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.

My GP wanted to prescribe them to me for T2 diabetes, but there is a huge shortage of them due to "rich people buying them to lose weight" to quote her.

So they can't put anyone new onto them, only the people already on them can have them.

So YABU unless enough stock is produced and they are given first to the people who need them for diabetes and other medical reasons, not just weight loss.

YANBU to think that if they work and have huge benefits, then they should be available to all, alongside education on how to keep the weight off once you come off the jabs.

Because it's the nhs, they do things that on paper is meant to be cheapest. I.e if you have chemo they won't give you the anti sickness the first time, just incase you aren't sick. So you wake up the next day, vomiting your guts up and 20 miles away from the hospital you had it done at. You phone the GP and they say the hospital has a duty of care.

All to save X amount on one box of tablets. You've just added an extra workload to drs, nurses, pharmacy etc for a day you weren't meant to be in.

@Readingallthetime

The huge amounts of money saved on treating health issues for obesity could help pay for all these other conditions. It's not rocket science fgs.

This is absolutely true but there would be a big initial cost in rolling this out. You’re right that over the long term it could pay for itself and generate savings but the problem is that money isn’t there for that initial rollout.

The investment in anti obesity drugs etc would have to come at the cost of investment in more acute health costs (cancer treatments for example) or would require additional budget. To do it properly would require a big step up in investment and thus taxation. For a brand new Labour government it’s too politically risky.

We already know they don't work long term and don't work for everyone.
Plus of course if not enough are available they are going to need to make sure the right people get them.
Surely you can see that?

nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.aao.org%2Fnewsroom%2Fnews-releases%2Fdetail%2Fweight-loss-drug-and-eye-health&data=05%7C02%7Cjtribe%40emory.edu%7Cbb58a078201e4c68633408dca9a06188%7Ce004fb9cb0a4424fbcd0322606d5df38%7C0%7C0%7C638571753511517964%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=IaO74j0k%2FQcX0bagWghIV1fEECB7lcZizcQaa0LA4cs%3D&reserved=0

A report from AOO showing links to vision issues - this may be the reason they are cautious- they just haven't been around long enough to get good data on all possible issues/interaction with other medications? Just a thought

You are giving out about being told that a pork pie has more calories or fat than an omlette and being told protein keeps you fuller longer but the simple fact is that weight loss is not rocket science and if you out down on one side of the page calories in so your daily intake, and on the other side of the page your daily expenditure and you expend more calories than you take in, remaining in calorie deficit for a prolonged time you will lose weight.

Should they not start with trying to educate people to help themselves the natural way, rather than jumping to expensive drugs with supply chain issues, and save those for people who really need them. Everyone would probably opt for the easy way out if they made weight loss drugs super accessible.

The nhs is not a bottomless pit of money. Maybe they feel other treatments should take priority which can’t be treated with counselling and self control. People will always look for the easiest route. The hard route is good nutrition and exercise.

Surely it is much better for one's health long term to tackle the problem of overeating by making changes to diet and lifestyle. This has to be better for individuals than taking drugs for (how long?) which have no effect after you come off them.

I think we've forgotten that, for many many people, your health is in your hands. If we all had to pay for the NHS at source I think we'd all work much harder keeping ourselves well.

What's the data regarding weight regain once you stop taking them?

Problem is they just haven't been around long enough to know the long term side effects. There could be a massive backlash in a decade of unforeseen side effects that the NHS would then have to deal with.

Honestly I don't think there is a long term answer to morbid obesity in the population. This is something we are not talking about or really accepting. Not everything has an answer or a solution.

As fast as weightloss drugs are produced, ultra process food is pushed more and more on the population. Individuals may find a way through but the general long term survival rates for morbid obesity are very grim. If the US is any indication it will just keep getting worse 😔

The NHS is very good at doing cost benefit analyses. They won’t be prescribed wholesale until there is robust evidence that they are the most cost effective solution long term - including dealing with long term and side effects.

Whether they remain good value when compared with supporting active travel and a healthier lifestyle - none of which are NHS responsibilities - is another matter entirely.

@MulberryBushRoundabout @StilettosForMiles

Of course therapy doesn't cure everything in which case people would fall into the really struggling and need specialist support category I also mentioned.

I'm fat, I have a bmi of 31, I eat like shit and don't exercise enough. That's my underlying issue! Some of my weight gain might be meds related but I can't be sure. Should I be expecting the taxpayer to fund super expensive jabs for me as the first line of treatment for my obesity? I don't think so.

I agree. The emphasis on local budgets leads to illusory short term small savings at one layer which eventually accumulate into a huge waste of time and money

as an illustration, I developed terrible eczema of the hands, probably because I had just had a baby and my hands were constantly being washed after nappy changes, etc

the GP first prescribed washing hands 🙌 n moisturising lotion instead of soap. I ended up with a lot of pus-filled blisters

then a microscopic dose of steroid- the least possible.

then a slightly stronger dose.

months had gone by, nearly a year. My fingers were peeling like bananas and I was in constant pain

i paid for a private derm; she prescribed a really strong steroid which sorted me out in DAYS.

all that discomfort, all those appointments and prescriptions, for nothing. I’m sure if I had been prescribed a decent cream in the first place, I’d have had less exposure to steroid overall, and cost the NHS far less.

Glad someone else said it.

Yes they are expensive but not THAT expensive. For me I saved a lot of money from not buying anywhere near as much food, no alcohol, and not wanting takeaways etc.

At some point you have to take ownership of your own health. If it's that important most people can make savings elsewhere to prioritise it. Cut out a £20 takeaway and two £7 bottles of wine a week, or £45 on one meal out plus two cocktails and that's the equivalent. Or buying 1 new dress a fortnight. Or cancel your holiday that year - drastic but if you really think it's going to work for you then one holiday vs a lifetime of improved health.

People pay for gym memberships, nutritionists, weight watchers, food supplements etc. to lose/manage weight. The NHS can't fund everything.

Because on a cost benefit analysis it's not financially viable

Oh yes, they’re very diligent about doing the analysis they do. What they’re not diligent about is factoring in all the downstream costs of not prescribing to that analysis, or thinking about the wider costs of convoluted hoop-jumping multiple appointments stretched over many months to get to be prescribed in the first place.

Perhaps people who through no fault of their own have diabetes are being prioritised as they should be.

In an ideal world a weight loss drug would be available but this is the NHS on its knees. We’ve tried taxing sweets and soft drinks however like cigarettes people are addicted to eating unhealthy food in large amounts.

Arguably there should be more hoops for fat people to jump through to help weight loss.

I work in the NHS, in the same team as our diabetes specialist.

These drugs are incredibly expensive. Mind-bogglingly expensive. The demand is huge, and once patients start these medications they will generally be on them for a while.

The NHS obviously operates on a cost-benefit model where if a drug is prohibitively expensive and other (cheaper) interventions will work for the majority of patients with fewer risk factors, common financial sense states that the expensive drugs are kept for the top level of the treatment pyramid when all other options have been tried, and failed. Just as bariatric surgery is no silver bullet and definitely not suitable for all, neither are the GLP1 injectables.

I hate this phrase, but there is “no magic money tree”. If people want to lose weight and reduce risk of CVD but don’t meet NHS criteria it doesn’t mean they wouldn’t benefit from these drugs, just that the NHS can’t justify the cost vs benefit. I don’t think it’s unreasonable that people need to buy it if the want it - we have to work with the system we’ve got. It’s not fair, nobody said it was.

Do 'we'?

Where are you getting this from?

Yep I can’t get creon and insulin is in short supply because of these injections. Diabetics should come first . People who are overweight will not die from not having these injections.

If you can afford to buy a dress a fortnight, or a takeaway plus two bottles of wine a week, then you’re in a much more financially privileged position than many of the people who could benefit from these meds.

I don’t disagree that people should take responsibility for their health. But as a society we should recognise where financial or other barriers prevent some people from doing that and look to help.

ApoodlecalledPenny, self discipline is even cheaper!!!

Oh ffs, you haven't got a clue, have you?

I think, unfortunately, it boils down to money. My SIL is paying privately for injections and is losing weight at a steady pace. She is, however, worried about what will happen when she reaches a weight she's happy with and wants to stop the injections. Anything I have read suggests that the person's appetite will return to its previous level and that therefore the injections need to be looked upon in the same way as treatment for a chronic illness - in other words, they may well need to be lifelong. If that is the case, it will take years of number crunching and deciding whether they are cost effective compared to treating obesity related diseases before the NHS decides to spend the money. It's always money.

My friend who is a GP said that she feels uncomfortable prescribing Mounjaro as it has only been available since 2022 and it has been shown to cause thyroid cancer in animals.

I worked in health promotion, but not weight management directly. Our tier 3 service had lots of success, and included clinical psychology appointments alongside other services eg a dietician. Referrals to other services such as MH and social services, community groups (social isolation was often a big factor) etc were also included.

To me that's what a good tier 3 service should look like, something that can help people to make lifelong changes which improve their physical, mental and emotional health. An injection doesn't do that sadly. If course, some people will still need pharmacological/surgical intervention, but I do think that should come after a more holistic approach has been tried.