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'm on Mounjaro, and paying for it. I do actually fit the 'coming soon' criteria for a GP nhs prescription (severe sleep apnoea) but I'll continue to pay as now I'm on it I've drastically reduced what I spend on food.

It's meant I can make good choices - I've completely stopped junk food, eat a healthy diet, given up wine altogether so the money I'm not spending on this pays for the meds. I had a month off as I'd had an operation and didn't gain the weight back that I'd lost, but noticed I had more of an appetite for my husbands crisps and chocolate so I'm happy I'm back on it.

I do think I'm one of the very lucky ones who has had no negative side effects. I don't think it's appetite suppression, it's just switched off food noise that makes you crave eating anything that's there. Today I'm 37lbs down from when I started in March.

For those who are saying you put all the weight back on - surely that's the same as any diet? Unless an effort is made to change diet and move more the weight will obviously come back.

It's likely this will be available via GP later this year for those with comorbidities. NICE guidance link below. The next meeting about this is in August with guidance expected in October. I think by the time it comes in I won't need it.

www.nice.org.uk/guidance/GID-TA11156/documents/draft-guidance-2

Oddly your 'friend' who is a GP is unaware that she cannot prescribe it yet anyway.

Back to Med school perhaps?

Our T3 service is brilliant.
We do talk about calories and portions, etc, because not everyone is well educated about their food choices, but we also talk about emotional eating, sleep, hormones, menopause.
We offer exercise classes, reduced price gym and classes, and 6 months of free gym access with our health trainers.
Medical weight loss has its place, but so far, all the research shows that when you stop using it, you will regain if you haven't made lifestyle changes.
GLP1 RA have been used in type diabetes for nearly 20 years now, and they are not a miracle cure, sadly.

Absolutely this, but to acknowledge this it's 'shaming' or emotionally damaging. Have seen on multiple threads the vitriol and screaming backlash at anyone who dares mention 'eat less, move more'.

There are a lot of possible side effects some of the less common ones really serious.

https://www.webmd.com/drugs/2/drug-184168/mounjaro-subcutaneous/details

I seem to remember also reading about mental health problems including suicidal thoughts. It should only be taken with proper medical supervision.

I think for some posters the most important thing is being able to demonise and castigate others. They love being able to disapprove of fat people being such a terrible drain on the NHS and economy and they're worried that if injections prove effective and value for money overall that they won't be able to look down on the obese anymore. They might not even get the chance to say their favourite things like 'we've lost sight of a healthy weight' or 'eat less move more' if enough people successfully reverse their obesity and weight-related conditions.

Right now is the best of both worlds because they can sneer at people for being fat and they can sneer at the injections too but if it really takes off and does end up saving the NHS money then it will be very distressing for the high and mighty to lose a punchbag that boosts their own moral superiority so well.

I’m 20lbs down in 2.5 months as I struggle not to eat. I run 30-40miles a week, and can run a 19min 5k every 3-4 weeks, even obese as I still am (just!).

I’m on a break whilst recovering from renal stones and a potential kidney disorder that may, or may not have been caused by Mounjaro. Renal specialist next month and further bloods, but hopefully back on for another 2 months to get a stone off and a BMI of 25-27 🤞

Oh, and those cravings for crisps and chocolate are starting!

If you do take Mounjaro, please drink plenty of water!

It’s the wait that would have killed me, possibly literally. On the bariatric surgery group I’m on-thousands of members-those who have gone via the NHS route have waited up to 5 years for surgery, the hoops they’ve had to jump through have been many and seemingly endless. It’s no wonder some people go abroad for surgery.

I have no experience of the jab, but I’m led to understand that the weight loss stops once they stop, so I guess it is a tool, much like surgery, where people frequently put back on the weight once the restriction eases, my personal worry. It doesn’t change the thought processes. Therapy might be amazing, I don’t have experience of that.

I do know I’m 10 stone down in a year and following a nasty accident, I can’t exercise like I used to when I first lost weight (50 lengths several times a week, riding two horses a day, epic dog walks, badminton) although now I’m a lot more mobile.

I guess as mentioned, there are loads of issues that could/should be improved by support from the NHS, but the funding just isn’t there for everything. I was happy to pay, not everyone can. I know some people don’t think the NHS should fund weightloss jabs/surgery and see it as a lifestyle ‘choice’, but is it also a choice when people have sport/driving accidents that aren’t their fault? They’ve chosen to drive/ski/ride/bike/do extreme sports.

@thefishingboatbobbingsea As far as Ozempic/Semaglutide is concerned it has nothing to do with NHS making a choice about not providing it. That was developed to help type 2 diabetics, but so many people jumped on the bandwagon to help them simply lose weight - especially in private clinics and the like - that the production of it couldn't keep up with demand for it.

Those already on the drug were allowed to stay on it, but NHS had no choice but to not let other people start on it, otherwise there wouldn't be enough for anyone! The time scale for ramping up production kept slipping too.

Currently the tablet form of Semaglutide is now obtainable again, but my Diabetes nurse advised me last week that the injections are not yet available again and it could be next year before they are!

Don't know about the other similar drugs, but I would imagine they are similarly effected.

Yes, you are correct about helping people to lose weight - but it's shocking, IMO that those of us with Diabetes and badly needed Ozempic couldn't get it, for a long time. It was developed for us. But it is what it is. You can understand why the manufacturers preferred to sell it to Private clinics and the like first!

I don’t think you’ve tried a GLP-1. I can assure you - and so will probably dozens more women on here - you simply cannot eat those foods on GLP-1.

First, your palette changes. I was the FIRST to suggest a McBreakfast. Now the even idea of it makes me gag. You only have the urge to eat quite fresh, basic foods. Even a gorgeous sauce next to a steak is a turn off. Even potatoes are pretty much a no. But if you DO eat those foods you used to eat, oh god the gastric side effects can be extreme.

Hop in our threads. We discuss nutrition, lean muscle buildings, bone density, our DEXA scan results. You name it. We are the 1st wave and we are highly motivated and informed.

A bit of my background: NHS health professional working in endocrine disorders. Obese since my last pregnancy in 2011. Generally ate well but portion control not great. Good cook but enjoys butter.

I started NHS tier 3 weight loss 12 mth ago and just finished. Lost a couple kg with monthly dietician check in and was also give 3mth meal replacement shakes (fast 800).

Very, very spendy for us, the taxpayer.

16 weeks ago I self funded GLP-1 (mounjaro). I’ve lost 15kg and BMI is 30 down from 36. I did this alone, with support from women on here. It cost the NHS not one penny.

GLP-1 drugs retail for £157-200 per pen (4 official doses, can get 5 out of them if you try). They cost £3-5 to manufacture.

last week in my final appt I was offered gastric surgery - yes, really - £££!! No one in my area currently prescribes GLP-1 for tier 3. So I am left to my own devices.

The NHS has opted to offer me a high-risk life changing surgery with life long follow up and all the cost associations, than prescribe GLP-1.

It's more than proven that losing weight is calorie deficit. There's no other way.

It's too simple for people to accept to take responsibility

Take out some of the ridiculous layers and layers of policy people. Pivot the NHS to prevention.

Erm, in order to make this change in the NHS and healthcare culture, you need people to decide the policy and he,p implement it. We call those people policy people or managers.

I'm not one, I'm a doctor, but I've got enough self awareness to understand that my skills lie with making people better and not implementing changes in the system.

However, onto mounjaro, I totally agree that it is a much better solution to obesity than the existing tools. But, like all changes in the NHS, it has to come from the DHSC.

YABU. No medication comes without side effects. There is no magic pill that will make people thin. Every medication given must be a risk-benefit decision. For example gastric bypass surgery comes with anaesthetic risk. From which you can die. People think these things like ozempic or mounjaro are a magic bullet when they are
not. Best to try the hard way with healthier diet and more exercise.

They are available privately, and very easily (apart from when demand outstrips supply) Asda, Boots, Superdrug etc all sell them.

Yes, the NHS is 'groaning' now. But, as someone else suggested upthread, if everyone was in good health, the NHS would go out of business! And it IS a business at the end of the day...

Diabetics now can’t get ozempic because so many people are buying it privately for weight loss.

also if you venture into mounjaro groups on Facebook you will see an awful lot of people with eating disorders, people who frankly are a bit too dim to be left alone with these injections. They constantly post asking each other if these prescription medications can be doubled up if they’re not losing weight fast enough, or asking each other when they should be moving up to the next dose. Getting upset that they only lost 3lbs in a week. Boasting about how their bmi is 28 but they want to lose a stone so they’ve lied to their prescriber that it’s 30+ to get it.

in amongst those are the people that genuinely want to make a change in their lives who should be helped to do it but unless you have a robust process how do you tell who those people are?

Yep I can’t get creon and insulin is in short supply because of these injections

I fail to see how these injections are causing a shortage of insulin, as they don't contain insulin.

Because the answer to everything isn’t that taxpayers have to pay

Oh those pesky fat people who don't work and don't pay lots of tax.....

It's a dreadful waste of public money for people who refuse to moderate their own behaviour and who need to develop a stop button.

If you are fat you eat too much. That's not difficult to understand.

Can't see the YABU/YANBU polling options

sorry, not sure what you are saying, it is not "proven" that calorie deficiency leads to weight loss, in fact it has been proven that it doesn't, not on it's own - so not sure what you are trying to say,

I am saying change your diet. Cut out sugar and UPF, and increase your greens. That will lower your calorie intake a bit anyway, but not in a way that is going to make your body respond by economising on calorie use in other areas like temperature and hormones, etc.

it is not "proven" that calorie deficiency leads to weight loss, in fact it has been proven that it doesn't, not on it's own - so not sure what you are trying to say,
Really? So a calorie deficit does nothing?

The NHS is very good at doing cost benefit analyses.

Indeed it is. Apparently, there's more 'benefit' in upper management getting bonuses than making sure doctors and nurses on the ground are being paid properly. Just saying...

I agree a healthy low upf diet is the way to go but eating less calories than you need definitely makes you lose weight.

fat jabs? why should the NHS promote laziness?

i believe they have a strict regime for these injections, same as weight loss surgery, you have to prove you want to do it and that you are going to put in the time and effort before they give you it.

otherwise.. very much like a friend i have, massively over weight who assumes because she is a large lady they should just give her everything.. she refuses to exercise of any kind and before people come at me with 'mobility issues' even a couple of steps a day can make the difference but she sits on the sofa refusing to move, she refuses to do the physio she's given.. why should she? she refuses to look at her diet..

i'm in full agreement with those who help themselves should come above those who believe they are entitled and are looking for a quick and easy way out!

and i dont think the injections are an easy way out, you still have to exercise, you still have to watch what you eat!