for this indication - in theory, meds management could claw back the cost from individual GPs.

not approved by NICE for use in primary care - when guidelinen comes out in October it will almost certainly say tier 3 clinic only.

Yes I agree. And I think the current system where all the weight loss drugs trials were combined with behavioural interventions is how it’s supposed to be. Handing out injections without any support available is not such a great idea.
In my country the support from the healthcare system is minimal, you can have a meeting with dietitian and that’s about it.

That’s for weight loss and obesity. Already approved by NIce and GP’s can prescribe for type 2 diabetes and already starting to

How is an injection going to cure the addiction or poverty issues though? I get there's a possibility that it might help improve some mental health issues, but OP admits they put on 2st while waiting for appointments - when she already knew she was obese. If people can't take some personal responsibility sometimes, then a miracle injection will just be another expensive short-term solution.

Well, now. How very unique your area is. Where exactly is it?

Just to say again:
Taking the injections is not denying personal responsibility. Taking the injections is a step of personal responsibility - taking a medication that requires significant changes to your life and comes with risks and side effects is not an abdication of responsibility at all.

And no injection can cure poverty, nor can any other weight loss strategy even your magical 'Taking personal responsibility' which most obese people have done many times as being on a diet is a high predictor of future obesity eg people have tried and failed often numerous times.

Poverty and obesity are highly correlated in the UK and that needs to be a government strategy. We can't let perfect be the enemy of the good - let's try to help reduce obesity where we can, how we can.

OP put on two stone in a little over a year, waiting for somebody to stop them from putting on weight. A magic injection isn't going to cure that.

So you are someone who doesn't understand the physiology and psychology of weight gain in people who are obese. Obesity is now acknowledged as a multifactorial disease; it's complex and once someone is obese then their body manages appetite, energy and weight in a dysfunctional way. Obviously, the ideal is never to become obese and to stay in a weight field in which your body functions normally and is not damaged, and that is where willpower and good choices really have an effect. Once obese, very likely with a long-term history of diets, weight loss and rebound that has seen your weight climb steadily upwards over years, it is very unlikely that people can reverse that which is where gastric surgery has been such a game changer.

The injections are not magic. They are not easy. What they do is allow people to successfully change their habits and break cycles of bingeing. Ill-informed people seem to imagine taking the injections to be an entirely passive act - that people are given it and then carry on with their lives just the same as always but the weight falls off without them doing anything. That's not how they work. They cut out the cravings and give people an experience of success when most obese people have encountered repeated and exhausting failure for most of their lives. The injections can restore a sense of control and stability and enable people to embed good habits and good choices over the course of months/years while they're taking them - and hopefully give people a good base for coming off them, or else perhaps be modified so that some people will take some form of them forever.

Imagine a future where obesity doesn't progress the way it does at the moment. You can lecture people about personal responsibility all you like, but these drugs might actually work to change people's lives for the better and that seems like a very good thing.

It seems that the attitudes of many posters on this thread are reflective of general attitudes in society. The NHS should act like a medieval church, deciding who is or is not worthy of a pardon for their obesity, from a purely moral standpoint. Some people's road to obesity is innocent and blameless, while others are greedy and lazy and need to do their fucking penance and stop being cry babies.

Imagine a future where obesity doesn't progress the way it does at the moment. You can lecture people about personal responsibility all you like, but these drugs might actually work to change people's lives for the better and that seems like a very good thing

100% disagree.

People should learn some self control, stop being such lemmings and expecting the rest of us to pay for your troughing.

Just walked past a drive through Macd's, must be 150 cars queuing, FFS go to supermarket and by some fucking salad, healthier and quicker.