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.

brace yourself 😆

That poster doesn't need to brace themselves, they've solved the obesity problem. If only someone had thought of promoting salad before, all this could be avoided. I'd suggest we get rid of all support and treatment to help people lose weight and just shout abuse at the lazy fuckers in the McDonald's drive-thru, job done.

Probably because people would gorge themselves, and then just get a monthly jab. If there's one thing humans do well, it's excess

maybe mental health specialists and wegovy prescribers should attend the long macd queues?

The jabs are weekly.

It's not possible to 'gorge' yourself while taking them. That would make users very ill and it also wouldn't work to help them lose weight. They are powerful appetite suppressants and change people's tastes. They also come with significant side effects that can commonly include nausea, diarrhoea and vomiting so no, people will not be bingeing or eating junk food while taking them - it's physically impossible on the right dose.

Is this the problem, that people have so little understanding of how the jabs work that they somehow think they melt fat off people's bodies without any change in their diets?

I don’t agree with excusing away personal responsibility and accountability. It’s about the only thing that works long term.

Could you share the evidence for that please?
So far the articles I’ve read show overwhelmingly that dieting doesn’t work long term, whether those partaking are being accountable (which most are, using groups of some sort) and taking personal responsibility (which they are as they are dieting).

One of my friends is a recovering alcoholic, has been sober for longer than I’ve known her. She regularly points out that her battle with obesity has been far more difficult to tackle than her alcoholism because she could stop drinking alcohol completely and change her patterns of behaviour around her drinking. You still need to
eat though so it’s impossible to completely change the habits that lead to binge eating (a known and diagnosed eating disorder, in her case that and alcoholism stemmed from abuse as a child).

@StilettosForMiles has posted about how the injections work, yet some are still coming back to play the superiority shame game. @persistentyes you seem to have come back twice as mean because someone else has piled on with the same derisive attitude. You’ve admitted you’ve no skin in the game, you clearly
don't understand, so why keep coming back? It really looks like you’re trying your best to fat shame people who are trying their hardest to explain it. It’s weird.

Yes. I meant GPs shouldn't be prescribing for obesity in those without DM.

fair point

back to the gardening

"dieting doesn’t work long term" - seems to work for most of the people who aren't obese.

"They also come with significant side effects that can commonly include nausea, diarrhoea and vomiting so no, people will not be bingeing or eating junk food while taking them - it's physically impossible on the right dose."

If the side effects of being on the injections are so severe, then surely they will lead to their own health issues in the long term which will be equally bad, if not worse, than the obesity itself?

@usernamealreadytaken are you suggesting that people who aren't obese are permanently dieting? So always in a calorie deficit? Seems unlikely to me.

People who suffer severely do quit the injections, but for most people the side effects settle down or don't occur - unless the user binges or eats a lot of greasy/fatty foods. Overeating junk food would, for most users, bring on unpleasant side effects.

But largely, from my understanding, the trade-off is worth it in terms of risk/benefit for obese people and the drugs seem to switch off cravings to binge or eat junk. So people taking them for several months will experience eating a healthy diet and establish good habits and choices in that time.

It's certainly not the case that anyone could take the jabs, overeat junk and magically lose weight. The jabs work to change a person's tastes, appetite and eating habits. People wouldn't lose weight on them if they somehow managed to override the drug's effect and eat too much.

I think it's quite telling @workingforcunard that the persistent poster leaves the thread whenever there are thoughtful arguments posted that she's incapable of refuting, but I'm sure she'll hop back on to cheer on anyone else who wants to abuse fat people.

They’re not dieting, they’re eating normally.
See also many posts explaining how obesity, often triggered by mental issues, actually changes the phsiology of the body, so you can’t lose weight in the same way.

In the 15-20 years they’ve been used I haven’t found anything to suggest this.

This is part of the issue. Dieting is what we have to do our whole lives, but some people see it as an abnormal restriction - it's not, it's a full time every day restriction so we don't get obese. Diet is what we eat, all the time, it is normal. Unfortunately those who overeat have to eat less and call it dieting, when it's really just trying to eat a normal diet again. My diet consists of food; sometimes more, sometimes less, but it's still all diet. I could easily overeat every day; I love food and I have developed a taste for foods which would make me very overweight if I didn't restrict them, so I'm eating less than I want, most days.

And you resent anyone who has struggled to achieve that for whatever reason getting any help and support in resetting their approach to food?

And just today, reports of trials underway that suggest these drugs might also help treat Alzheimers. So more reason to celebrate their development.

https://www.theguardian.com/society/article/2024/jul/30/liraglutide-alzheimers-cognitive-decline

@usernamealreadytaken so to be clear, you're not suggesting that everyone who is not obese is permanently in a calorie deficit? What is the point of weasel words about the dual meaning of the word "diet"?!

You seem to be quoting my post, which was about alcoholics, or about comparing other addiction to overeating.

There’s quite a lot of research into the AA model which exists since 1935. It’s much more successful than other interventions in all its variants, including the more secular ones, and basically everything evolves around accountability. The meetings, the sponsor model when you are first accountable to a sponsor and then become a role model to a sponsee (even more personal responsibility).

So yes what I said holds, accountability and personal responsibility is about the only thing that has been proven to work long term.

But when people, for whatever reason, reach a certain BMI they literally cannot lose weight in the same way. This has been researched. The way our hormones work is different. Our mental and physical responses are different.

And please don’t come back at me with “personal responsibility” and that we shouldn’t be fat in the first place. Shit happens, life happens, people, lots of them, get fat. In case you missed it before - addictive cheap food, crap diet advice (low fat high carb which may actually be responsible for the growing levels of obesity), busier lives, more MH issues, medications (loads of different ones - in my case steroids) are known to cause weight gain. But it’s still a case of beat the fat people so they know how crap they are - but this method isn’t working.

What is difficult to understand is why when this is all known there are still people gleefully jumping in to make sure fat people feel even more shit about themselves.
Someone else being obese does not hurt you. An obese person reaching a healthy weight with added benefits (reversing/preventing diabetes, less heart disease) will not only help them but may help the NHS. Why do you have such a problem with it?

It's interesting that the Overeaters Anonymous model has been much more limited in its success than Alcoholics Anonymous. Their twelve step plan for Overeaters has been criticised for triggering bingeing behaviours from what I've read, though I don't think there's a huge amount of research into it. Maybe that kind of accountability somehow, for some reason, works better for alcoholics than overeaters? I don't know how Narcotics Anonymous compares to either. It would be interesting to know if the model of personal responsibility and accountability exemplified by AA does translate into other addictive/compulsive behaviours.

My DH was obese before I met him. I saw photos, he lost around 40% of his body weight. He lost weight and has been slim for the last twenty years, I met him in 2006 when he was slim, and he has been more or less the same weight since. So he’s one of the 10% of people who managed to lose weight long term.
He:

• never eats three courses in a restaurant, usually a main followed with a cup of espresso
• never eats a whole pizza by himself, usually a half
• buys 1 small treat every Saturday (kinder bueno usually) and makes a huge effort for some relaxing me time to eat it with a cup of coffee
• never snacks in front of tv
• when drinking he really watches his intake and never gets drunk
• doesn’t buy snacks to stash in the house
• never drinks fizzy drinks, but religiously puts half a spoon of sugar in his coffee

Does these look like dieting? I don’t think so, these are normal eating habits. He doesn’t come across as a person who watches his food intake constantly. I don’t think he’s a freak of nature, doesn’t have good genes either - both parents obese and some of his siblings are diabetic.

@CortieTat what's the relevance of your long post, which seems to just be agreeing with me that people who are not obese, or no longer obese on a long term basis, are not permanently in a calorie deficit?

My apologies, I should’ve been more explicit. He had to change his eating habits permanently, and there’s no going back to the previous eating habits.

I wouldn’t call this a diet but he is exercising moderation every day, so I agree with the PP you challenged.