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.

@jasminocereusbritannicus

That's great for you

It varies from area to area some GPs prescribe specifically only to people with diabetes and others not at all

Where is your evidence that people are doing this?

If the government as no rationing at all and tej drugs were freely available from the GP the loads of people with only a small amount of weight to lose would definitely want them

So there needs to be some rationing at least by BMI surely so that they are prescribed for those people whose obesity is a medical not just a cosmetic issue

Currently it's rationed by BMI and medical comorbidity which surely most people can understand but also by attendance at these courses etc which it seems to me is essentially a bit of a test of motivation. Like requiring drug and alcohol addicts to engage with a community rehab programme before they get an inpatient detox. If you don't do that you just end up repeatedly detoxing the same people at great expense with them relapsing straight away. I think there is some kind of reasonable analogy there that weight loss drugs and surgery have their place but ought to be accompanied by some motivation and commitment to a diet and lifestyle change.

And in the meantime there is an obesity crisis in young children. If I was a cynic I would be taking out shares in weight loss drug companies because they are going to be a money spinner for the next fifty or sixty years until people stop feeding their kids meals full of fat and sugar and topping them up with unnecessary snacks in between. When you have four and five year olds wearing clothes sized for seven year olds the alarm bells should be ringing.

Nobody should be getting them while diabetics cannot due to demand.

I share your frustration, and that the obesity 'help' given is useless - I did a trial with a nutritionist over the phone who sounded about 12 and who did not tell me anything I did not know. The NHS really does seem to be stuck in the whole -its easy, eat less move more mentality and I would guess there is no push to move this along.

Do you take medication for any long term ailments though? I'm almost certain that an anxiety med I'm on has contributed to a 5 Kg weight gain since I began taking it two years ago.

To the pp who think it's easy to just eat less and lose weight. I'm short, have an active job, exercise, and walk over an hour a day with a fast dog. My BMR using all these is 1300 calories. To lose 1lb a week, I need to eat under 1000 calories. That's not fun or easy. Especially factoring in the menopause.

Surely it can't be good to take medication for life, unless it's actually keeping you alive. Not that long ago there weren't large numbers of obese people requesting these drugs. It's got to be better to educate people about how we've ended up with such an overweight population so this issue can be rectified than offer drugs as the natural option.
Obviously I'm not including people who are overweight because of existing health conditions like rheumatoid arthritis, disabilities that affect mobility etc

There's a shortage so it's rationed. OP has a gastric sleeve box ticked. Another patient is diabetic so needs the jabs.

Only alternative go private to lose the last of the weight

I don't understand this argument.

In and of themselves they are not life saving drugs. They are a tool to aid weightloss. They are not the only way to lose weight though.

My MIL was type II diabetic. She went on a diet, lost 9 St and came off her medication. It was really hard and took determination but she did it. If you're that ill due to obesity you need to do everything possible to avoid losing your life or even a limb!

I don't disagree with you (on taking medication for life) but compared to being obese for Life it might be the least worst option🤷🏼‍♀️

So are you saying people shouldn't take personal responsibility for what they eat? I find that incredible.
Presumably we are in the same country and I feel no compunction to eat fast food. I like cake etc but I'm not eating it 24/7.
I want to eat healthy food because I value my health in the same way I don't drink loads of alcohol despite seeing it everywhere. I know it will make me feel bad, so I have the odd glass.
I really feel personal responsibility for your health and how to go about it is something that should be on the curriculum.

So are you saying people shouldn't take personal responsibility for what they eat? I find that incredible.
Presumably we are in the same country and I feel no compunction to eat fast food. I like cake etc but I'm not eating it 24/7.
I want to eat healthy food because I value my health in the same way I don't drink loads of alcohol despite seeing it everywhere. I know it will make me feel bad, so I have the odd glass.
I really feel personal responsibility for your health and how to go about it is something that should be on the curriculum.

What magic secret did you think they might tell you? Surely all the injection (and indeed surgery) does is make it easier to eat less. It doesn't suggest there is some different paradigm other than eat less move more.

Once someone is obese it is very difficult to make the necessary changes as vicious cycles are set up and habits are ingrained. All the data do suggest that it's hard to make a sustainable change so anything that assists is good but it's just assistance. Fundamentally changing diet and lifestyle will still be necessary. As someone else has said what about obese kids? Are we going to jab them all too?

We do live in a massively obeseogenic environment and it requires active resistance to avoid weight gain. I don't think it's a personal moral responsibility problem I just wish that the government would take some decisive action like they did with the smoking ban because this is a public health emergency and we need to stop people from getting to a point of leading lifelong meds.

It is on the curriculum.

I can think of several conditions that aren’t life threatening but which require lifelong medication. Management of chronic pain springs to mind for starters. Also, it’s so patronising to say that people need to be educated. I honestly doubt there’s an obese person on the planet who hasn’t heard it all. It’s a bit more complicated than that.

Yep - and ofc some meds impact appetite etc. And like I say, it was really hard. I consciously decided to shed weight, it really wasn't fun. I love carbs.

I'm not saying they shouldn't take responsibility, more that it's not that simple.
I speak as a lifelong health freak, I have never been overweight, I have always exercised; weight lifting cycling swimming running yoga etc.
I never eat junk food, I have no difficulty controlling the amount that I eat or controlling my weight.

What about the nutritional effects?
If feeling full is the objective - and that is a hormonal issue as much as anything else, and the injection achieves a feeling of fulness without eating (as much...?), -where is the actual nutrition, and everything that includes, coming from? Especially if a poor diet is still kept to, just less of....

I know (of) someone who has just lost a lot (but still has massive boobs, a but like Katie Price|) and has now had various pieces of skin cut off. I wonder what will happen if she unfortunately regains if/when stopping the drug.

She is involved in/co-owns a Gym, and to me, is a really bad example (and also offers the injections herself). Is on fb, so no big secret.

@Iloveeverycat Yes you will lose weight if you eat less, but it's not as simple as willpower over a sustained period of time. I don't think that you can compare the environment of that program to ordinary life. As I said, perhaps inform yourself of the environmental, food type, calories in/out, weight set points and genetic factors which van Tulken and Jenkinson explain in layman's terms (or if it's easier for you then carry on being uninformed).

I was looking for some help I could not access by myself. It is not an issue of information for me - but something that would have changed hormonal make up like bariatric surgery or the jabs do. I get that they want to check your level of understanding, but the nutrition course was absolutely useless. After a life of struggling with my weight, it offered absolutely nothing of value. And there was nothing else on offer.

Don't know the truth of it but if heard GP's were giving tablets rather than jabs as much of the injectable drubbing was being grabbed by private weight loss clinics. Presumably they feel they can charge more for jabs than tablets.

If she is selling them herself then she must be purchasing them on the black market in bulk with a view to making a profit. I would suggest that her legitimate business is actually a cover for drug dealing.
(The drugs in this case being unlicensed black market pharmaceutical products)