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.

I have written on here about Dr Robert Kushner who prescribes and researches the jabs. He says science has discovered the body establishes a biological set point that the brain has of where your weight ought to be, namely at the higher weight if you have been overweight for more than just a short amount of time..

He says after dieting or coming off the fat loss injections your body will be fighting to get back to its set point at the previous higher weight through increasing hunger hormones and suppressing satiating hormones. For this reason he believes obesity is a chronic relapsing condition and people need to stay on the injections which he supports.

Tackling obesity can be approached on multiple levels, support and education to try and limit people gaining weight but for those who are obese injections or surgery is probably the only long term option.

I was listening to that podcast last night. Was interesting that he said that obesity could be caused by a hormone issue and these drugs might help with what the body is lacking to support weight loss. Sounds like more research can be done to see why /how these drugs work exactly and why some people are super responders and some don't respond at all. It's very fascinating. If obesity is caused by hormone issues in the body and scientists can figure out what it is, then maybe one day obesity could be cured.

Obesity and such diseases may be linked, but one does not definitely get these diseases if fat.
So, no, you won't die without the drug. However, many diseases will kill you and it's bad enough trying to pay for those without having to fund what many think, is a lefestyle problem

Sorry I just want to check is he saying the hormone issue makes you obese or the hormone makes you want to eat more and eating more makes you obese? The same with medication, does the medication make you obese or make you want to eat more.

I think the way it is being presented can be confusing.

I think he's saying there could be hormone issues that can possibly cause obesity. But does say they don't know yet so more research needs to be done to find out if there are hormone issues. I'm not sure if it makes you eat more or makes you obese. I'll need to listen again and see if it's clearer.

Fat tissue is like a big endocrine gland, it does secrete hormones in all people, not just obese people. Some of these hormones regulate appetite (leptin is the satiety hormone). If you lose a lot of fat, the body makes significantly less leptin so it wants to return to the previous scenario with more leptin onboard. This is a very simplified explanation of course, and leptin is not the only hormone secreted by fat tissue.

Hormones and medication can affect fluid retention and energy balance (some extra weight), but they also increase appetite.

If obesity just happened to people randomly without extra food, the humanity would have solved the problem of malnutrition and starvation overnight. There wouldn't be millions of people starving to death in the twentieth century alone if people in famine or in concentration camps could just get their calories from somewhere without eating.

So whatever contributes to overeating, greed, ignorance, hormones, genetics, it is the overeating that causes the obesity. Is that right?

I don’t see why they’re doing it at all. It’s not difficult to diet, just eat less and move more. I’ve lost 1.5 stone in the last 3 months doing just that. ‘Fat jabs’ are for people wanting a quick fix and it doesn’t change the mindset. It actually makes me quite cross to think of the money being wasted on this when there’s so many underfunded services. Dentistry being a perfect example.

Rest assured, no NHS money is being "wasted" on these injections at the moment. That's rather the point of the whole thread, that they are not being prescribed.

If it was as easy as you say, then why is there an obesity epidemic??

The injections aren't a "quick fix"? How do you think they work - do you think you get an injection and then you lose all the weight overnight?? They take the same amount of time as dieting, but they make it much much more achievable and manageable to stick to. Isn't that a helpful tool?

Yes. I think it’s quite common knowledge everywhere outside threads like this :-)

The jabs work because they decrease appetite.

I have to say, I think weight loss would not only help with physical strain on the NHS but also mental health. I feel so much more driven, confident and happy when slim…
I am struggling to loose weight, yes I know I should live in lettuce, eggs and chicken… but good god it gets boring/depressing … and the extra weight means I am too conscious to go to the gym or other group fitness activities. If I went to the gp’s they’d give me a cheap/free gym membership or a membership to weight watchers etc and I’ve no interest in attending either at the moment… I lived off salad and roast dinners for almost a year and lost -almost 2 stone, then had a total hysterectomy and regained it all 2 months !! It’s utterly depressing how hard it is to loose it and fast it goes on again!

😆🤣😂

Funny how things which happen organically and are cured by medication, are often backed up by science quoted by people who profit from medication...

Dr Michael Mosley, however, discovered a particular diet which not only helps people to lose weight and keep it off, but also can reverse T1 diabetes, and it's freeeeeee. Only problem is, you have to have the willpower.

You're very low on facts, @usernamealreadytaken. Mosley didn't invent the 5:2 diet (or any other). He just publicised it. It was developed by a neuroscientist, Mark Mattson, Michelle Harvie and others.

If it's "so easy" why did you have 1.5 stone to lose?

ObsidianTree , yep they're all miracle drugs until they're not!!!

Dr Mosely’s 5:2 diet and v low calorie blood sugar diet was partly inspired by the the work of Professors Mike Lean and Roy Taylor who studied low calorie diets for putting those who had type 2 diabetes with less than 6 years’ duration into remission known as the DIRECT trials. At 5 year follow up only 13% were still in remission and after the initial substantial weight loss during year 1, the DiRECT intervention group had progressive, but incomplete, weight regain. Of interest the study noted a rise in ghrelin predicted weight regain.

See the attached study graphs charting weight regain.

The study recommended research is needed to establish methods to overcome the physiological adaptations and external factors which drive weight regain. Diabetes U.K. commenting on the five year extension study said. “People living with overweight or obesity on a weight management journey are fighting against their biology and the food environment. Over time, this complex interplay can make it difficult to avoid regaining weight.”

It is clear that willpower alone for the vast majority will not achieve sustained long term weight loss although in this study most did not regain all the weight which is encouraging, Of interest the study concludes:

“Not all people will succeed with purely dietary intervention, but the new and highly effective GLP-1 agonists and related agents offer additional support for weight management if they are affordable.”

I can’t find any study doing long term, a couple of years or more, follow up of the 5:2 diet.

Semantics. It works, long term, is free, and requires personal responsibility.

You only put weight back on if you overeat. It's practically impossible to put weight on if you're not in surplus. Maintaining a healthy diet and a healthy attitude to food should be the goal, not a long-term reliance on medication which can be avoided.

That is not what semantics means, @usernamealreadytaken. It doesn't cover factual errors that reveal the superficiality of your knowledge.

To be honest, I placed an order of MJ myself, privately. I don’t necessarily think the NHS needs to fund it. The truth is, weight loss is as simple as eating in a deficit. Or incorporating more exercise. I don’t think all overweight people necessarily do that. Yes there’s a question of will power but that’s likely a mental health issue and weight loss injections are not addressing the root cause. Again, I’ve placed an order of MJ myself and I used to be skinny so I’ve seen both sides of the coin.

Plus the long term effects of this medication are yet to be established.

No doubt you’d get people who don’t use the medication properly, there’s risk there.

plus you’d get people who refuse to take it.
There would likely be another product that ends up being the next miracle cure anyway. I don’t believe it’s as clear cut as being made out

I expect that the most common long term side effect will be that the drugs will gradually work less and less.

Hunger is key to survival, it’s so important for survival that there are many documented tragic historical cases where people who found themselves in situations of extreme food scarcity turned to kanibalism.
If such a vital survival mechanism could be permanently switched off with a simple drug we would be doomed as a species.

I don’t think the scientists working on these trials are not aware of this, but as long as the drugs are still under patent and expensive it makes sense for the producers to advocate them as a long term solution. Once the patents expire they will probably end up on the same shelf as all the other once miracle drugs.

But you’re ignoring the fact that past a certain BMI the physiology of the body changes, the way the body and brain react changes, which is why most obese people who lose weight will put it back on. Obesity is considered a disease in that in the vast majority of cases weight loss and long term maintenance is very unlikely.

It’s not a long term reliance, but more likely a long term need in order to improve health outcomes, cut costs of obesity related issues, and perhaps inform NHS/education/government of better and more effective ways to prevent obesity in the first place (their methods right now are shit).

Not suitable for people who have had eating disorders - fasting triggers terrible binges in people vulnerable to this from previous history. But BED sufferers have been approved for Mounjaro and given that time to live free from the disordered, destructive, unconquerable compulsion to harm themselves via bingeing. I've tried to avoid making this discussion about 'worthy obese' and 'unworthy obese' because I think that attitude is abhorrent, but in this case I really need to tell you that 5:2 and other fasting diets can be incredibly dangerous to certain people, and BED is not uncommon among obese people though it is an eating disorder that is associated with great shame and secrecy and not always recognised so I wouldn't be surprised if it was under-reported. Time on weight loss injections can give sufferers a chance to address the disorder while not in the grip of it. And the injections don't kill appetite entirely, though initial stages of each dose can. As the body adjusts to the medication, users feel hungry but at appropriate times and to a lesser degree. So people can eat a normal, healthy diet of good food while taking them as opposed to a crash diet which destroys the metabolism.