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.

Isn't the catch with that is if you haven't got the £5 now you can't spend it. At the moment they have all the issues they have to deal with so where do they find the £5 that will save them money in the long run? Are we all prepared to make a big payment now to save money in the future? I can imagine lots of people who are struggling to put food on the table would resent that.

No, GP'S shouldn't be able to prescribe these drugs. I don't think they should even be available at private pharmacy's without physically seeing a health provider for a checkup before having a prescription first either.
It seems like a minority of people are misusing these drugs already. When they are not overweight enough to even need them. If GP'S could prescribe them then people would just try and get prescriptions when they don't qualify.

Maybe the current process isn't right at the moment either but I do think it should be a weight loss clinic prescribing not a GP practice.

well not quite.. but the basic theory is correct... its all calories in verse calories out!

but not all fat people are fat purely because they have a shit diet...

not on its own, and not long term, it is the type of food as well, otherwise you just end up putting on more than you lost over the next few years

Fat doesn't = stupid

But thinking that weight loss drugs = insulin ...is very stupid indeed.

I'm fat and the reason I'm fat is because of reasons I need therapy for, I also need to overhaul my diet and exercise regime. I could ask for a fat jab but I know until I fix the reasons why I'm fat it will be a waste of NHS funds to let me access the fat jabs. I feel this is probably the same for most overweight people.

You are 100% correct. It's the NHS funding model that is the problem.

Firstly, the NHS commissioning organisations are supposed to stay within their funding envelope every year. Then the funding envelope is top sliced sliced each year. Different names are given by politicians and civil servants for this but I find the word cuts does the job.

Then the careful budgeting by the commissioners gets blown out of the water every year because there are always more emergency admissions to hospital than planned for. It's the household equivalent of planning your budget for the year and then having to feed 2 additional people. Suddenly the budget for car maintenance takes a hit.

So the NHS pushes the can down the road. They know, not treating obesity will cost more in the long run. But this year, it's cheaper to give people a diet sheet than prescribe medication.

It's the same with orthopaedic surgery. Delaying surgery while asking people - who can't exercise - to lose weight pushes it into next years budget. Most of them won't successfully lose weight, their joints will get worse, their surgery may be more complicated and their recovery will take longer. All of which costs more.

I have sleep apnea. Last year I was referred, assessed and had a cpap given to me within 5 months from start to finish. I had a deviated septum and polyps in my sinuses and was referred and operated on within 8 months from start to end just 4 years ago. Both with the NHS.

You sound incredibly judgemental. You really think obesity is simply caused just by people just choosing to eat too much?

So it helped while you had the injections, but stopped helping when the injections stopped? I think this is a big concern, that they can't keep prescribing then forever due to the cost. I think if there was strong evidence that prescribing a 6 month course, would then keep weight off for several years by changing eating behaviors, then nhs would be much more likely to fund.

I don’t think the nhs thinks long term. I’ve been anaemic for years. Doctors have fobbed me off with iron tablets as a “menstruating woman”. Surprisingly I’m now dangerously anaemic had a 3 day hospital stay where I had a blood transfusion and an iron transfusion. I’ve got appointments for many tests as I’ve hit a threshold. I suspect that there was probably a time (years ago) for less urgent investigations but preventative care isn’t the big thing it’s a threshold.

Possibly if I was richer I’d of paid for testing as I knew something was off but hey ho. I do think if you can afford it it’s probably easier just to buy it yourself rather than jump through hoops. I know everyone is anti private medical care but my American relatives get really good preventative healthcare, expensive though. NHS is very good in an emergency.

Totally agree with this.
Obesity is incredibly complex and a large part of food addiction is due to ACE and trauma/ MH issues .
A symptom

Whilst the jabs work temporarily they dont address the core issues.

Same as the jabs then? So why demand them and rubbish dieting?

Yabu because this treatment cannot successfully be used just in isolation by most people. Unless you are ultra-disciplined you need a certain level of supervision while on this treatment and the nhs doesn't have the staff time and resources to provide that for everyone. Part of the reason for the cycle of "hoops to jump through" is about how well you can stick to a disciplined regime.

Like with the people who manage to still gain weight after stomach stapling by working out how to get the food in regardless, some people would take the medication and still find ways to gain weight.

It's so annoying isn't it? Eat less, move more is just not the help we need! Last health coach told me to do half an hour of exercise per day. She suggested going for a walk. I told her I already do more than half an hour of exercise just doing the school run. Then I do gym or class plus swimming 3 days a week and twice a week badminton and swimming with the kids. I was also doing C-5k at the time! She just looked at me blankly. Then she asked me what I eat. Told me I don't eat enough. I needed to eat more to lose weight apparently. Even though I told her the only way I seem to lose weight is 800kcal a day. The trouble is I find it hard to maintain long enough to get all the weight off. I'm sick of being overweight!

Pork pies have calories in them ? 😳

I got put on them for diabetes ( not weight loss) without even asking

Probably due to the nhs shortages with more trad diabetes drugs like victoza

So maybe they are going to diabetics as priority

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...

FFS. I've been an NHS clinician for 30 years. I'm now a Clinical Director and my partner is a Director in the local ICB. Bonuses do not exist in the NHS for anyone. Ok, I get a clinical excellence pay,ent for being, well, clinically excellent...but my partner gets his salary and thst js it.

Can we please stop these myths about the NHS and it's staff? It is just right wing propaganda and doesn't add to the debate.

So maybe they are going to diabetics as priority

GPs don't have the resources to provide the monitoring that should take place whilst these drugs are being used because the liklihood of serious side effects is quite high.

I also went through Tier 3 but my experience was not anything like yours. The exercise sessions were fun and useful, the therapy remains one of the most beneficial things I've done and the nutrition sessions were quite useful.

All the diabetics kicking off about people using MJ for weight loss only, a huge proportion of people with Type 2 Diabetes have it because of poor diet and lack of movement (before anyone kicks off, I say a huge proportion NOT all).

Of the people with Type 2 Diabetes who have it because of poor diet, inactive lifestyle and being overweight/obese, their is lots of evidence a change in diet and activity levels can really help with their blood sugars and insulin resistance putting them into remission.

If they can't do it without an injection that curbs hunger and steers them towards being able to make better food choices because they won't make the changes through willpower alone, I don't see why the overweight/obese people who want to buy these injections privately should be vilified for doing so in wanting to prevent illness, like Type 2 diabetes.

The NHS wastes so much money on non life or death issues, that prescribing weight loss injections wouldn't bother me as hopefully the long term benefits of a less obese country would be far better.

Hopefully there will be positive changes to the supply issues these medications are having and they will be available to ALL regardless if it's to manage lifestyle related Type 2 Diabetes and Obesity.

I agree. It's crazy how obesity is so vilified but not Type 2 Diabetes!

They do not prescribe easily because the jabs can cause severe digestive problems, pancreatitis and other things.

www.medicalnewstoday.com/articles/drugs-mounjaro-side-effects#:~:text=The%20most%20common%20side%20effects,gastroparesis%20(slowed%20stomach%20emptying).

It would be irresponsible for doctors to casually hand out prescriptions for this.

You can buy it online, prices vary.

I wouldn't touch something like it. Once you have injected, you have no control over its effects until it is out of your system.

For sure this will be part of it and it will require a grown up conversation in government to fix this, so that there is an overview and enough overall cash.

It doesn’t necessarily mean hiking taxes, though I guess that’s one option. The government could borrow knowing the investment now will save money in future. I’m hopeful that Streeting is wise to this issue, he seems to be thinking more broadly than just a siloed mentality, eg his comments about the cost of long NHS waiting lists to the economy when so many are unable to work because of poor health.

People with type 2 diabetes often develop it because of obesity, it can be avoided. My late husband was very overweight and a type 2 diabetic. He took a lot of stick for it from close friends.

With the long term risks currently unknown its good they make efforts to ensure it really is a last resort for people, because at that point the risk of serious health problems developing due to weight is probably higher than the at the moment largely unknown risk of using these. It's not arbitrary hoops to punish fat people. There are of course the considerations around price, people saying yes but spending £x now saves £y later on must have no clue what state the health service is currently in.