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.

Waveforme , oddly enough you'll probably get fat again.

Because people are still killing their organs piling in the junk food thinking they can get rid of the consequences by taking a jab. Skinny does not = healthy.

People should take responsibility for their own health and eat better.

Had this exact same issue from all the hand washing with nappies and bottles! Same thing, took a year to get to see a derm, who then got it sorted in one appointment.

Me seeing the GP 6 times and then seeing the derm was way more expensive than seeing the derm for appointment 2 or 3. Plus I had a year of unnecessary agony. Not that the bean counters give a shit about that, of course.

@thefishingboatbobbingsea In my area, at Tier 2 they offer Wegovy?

Everyone would probably opt for the easy way out if they made weight loss drugs super accessible.

The idea that this is a bad thing seems insane to me. If there's an easy way to do something and a hard way, who in their right mind picks the hard way?!

In any given year, only 1% of obese people will reach a healthy weight. Over a lifetime, 70% of heroin addicts will get (and stay) off the drugs, whereas only 30% of obese people will reach and maintain a healthy weight. It's so easy to judge fat people as lacking willpower and to insist that they must get better without any help. But unless you're also describing recovering heroin addicts in the same way and saying they're weak for needing withdrawal meds then you're a bit of a twat.

I totally agree with you OP. The drugs needs to be available much easier - and they probably will be in a year or two when the supply chain is more robust. I do think patients should have access to a proper nutritionist at the same time though.

This seems like common sense but is very short-sighted and simplistic. It is absolutely not just a case of eating too much of the wrong food and being lazy, or having poor self-control. It just isn’t. This is a problem affecting pretty much all of the developed world and countries where GDP is rapidly increasing meaning western-style lifestyles are more common. We need to be intellectually curious and pro-active about sorting this crisis on a global level, shame and judgement isn’t really going to help but I do agree that we need to be encouraging and championing individual responsibility for good health management, helping patients to help themselves.

If GPs could just dish these out freely it would bankrupt the system. It would also put huge pressure on GPs themselves having to explain to people why they couldn’t have the drug. The issue with all this is at some point you will stop taking the drug. Just like anti depressants don’t fix the underlying trauma, fat loss drugs don’t fix the underlying issues causing someone to over eat. They are also not side effect free. Far far better to work on why you are over eating and address that rather than medicate. Sure there are things that make weight loss harder such as being older or menopausal etc etc, but to be blunt it’s not a reason for expensive pharmacological intervention.

The fact that Oprah and pals can pay to jump the queue is as old as time itself. If you have the means to pay for whatever in life then have at it. If the taxpayer is picking up the bill then it’s a different story. Ozempic et al won’t prevent future issues, they will simply delay them in most cases as the over eater will inevitably at somepoint return to over eating.

It's unclear which is more effective in the longterm - surgery is (usually) permanent and so far it looks like once you stop the weight loss injections you regain the weight lost. Plus there is no money.

It has, in rats. It doesn't mean it could in humans. But obesity is a major factor in all sorts of cancers. So someone might weigh up the risk of staying obese and increasing their risk of getting one of those types of cancer, or losing weight with the jabs and potentially risking a higher likelihood of thyroid cancer though that's not proven.

I totally agree.

Overweight and obesity are incredibly complex conditions - much, much more complex than the much-repeated line of "it's just calories in versus calories out". Any health professional with an interest in bariatric medicine know that.

Weight-loss injections are just one tool to support people to get to and maintain a healthy weight and the fact they're largely only available privately is ridiculous. No, they're absolutely not suitable for everyone and no they shouldn't be the first line for most people because of the complications they can cause. But for people with long-standing obesity who have tried for many years to lose weight they should be made available with greater ease.

Yes, they're expensive.

But they're much cheaper than treating obesity-related conditions such as T2DM, osteoarthritis, hypertension, CVD and more.

Failing to offer weight loss injections feels like a wildly inefficient and costly way to run a health service.

When did we become so entitled that we think the taxpayer should pick up the tab for our unhealthy lifestyle choices, while there are people who are genuinely sick through no fault of their own? Those jabs cost hundreds of pounds per month.

Alcohol, smoking, rotten teeth, obesity. Do you what you like, drink, eat, smoke yourself to the brink of death and me and other people will go to work every day and pay for you. Stop being a deliberate drain on other people.

I totally agree.
Obesity is a huge cost to the NHS. Diabetes is off the scale & is only going to get worse. High BP leading to heart attacks, strokes & weight leading to lack of mobility all contribute to this huge cost. If these injections work on even 50% of these individuals surely the cost savings would be immense. Even if individuals have to be on them in the long-term. As an alternative to expensive surgery, diabetic amputations say & expensive long-term medication for other issues. Plus how many of these individuals are off long term sick & are not able to contribute to the economy? 22% of the working population are currently unable to work.

My husband is diabetic and was prescribed the injections. They worked brilliantly and he was doing well, that is until they were no longer available. Supply dried up and the GP could no longer prescribe, as stopping and starting all the while, as and when available was not good. I assume supply was diverted to private sale as it was available on line at huge cost.

I think the NHS wouldn't want to be in a situation where every person with a BMI over 35 or whatever, were allowed to get weight loss drugs prescribed. I imagine there would be a lot of people wanting them. However, I think once the patents expire for the big brand meds like ozempic, Mounjaro, then generic versions will come out for a the fraction of the cost and then NHS will invest in that. So maybe not to long away.

But agrees that NHS isn't ready for preventative medication yet. They are barely coping now so for them them to see long term will be unlikely at the moment.

I myself am on Mounjaro and think I am close to my pre baby weight! Which is huge! So my weight from 12 years ago that I haven't been able to get back to with any other diet I tried. Another stone or two and I'll be back to my weight from my early 20s! This is an amazing drug and so thankful I can afford it.

It should be available privately. Win-win, you pay when you are motivated and you don't bankrupt the NHS.

A thousand times this. There’s an abject lack of personal responsibility in so much of the thinking around this issue, partly because the great god NHS will be there to catch you when you need a triple bypass / a carer to wipe the ass you can’t reach / adapted living environments. But feel free to keep complaining about the shortage of GP appointments and diet drugs.

Because they have to be sure you will make changes. Some won't they think it's a magic solution and carry on eating junk. And yes some do need it spelling out for them. But it's no good if they are going to celebrate a 1lb loss by pigging out on a Chinese takeaway.

An aquantance of mine moans her son is overweight. But they pig out on Dominos every week. At one time it was the only thing he would eat for tea. They got a load of Dominos pizza boxes to put a shop bought one in. But there's a lot of saturated fat and not much nutrition or fibre in just one pizza. As well as all the sides.

And here we have the "whataboutism"

I agree - the Government should be looking in to making the jabs cheaper. They're the people in charge!

Unlike literature, where copyright protection can last a whopping 95 years or more after initial publication, most drugs are under patent protection for just 10 to 15 years. Companies that successfully bring a drug to market have only that time to charge high prices before the drug goes generic

The other issue is that people are buying this from non approved vendors, which opens the door to problems with genuine products

> (I can only assume that the NHS believe that old stereotype of Fat=Stupid. )

Yes. Definitely.

I'm amazing at calorie counting, my diet is healthy, my exercise is incredible, I am very knowledgeable but because I remain fat (lipoedema) I am discounted at every turn.

I feel the same way about the new weightloss drugs as I did about xenicol and gastric surgery. Wait a while and see when the harm appears.

• The NHS has no money.
• The "fat jabs" have numerous side effects, one of which is increased likelihood of thyroid cancer. So having to pay for this and then a ton of expensive cancer treatment further down the line for everyone isn't great.
• YOU wasted all the professionals' time that you mentioned, no one else. Lack of personal responsibility is a major issue here.
• You could pay and go private.

The entitlement is crazy. You need to take some personal responsibility somewhere for your own life and health. I'm not a size 6 either, I've struggled with my weight all my life. But I don't blame anyone except myself. It's my own hands putting food to my mouth, no one is physically force feeding me. And I certainly wouldn't have a level of expectation of that much free help and on top of it blaming other people. People need to take more responsibility, not rely on "magic" solutions from the government that don't teach you shit about actual nutrition. If you're not as hungry but when you are you're just eating cream cakes and fish and chips, your body is going to be fucked long term. Not obese doesn't equal healthy or good role model.

Because weight loss jabs are not a long term solution. The long term solution is change of diet, cut out hpf, cut out sugar, eat 10x more greens

Thats not the approach the NHS is taking.

👏👏👏

I agree that prevention is better than cure but presumably the NHS is prioritising life saving medication/treatment above weight loss medication. And by life saving I mean insulin for type 1 diabetes etc.
I'm not unsympathetic but if there's limited funding as there is, I think supporting people with non curable ailments trumps paying for medication to help someone lose weight.

what isn't? I dont understand what you are saying, it is the universally accepted route to losing weight