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.

The problem with that is they would probably spend lots of money testing people who just need iron tablets. I was anaemic for years, took iron tablets, post menupausal and not needed iron tablets in 20 odd years. I suppose there is a golden spot where you aren't wasting money on lots of unneeded tests and not waiting too long to test the people who really need it. I guess finding the golden spot is the hard bit.

But your GP wouldn't have been following the evidence based guidelines if they'd jumped straight to a stronger steroid cream - which most people don't need. Following the guidelines will work for most people, obviously not all which is why there will be a scheme of treatment options to escalate through. You having problems for longer has been inconvenient for you but over using high dose steroids in people who don't need them would have far greater consequences for patients & the NHS overall.

I asked my GO and he referred me to the diabetic research centre here. 6 weeks later I got weighed, measured and prescribed Mounjaro to collect from the hospital pharmacy.

Pretty straightforward, but I am diabetic as well as overweight.

I'm not convinced they are a miracle cure at all though. Have you seen how people look, the ozempic face? You don't look slim and healthy like when you've lost it naturally, you look sort of hollow and dull. I bet it will come out at some point that the jabs aren't good for you at all!

I wonder how people using the jabs will impact the choices they make when feeding their kids. I live in a seaside town and there are loads of kids here over the summer holidays. I know I sound like a giant arsehole saying it but the size of a lot of these small children is astonishing.

I agree OP the NHS just cannot be proactive with regard to health issues. It’s so shortsighted as a proactive rather than reactive response to health in all areas would save so much money in the long run.
On a different note I would love the weight loss injections. However I have gallstones and episodes of gallbladder flare ups so they are contraindicated for me. I believe that even having the gallbladder removed does not allow the injections.

I'm thinking it's probably a combination of multiple factors?

Losing significant weight will change your face as you lose fat on it regardless of which method you choose to lose the weight.

Even slow and steady weight loss will cause facial changes.
I have lost 8 stone slowly and naturally by calorie counting for the past 3 years, I have recently ended up with the under area of my eyes looking dark and almost 'hollow' as my cheeks still have a bit of fat on them and 8 stone spread evenly over 8 years is not rapid weight loss.

Typo!!
8 stone over 3 years, not 8 years!

this..

You don’t think there’s a middle ground between the GP jumping straight to the strongest steroids and somebody spending a year in agony with 6 wasted appointments, all of which costs the NHS more money?

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

So we’re saying that doctors currently casually hand out prescriptions?

I don’t get all the points like this. There are plenty of medications currently available to GPs to prescribe which need careful monitoring, regular check ups, input from other health professionals, etc. It’s not like they just say “here you go, off you fuck”.

I so empathise! I'm 76 and unable to exercise, even walking any distance is a problem as I suffer from extreme fatigue. I don't count calories but my portions are very small now. Example of meals: Breakfast is 2 X oatibix and cup of tea, lunch is mozzarella cheese and tomatoes with some fruit* afterwards and supper a chicken tagine ( tiny amount) I've cut out all cakes and desserts so my only treat is a small cup of coffee with two pieces of chocolate in the afternoon. I don't enjoy eating at all any more and am so fed up with carrying this extra weight around. Back to GP this week even though thyroid issues have been discounted :-(

• I know this is sugar but it is minimal compared to what I used to eat up until recently!

Maybe because it’s a slippery slope? If the next generation grow up knowing you can eat as much as you like and be sedentary because there’s an injection that will keep you slim, where’s the incentive to live healthily?

I’d agree. There is a reason that people say you can say your face or your arse as you age.

Yes I get that but there's a very distinctive look you get with the ozempic. It's quite obvious I think when that has been the weight loss method. Which is weird in itself isn't it? Can't be good!

The underlying reason for me being fat was that I was hungry all the time. I know what to eat to lose weight but the reality was that this was not enough food to stop me from feeling hungry all the time.
Mounjaro stops me from feeling hungry all the time and I am now happy eating the amount of food that enables me to lose weight. I repeat, feeling hungry all the time was the underlying reason I was fat.

The NHS puts everything into "pots". So there's x amount for staff, x amount for appointments, x amount for drugs etc etc. If you don't balance it exactly for each pot, the pot shrinks next year. So you might need to use up the seventy billion appointments otherwise you'll lose that pot of money next year.

Yes, on its own.

When my daughter had an eating disorder and ate tiny amounts she lost loads of weight. When people go on hunger strike they lose loads of weight. When people don't have enough food eg famine, they always lose weight.

I'm not suggesting people starve themselves, obviously, but eating less calories than your body needs always results in weight loss no ifs no buts.

This

Doesn’t work like that. Needs to be alongside a healthier diet. You can’t just eat junk and lose weight on them.

I think it's because it doesn't fix the underlying cause of obesity. It's right that that has to be addressed as once the injections finish what then? Weight goes back on and you'll want more drugs to fix it.
And these drugs are on short supply for some life threatening conditions.

I don't think blaming the nhs for your weight gain during the programme is right. You didn't engage with their advice and sometimes we have to have accountability for ourselves. Giving you drugs and not attempting to deal with the root cause won't be a long term solution.
And I speak as someone who has naturally and carefully gone from a BMI of 31 to 26 in the last seven months.

Have you looked at self funding the prescription. There are lots of pharmacies that offer it online?

Don’t think that’s accurate tbf. it’s just the faces of people who have lost a DRAMATIC amount of weight, not the odd stone or two.

@Racheltension1

I respect your opinion, but people on the weight loss injections tend to lose the weight far more quickly than people not on them.

A well known, slightly older celebrity for example has lost a lot of weight very rapidly due to injections and because her weight loss has been quick, it's easier to compare her face now after weight loss to before as it wasn't long ago her face was more plump and looked more 'her' and she is regularly in the tabloids and TV for it be be seen.

Myself for example, losing weight gradually over 3 years, the changes have been far less rapid, very slow actually, so people have had chance to see my new body and face change over a period of time rather than me just turning up after a few months with sallow eyes.

I'd be devastated if anyone accused me of weight loss injections as I now have a different looking face to how it was when I was 20 stone and have put my heart, sole and every ounce of willpower into it by not binge eating when I'm stressed (the cause of me being severely obese)

I still have 3 stone to lose so maybe I should brace myself for comments like yours in the future as who knows what my face will look like by the time I get into the middle of the healthy BMI bracket....

Yes my husband had type 2 diabetes. He has lost a significant amount of weight and is no longer diabetic. He is disabled and can't do much in the way of exercise and he has a sweet tooth and likes all the wrong food. He didn't adopt a healthy diet he just had less of everything so a small slice of cake instead of a big slice, a small portion of chips instead of a large portion. The good thing is that now a small portion is enough for him, he couldn't eat what he used to. So I don't think it is about exercise, healthy food choices or any other woo, he just has fewer calories and loses weight. I absolutely know that not everyone can do it as it takes a lot of self control but at the end of the day it isn't rocket science, reduce calorie intake enough and you do lose weight. I suppose the secret is how you manage to reduce the calories, self control or drugs.