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.

A genuine question and this is not a dig, but what happens when the drugs stop? As they will have to eventually, and if it's a physical issue like hunger that will come back. You'll regain the weight and your back to square one. How will that be addressed

I totally agree with this. If you eat less you will lose weight even if you don't exercise. I don't know why people don't believe this. It's just down to will power.

Haven’t kept up with the full thread, but does anyone work in mental health services here? Patients with an SMI die on average 15-20 years earlier than the general population due to preventable diseases, primarily cardiovascular disease. A significant proportion of this increased risk is directly as a result of atypical antipsychotic drugs, which cause obesity, high cholesterol and diabetes.

If the NHS is able to increase the accessibility of GLP1’s, I’d argue that this group should be the highest priority. What I think we should be looking at is preventative treatment with GLP1’s for SMI patients starting atypical AP’s, and removal of the eligibility criteria for GLP1s for those already on them with a high BMI. We know what the consequences are for patients taking mental health medications, alongside all the other risk factors.

It's a funding issue. Tier 3 services are specifically funded to provide weight loss support to patients whereas GPs are not. I think there is also a supply issue with weight loss jabs. I agree that as much support as possible should be given to help people lose weight but the cash to do so has not been provided by the government thus far. So they then have to spend more money treating weight related illnesses. A false economy!

I was sad to see Drew Barrymore has gone down this path.

I wouldn't mind losing a couple of stone but personally I wouldn't touch these drugs - there are already reports of some very sinister side-effects. The NHS won't want to pay because as soon as people stop taking them, the weight goes back on - they'd be bankrolling the prescriptions for decades. It's not sustainable - healthwise or financially IMO

But loads of treatment, not just related to weight, has hoops. It's - and you'll hate me for saying this - to discuss relationships around food, exercise etc. I would think it much more safe for the NHS to try and encourage weight loss naturally than the first port of call be jabs. Just dishing them out willy nilly isn't tackling the root cause of obesity

Surely you could just stay on the injections for life provided you could afford it?
Also the fact that obesity is such a big problem provides a large incentive for pharmaceutical companies to provide even better (meaning more effective with fewer side effects) weight loss injections.
That being the case it won't be a problem staying on them for life, surely?

They were turned off when the post was made. This usually happens when the OP already knows they're being unreasonable.

I don't think natural weight loss is realistic or achievable when we live in such an unnatural environment.
When I say unnatural I mean from the point of view of the food that is available, i.e the constant temptation from highly palatable food-like substances which have been engineered to be as addictive as possible.

@Iloveeverycat it's really not as simple as willpower. If you want to be informed read Ultra Processed People by van Tulleken or Why We Eat by Andrew Jenkinson. Or if you don't want to be informed you can carry on lazily believing "it's all about willpower".

Blackshuck3 I wasn't sure you can stay on them for life without an underlying health condition? Would that not mean you'd creating more issues for yourself. I genuinely don't know hence asking

If you can afford to buy them privately or you can access them on the black market you can stay on them for as long as you please.
I'm not saying that's advisable I'm just saying you could.

It is because I've done it. It's not easy though!

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.

If so many people already know this why don't they apply it to their own lives?
There comes a time when we have to take responsibility for our own actions. Why blame and penalise the rest of the population and expect us to share the nurses time and other resources with those who can't be bothered to control what goes into their mouths food or alcohol?
The NHS is for people who are ill not for the can't-be-arsed team.

There’s much more science to it than willpower though.

Fair enough. I think that's a very unhealthy way to live.
I do think supermarkets and governments need to make healthy food cheaper and processed food expensive so we are drawn to healthier options like fruit and not a grab bag of crisps for example. And I've been there and done it. I'd choose processed food every day it's been a real struggle lose my weight

Pushing healthy natural steps to lose weight through diet and exercise isn’t jumping through hoops though. As with any quick fix, unless someone learns to control their weight themselves then injections are just a temporary fix.
It’s not sustainable to be injecting these medications forever.

So you know that it's achievable for you, but that doesn't mean it's achievable for other people.
The levels of obesity and the levels of recidivism strongly suggest that it's not achievable for most people.

If you eat less you will lose weight. Look at the contestants off I'm a celebrity. Some lost 2 stone by the time they left.

The hoops are rationing. The NHS cannot afford for everyone to have these drugs. Even if there would be future savings it does not have the money right here and now to spend

OP you say you knew all the healthy eating advice but I am sure there are many people who actually don't and would benefit from having that knowledge even if they also need surgery or injections. Surely the surgery and injections have to go alongside people changing their habits and they need knowledge and accountability to do that.

You do see people who regain weight after weight loss surgery because they learn how to get around the restriction and consume more calories even if it makes them ill. It's a waste of a precious resource to give that surgery to people who won't ultimately benefit. Same as a liver transplant or a detox of you are not ready to stop drinking.

Lots of treatments are rationed because we don't have the resources. They are rationed by a waiting list if nothing else. I guess you could have just sat around on a waiting list to have the surgery but it seems productive to try to use that time to impart some knowledge that might have helped some people.

So I think it's all of

• no money to give it to all
• wanting to select out people who will have long term benefit
• wanting to enhance the effectiveness with education

I wouldn't mind losing a couple of stone but personally I wouldn't touch these drugs

You don't need to 'touch these drugs' at a couple of stone overweight. It is people who are classified as obese who could be significantly helped and for whom it would mitigate some of the long term health risks associated with obesity.

Get rid of all bread, cookie, rice, cakes and sweet mueslis in your diet, bump up the porridge, meat, fish, fruit and veg and in three months you would be down to the correct amount of weight - neither overly skinny, neither feeling hungry

Except it is possible. Biologically, we're designed to gain if we eat a lot, and lose if we don't. Agreed that it may be more difficult, but it is definitely achievable. To say otherwise is crazy. We're all the same species, after all. The process of losing that amount of weight is not fun or easy, but everything is too much like hard work for us these days as we've been spoon fed everything and had our lives run on convenience.

I’m a little confused… I haven’t had any problems with being offered weight loss injections from my GP.

I was diagnosed type 2 diabetic 2 years ago now, and have been on Ozempic from my GP for about the same amount of time, along with metformin/dapagliflozin. I was 23 stone and now I’m 16.5 stone. The weight loss has slowed down, but is still happening. I was very sick with it to begin with, but after about 4 months the awful side effects stopped.
There was a few times when it was difficult to get hold of my prescription, but that seems to have sorted itself out now.

I do worry that that it maybe stopped… I know that I would easily fall back into old habits. The injections not only make you feel fuller, but actually puts you off some foods!

whilst I am glad to have lost the weight, it has also left me with spare skin on my arms and tummy, but that can easily be disguised, so is not a huge problem to me. I think people aren’t clear on how massive weight loss leaves you. If you’re not able to cope with an ‘imperfect’ body, it will not be useful to you at all!
( I know it’s not just me… a person I work with who also was diagnosed type 2 diabetic has similar ‘problems’’ to me.)

I have a BMI of 45. The only thing I was offered was a one hour virtual seminar on the food pyramid.

I'm fat, not stupid.