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.

Did you not read the bit about it saving the NHS money in the long term?

It's so easy to judge. I eat less than my aunt, she's a size 10 and I am a size 18.She hasn't got a concept of healthy eating because she can literally eat what she wants and never gains weight. It's not just about healthy eating and exercise. I exercise for at least an hour every day, I eat sourdough bread and lentil pasta most days. I never eat takeaways or biscuits or cakes. I never fry my food. I am only eating lunch and dinner and I am losing weight very very slowly. But it's been a complete lifestyle change for me since I was told I was prediabetic. The medication sounds good but personally I'm not keen on the idea for myself. I have doubts due to the side effects and the rebound effect afterwards. I definitely wouldn't want to be on something like this permanently. I think it's mean spirited of you to make a statement like that. A lot of slim people eat really badly.

I've been doing it for six months and have only lost about half a stone, if that. Get off your moral high ground it doesn't mean that if something works for you it will work for everyone.

I understand your pov, but if your aunt is "eating what she likes" she is still eating an amount which is around or under her calorific need, or she would put on weight. If you are/were eating less and still putting on weight, then you are/were likely eating calorie-rich food, and more than your body needs. I'm a size 10 and often eat huge portions, fried food and takeaways, but it's balanced with healthier eating and I suspect this would be similar for your aunt, but you're probably not there to see that.

Good to hear you're losing weight, albeit more slowly than you'd maybe like. It's the long-term changes we need to make to lose weight and keep it off that I worry about with the "magic" injections. BTW, bread and pasta are generally seen as simple carbs which cause high blood sugar and make weight gain more likely, unless they are wholemeal.

I'm sorry you think my comment was mean-spirited; I see it more as a generally accepted fact. Lots of people don't like facts these days. It's a fact that, with a very few actual medical exceptions, you only get fat by either overeating, not using the calories you are eating (not enough movement), or a combination of both. The underlying issues leading to both of those things are debatable, but that's the crux of it.

Get off your moral high ground it doesn't mean that if something works for you it will work for everyone.

This is so true. I think recognising that different approaches work for different people is the key. My youngest son has Crohn's Disease. He was put on a temporary liquid diet, followed by a biologic over a year ago and it has worked brilliantly. Other people have had to try numerous biologics, steroids and other medications to find the right fit. Some couldn't manage the liquid diet and needed to be tube fed. Because people's physiological make up is different. People's brains are different. Eat less move more is a seemingly simple solution and it works for some people. Why does that mean that those for whom it doesn't work are failures or somehow lacking in willpower? It's ridiculous.

Mounjaro is known to cause clinically significant loss of muscle mass. Of course it’s easy to drop weight when you are losing muscle 🤦‍♀️. This will lead to people becoming more predisposed to things like cardiovascular disease. Not a good idea.

@3CustardCreams is the muscle loss greater than what would happen on calorie calorie-controlled diet or through bariatric surgery? Is the increased risk of cardiovascular disease shown through the clinical trials of semaglutide and tirzepatide? Is the increased risk of cardiovascular disease higher than the risk of cardiovascular disease caused by remaining obese, particularly morbidly obese?

Yes the mounjaro muscle loss is greater than what would be expected from calorie controlled diet/bariatric surgery. Clinical trials on semaglutide and ?tirzepatide for weight loss are not extensive at this point in time.

@3CustardCreams that's very interesting, can you tell me where you've found this information from?

Are the SURMOUNT trials for tirzepatide not considered extensive?

So which trials are you getting your unique muscle loss data from?

GPs just haven't got the time to see every obese patient in the country and prescribe these jabs. I don't think obese people should be prioritised over everyone else. There is also the cost of the jabs themselves. We don't know that they will save the NHS money in the long term- there needs to be more research before they know that.

The surmount trials are incredibly new. They also show that one’s body becomes tolerant to the drug so you’d surely have to keep increasing the dose. And also that effects stop as soon as you stop it, so people would have to take it for life? No these are no extensive trials. And the results so far raise a lot of questions.

No one is suggesting that GPs see every obese patient. What would happen if the NHS decided to prescribe injections as a tier 1 response, would be at most contacting patients who are recorded as obese on their systems and offering them treatment. More likely, they would probably just wait until obese people individually asked for weight loss help.

It sounds like you think obese people don't deserve the same consideration as other people, to make a GP appointment about their own health.

@3CustardCreams you're dismissing all four SURMOUNT trials as not sufficiently extensive? Ok.

Yes 4 is not a lot. Compare 4 to how extensively something like metformin has been studied. Ok

@3CustardCreams you're not comparing like with like as metformin was discovered in the 40s.

Is it the scale of the surmount trials that you have an issue with, or the fact that there have not been enough of them? Why do you think that the various health safety bodies in the US, UK and so on have been satisfied with the extent of the research and trials where you think it's inadequate?

I don't know if anyone is suggesting that they see every obese patient but this thread is about why they aren't seeing a lot more isn't it? According to NHS England calculations, around 2.8 million patients would be eligible for tirzepatide as the recommendations currently stood. If everyone came forward and 70% of those were started on treatment around 18% of GP appointments would be taken up just initiating and managing the medicine.

There needs to be an increase in weight management services but it is going to have to happen gradually and be properly assessed so that we know that this will keep peoples weight down and improve their health long term.

My point is that she has a high metabolism and her ex husband used to call her Horse because she ate so much. I know about bread and pasta which is why I eat sourdough and lentil. They have the lowest carb content of any bread or pasta. I literally couldn't eat less than I do now, as the only time I am not hungry is about two hours after lunch and again after dinner. I started gaining weight in my forties despite no change in my eating habits.

"I started gaining weight in my forties despite no change in my eating habits." - you started gaining weight BECAUSE you didn't change your eating habits.

I started gaining weight in my forties due to menopause, and changed my eating habits BECAUSE of that. Keeping eating the same amount when you can see you're gaining weight, and you will gain weight. We have to adjust our eating patterns as we change with age.

Although lentil pasta is slightly healthier due to being higher in fibre and other trace minerals, it has pretty much the same carb and calorie content as wholewheat pasta, and not much less than white pasta. If you're eating it most days, that might be an issue.

I think sourdough bread is higher in calories, although a better bread. Wholemeal bread is lower in calories and higher in fibre.

I wish you luck with your weightloss - having the willpower and drive is a large part of the battle, and it sounds like you're really trying.

WorkingForCunard, why should NHS deal with poor lifestyle choices? Shouldn't individuals start taking responsibility for their own health?

Side effects are still effectively unknown- see eye condition found by mass eye and ear

www.massgeneralbrigham.org/en/about/newsroom/press-releases/popular-prescription-weight-loss-drugs-linked-to-uncommon-blinding-condition#:~:text=A%20new%20Mass%20Eye%20and,ischemic%20optic%20neuropathy%20(NAION).
I was discussing with a doctor and they thought this might be just the tip of the things that will be found in the coming years - his words were I wouldn't take it for any money! Not just eye conditions obviously- but if your GP prescribed it and you were one of the people to become blind would you then sue the NHS? There are some drugs that had ben approved that are found to have serious side effects many years after release

@JudyP that's an interesting study, the authors say the findings are tentative and there are issues with the data set used. In addition, this is specifically about semaglutide (Ozempic/wegovy), not tirzepatide (Mounjaro).

True - but just to point out this was an unknown finding and we dont know what we don't know about any WlI and especially monjuaro - it might have no major side effects with long term use but we won't know until it's been on the market for years and years is my feeling

@JudyP is this different to any other recent drug on the market? Is there something specific about GLP-1 agonists that concern you, or does your caution apply to all new medicines?

It almost seems like people are wishing serious side effects on obese people for daring to use a licensed medication that is available to them to treat obesity.