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.

There are lots of conditions that require lifelong medication.
Anecdotally there are those who take injections and there is a longer lasting effect. Statistically if an obese person diets they will put the weight back on and more. Just pointing out again that this is not because of laziness and greediness, it’s because of physiological differences causing the brain and body to react in a way that doesn’t happen with a person who only needs to lose a few pounds.

This, of course, doesn't apply to those with actual medical conditions that retain weight and fluid.

Being obese is an actual medical condition, and very often caused by a medical condition.

Every obese person I know has got to that point through mental illness, chronic illness and/or the medication they were prescribed. There’s an emerging theory I read that certain medications change your gut biome which has a huge effect on weight and cravings.

Obviously there are people who have, for whatever reason, eaten too much, but I’d argue that mentally and physically healthy people don’t do that, and it’s far too easy to blame people for being obese, when by that point the physiological changes within their bodies means it’s almost certainly going to need treatment of some sort to overcome.

Op i think your post is such an interesting one and really valid.

I suppose though moaning about going to these workshops and saying you know all of this....yet didnt apply any of these practices into you own diet is a bit laughable really.

I was overweight, actually have been all my life until fairly recently i took control, whilst i would ive claimed to know whats healthy and whats not it appeared i hadn't fully realized the sheer amount of calories i had been consuming.

An example would be mayo, switching from full fat to low fat and actually weighing it out makes you fully realize what your eating and consuming, perhaps these workshops are there not only to teach about calories and protein but to try and get you to hold some accountability.

I do wonder if its made easier will then people hold zero accountability for their diet/lifestyle and rely on this.

The only put weight back on if they overeat. The problem with dieting or magic pills or injections is that people still don't take responsibility for behaving in a normal and healthy way.

I really don't know why I'm bothering to come back because people don't want to understand. But I'll try one more time and say:

Choosing to take these injections and accept the risks and the unpleasant side effects that accompany them IS taking responsibility for behaving in a normal and healthy way. Because yet again I'll say - taking these injections ONLY works alongside a healthy diet and calorie deficit. It is not possible for people on these injections to continue with previous unhealthy choices. Doing so while taking them would make you very sick.

Therefore, people on the injections can experience several months eating a healthy diet of small portions - long enough to embed good habits for coming off the injections.

The injections are NOT MAGIC. They are a tool to help people lose weight because losing weight is very hard and becomes much harder once obese because of physiological changes within the body.

Choosing to take medication to improve your health is not a cop-out.

I realise that there are enough people utterly blinded by prejudice and misinformation about obesity who will refuse to understand what I'm saying but I'm hoping maybe some of you will finally get it.

@StilettosForMiles thanks for that extremely clear explanation, hopefully it will be of benefit to plenty of people reading this thread.

Something tells me it won't get through!

OK that has made my day and I might now hide the thread so I don't have to see what ignorant, hateful bile gets posted by others. Thanks!

I almost started a thread about this a while ago because I completely agree. I recently spoke to my GP about it, who wanted to give it to me but of course, couldn't. He had seen it work wonders on family members, he actually told me to go for it privately - aka buy it myself.

I think the NHS need to weigh up (intended pun) the cost of an obese individual vs paying for weightloss jabs, I'll bet my bottom dollar that the latter is much, much cheaper.

I'm fat and my knees hurt, I get sciatica, have gallbladder issues, depression, and I'm pre diabetic. I'm doing something about it by using MJ but I have to pay privately for it, which is OK for me but not everyone can afford this.

Just think of the conditions and illnesses that could be avoided completely, lessened, reversed or made managable, back/hip/knee problems, diabetes, heart disease, liver disease, cancer.

And I've tried traditional dieting, many times in different guises in the past 20+ years, MJ is like a switch turning off a lifelong food obsession and that, frankly, is what most obese people need.

People make judgments about weight far more than they do pretty much anything else.

Yes it's important to mention the other benefits Mounjaro has apart from weight loss and helping diabetics etc. More findings from America as they have had access to it for longer, but it's helping people with addiction issues, reducing fatty liver, reducing inflammation, helping autoimmune conditions etc. Someone has reported its helped with her fibromyalgia and her thyroid problem hashimoto has been going into remission. The benefits seem to go way beyond just weight loss. It is a miracle drug. People might not want to believe that, but long term, more and more evidence is coming out that it is.

The injections are a diet. Diets don't work long term.

So you're saying all fat people are doomed to fail long term regardless of what method they use?

It isn't licensed for weight loss so that's why. Eli Lilly are releasing anew version soon that is licenced just for weight loss

However it's very expensive. All new drugs are so the nhs are likely to still make you jump through hoops.

They help to make diet more achievably effective.

Diets alone statistically don’t work, but then we’re in a crappy situation where those of us who are obese are damned if we don’t try to diet, damned if we do, and double damned if we take a medication that not only helps us but helps other health aspects!

Yes it is. Both mounjaro and wegovy are licenced for weight loss. They were both first designed for diabetics but the side effects of weight loss is the reason they can be used for obesity also.

As a bit of background, I am a dietician (although now for cancer not obesity) and I have a job based in the ICB (commissioning).

The main reasons for blocks are that a) there is no money, the NHS simply cannot afford it. B) there is limited evidence of long term benefit, so it is excellent for things such as rehabilitation to reduce risk prior to an operation for example, but to invest so much into it for people with obesity or diabetes is still lacking in evidence to be cost effective long term, and im afraid everything comes down to money these days. C) There is also a significant number of risk adverse individuals, conscious that people who are border line can stop eating altogether and then develop other issues, but we do not have the capacity or funding to review these patients.

As an aside note, your experience of tier 3 is not what a tier 3 should be, although the long waits to be seen is sadly a state of the nation right now.

Good luck!

I never really get to the bottom of why, on threads about injectables, some posters are so invested in them not working, not being good for all the things that they are proven to be good for, not being great tool to help people become a healthier weight. It's so bizarre!

I'd rather follow what doctors and scientists say than randos on the internet.

The NHS picks up the tab for obesity related diseases anyway. If prescribing medicines that actually seem to work reduces pressure on the system and saves the NHS money, why not?

Exactly @Pussycat22

Show me where I said it was easy?

I have an ND child, have my own health issues, can't work full time and rely on benefits. Our household budget is small, my ex was an unsupportive abusive dickhead. I also struggle with food issues, and emotional eating, and gain weight very easily. But I work on making healthy choices and prioritise healthy food in my grocery shopping. The reason I'm not more overweight is because i know it's ultimately my responsibility because I'm the one that puts the food in my house and in my mouth. But it's not easy.

As a population we need to acknowledge the real issue, and then the NHS needs to be funded to tackle it, with proper mental health support, not with short term solutions like injections.