AIBU to think it's time for the NHS to do itself a favour and make WL injections readily available.

[nextdoorconundrum]

I've posted about this before but following the news today from the chief scientific officer for the British Heart Foundation - Professor Brian Williams - that the health benefits of these drugs appears to be beneficial in the reduction of heart disease, high bp, stroke , arthritis and even Alzheimer's.. (interviews on R4 today programme and channel 4 news just now for anyone wanting to hear all he had to say ) .: Is it not time now for the NHS to actually save itself the fortune it spends in treating obesity related diseases - rather than obesity itself.

There is also something highly questionable about a drug that is readily available to people who can afford it - but is mostly not available to those who most need it . With extremely narrow parameters and some ridiculous hoops to jump through before being 'allowed it on the NHS.(Obesity affects 39% of women in the most deprived areas as opposed to 22% in the least )

www.nice.org.uk/guidance/cg189/documents/health-inequalities-briefing-2#:~:text=The%20greatest%20rates%20of%20adult,in%20the%20least%20deprived%20areas.

I say this as a financially comfortable mc woman who has lost 4 stone on WL injections. I no longer cost the NHS any money in BP drugs, Sleep Apnea machine, Corticosteroids for knees etc - in fact for the first time in 26 years I only take thyroxine which is not something that can be reversed. The only reason I have managed this is because I could afford to buy it. Surely this is not only wrong but immoral in a national health system ?

The argument of 'is it safe ?' doesn't hold water . It has been approved through extensive and thorough trials across both the United States and most of Europe. It is no more or less safe than any new drug.

The argument of 'some people get nausea and vomiting and other side effects ' yes this is true. As do some people on all kinds of drugs . I personally can't tolerate penicillin - doesn't mean it should not have been allowed to save the lives of millions for 70 years. !

Last but not least.. what happens when you get to a healthy weight and stop taking it ? Well I guess it's exactly the same as blood pressure medication. You take it when it creeps up again .. perhaps it just becomes one of those drugs that you take lifelong on and off to maintain good health ..

Far far cheaper than treating all the current diseases associated with obesity and morbid obesity..

YABU - we can't afford it
YANBU - it's a false economy not to make it readily available to people with obesity if they want to try it.

I see both sides.

Tackling obesity would massively reduce the strain on nhs and mental health support, let alone save money on fuel consumption and is better use of space (as in people weigh less / take less space up in small areas etc)

It could potentially save a lot of money but if the people are still consuming so much food the impact on the environment will still be there etc.

Big people will raise big children and the cycle will repeat- so how does the drug deal with this?
Would the smaller people feel more inclined to exercise as it impacts less on joints and therefore it solves the problem or will people then be lazier as there is no need to exercise and therefore raise kids who don't see it as important?

I think it's a no brainer if it saves the nhs money. There could even be a loan system like a student loan, potentially where the person pays I back pre tax if there is not the money in the pot?

My adhd meds make me far more productive and I therefore am able to save the country money by doing more in my working day and not having time off work. So I see the theory.

My back of envelope calc's...
14 mln children in UK
67 mln ppl in UK, of whom 58 mln in England (86%)
54 mln UK adults, of whom 25% are obese, call it 14 mln
Suppose only 25% of them want these drugs, 3.5 mln, or will have the equivalent doses each yr.
Cost seems to be £70/week. 52 weeks a year, 70 x 52 = 3640.
£3640/yr, 3640 * 3.5 mln = £13 billion a year.
I don't cost the NHS £3640 a year for any health issue much less a preventable health condition.
I could be kind of annoyed to be asked to help subsidise that.... for a condition that can be treated much more cheaply and is usually preventable.

NHS England annual budget is about £181 bln, 86% of £13bln is £11.2 bln. Wegovy doses could be 5% of total NHSE budget.

ps: being obese is mostly very socially unacceptable in Japan AND they do active travel all the time, a great place to walk or cycle.

Exactly. You are talking about a medical need. This is what I have been trying to get across. This isn't about an 'easy option' for all and sundry who want to lose a few pounds.

I disagree as weight is mostly about nutrition and there are always safe ways to exercise, it's just about priorities and mobility.

The issue is that the bigger you get the harder it is to exercise safely

I can't walk far or stand for long periods. I have no idea how to start exercising. I tried to see a physio at the doctors who said lose weight...

Also how much are these obese people paying on food bills compared to being a healthy weight? Is it more or less expensive to be slim?

I think there is a belief that obese people pay a lot more for food ie takeaways nightly, so therefore it is a lifestyle choice. Where as often the cost of crap food is far cheaper than buying healthy or meal prepping.

I think the lifestyles / values of the ultra healthy and the obese people are so different it's hard to find the common ground, to actually imagine how debilitating obesity is and understand the need for the drug.

I haven't been able to even see a physio so don't let that stop you. I found YouTube guides to gentle exercise for my ability which helped loads. I also know weight loss is 80% diet and just 20% exercise. I've barely exercised in my own loss and still reached 80 lbs down so really don't let it hold you back. Keep chipping away at it with reducing calories, actual portion controlling, upping your water intake and little steps. You can do this and unfortunately nobody can do it for us so what other choice do we have? Wishing you and all others on here every success

ps: being obese is mostly very socially unacceptable in Japan AND they do active travel all the time, a great place to walk or cycle
I think this is a very good point @lljkk
In my view the primary cause of obesity is to do with the obesogenic food environment and lack of exercise opportunities, and the normalisation of obesity would be a secondary cause.
It seems plausible that there could be genetic factors which make Japanese people less prone to obesity?
Can we adopt things from other cultures that would help us in the UK?

I think the problem is that the doctors also don't understand or have the time to help
People carve a fitness plan that is accessible to them.

For yourself if your barrier is your size and weight I would give you very small daily goals which increase and are achievable, but to give these goals takes time to understand your daily life if you see what I mean (and I am not a pt but love fitness and program for friends and colleagues as a hobby)

If you struggle to stand I would focus on this and then sat or led down movements. Mobility is so important and so difficult to regain

I'm not sure we have lack of exercise opportunities nowadays. People in the past mostly didn't exercise because they "could" or because they wanted to, they exercised because they had to. We evolved in an environment where we had to fight for every calorie. That has implications for our instincts concerning food, but also for our instincts on exercise.

@InfradeadToUltraviolent
We are in agreement. Prior to modern times exercise happened by default. It no longer does (for most of us) ergo we are lacking exercise opportunities!

Exercise will not make you thinner unless you are able to create a 3500 deficit. 10k steps a day x 7 days = about 1 Ib of weight. That's 35 miles a week !!

Exercise improves cardio vascular health which is a good thing.

The only way to lose weight is to eat less. That's why the weight loss jabs are amazing. They make that easy - and then when you get thinner movement gets easier.. and you lose more. A moderate amount of exercise with a much decreased food intake is the ideal .

We aren't though. We can exercise by taking stairs instead of a lift. Or if we are chair-bound we can do gentle movement exercises at home. I do my exercises at home either just before bed (on my bed, core exercises like sit ups, leg raises etc) or while I'm making a cuppa I might do some arm exercises while the kettle boils. We cannot go down the route of blaming others for our own inability to do exercise

Sorry your maths is way out.

The cost is £80 PER MONTH. to the NHS . I have never paid more than £149 privately !!

You have also failed to remove the cost of those people being obese.

@HeySummerWhereAreYou

And frankly, your comment that I am 'lacking in knowledge' about weight struggles, and eating disorders, disgusting - and insulting.

I mean you used the good old 'cut down food and increase exercise' so I based my comment on that. I certain didn't mean to insult you at all but if you make a comment that suggests you don't really have the knowledge then people will assume that you don't.

I don't think I was being rude but I apologise as I do seem to have upset you quite a bit.

On Japan - I am at a food market in London. I have just bought lunch from a Japanese food stall - they were selling modest bowls of sushi rice topped with pickled ginger, wilted bok choi, half a boiled egg and then either strips of lean pork, chicken or tofu.

Next door was an American waffle stand selling massive waffles topped with pulled pork, BBQ sauce, melted cheese, bacon and maple syrup or sweet ones with chocolate, cream, bananas and sugar sprinkles.

We'd need a health economics team to work out the cost and clinical effectiveness. Together with the Treasury, they'd be able to assess the impact on wider productivity and the economy.

There would be people with (largely treatable) side-effects which the NHS might not necessarily have the capacity to cope with for some time. E.g., gallstones are a common consequence of rapid weight loss and some people will need treatment for that. There will be people with substantial excess skin to be removed because folds of skin can develop extensive fungal infections that need treatment.

There may well still be substantial savings in other areas but they may take a while to play through while the nearer-time side-effects might need treatment far sooner and increase some costs.

If I just want to lose a stubborn stone, roughly how many injections would I need?

I can probably guess which had the longest queue!

It was the same at a food market I was at recently - buddah bowls with bulgar wheat, hummmus, beef/chicken/tofu, pickled cabbage and a chunk of flat bread which was all delicious, fresh and nutritious. And then another stall selling loaded fries. Both were the same price but everyone was queuing up for the fries.

Difficult enough in itself to assess, I think. Say 4-12 months, depending on how long it took you to titrate to an effective dosage, your starting weight, state of health etc. ETA: maybe also if the "stubborn stone" is for personal reasons or actually puts you in the overweight/obese/morbidly obese category. (Assuming someone isn't already lowest BMI for their height etc. or actually underweight.)

Maintaining that loss might mean you'd need to continue to take the drug (maybe at a lower dosage). Say, another year or 2. Maybe more? It might depend if you're TTC, pregnant etc.

However, someone might have some actual data for you that I haven't seen.

ETA: also may depend if stubborn stone is body fat or lipoedema which doesn't always respond well to weight loss.

The health economics analysis has been done/is being done as part of the NICE assessment process, although worth pointing out that NICE formally only considers costs/benefits to the NHS and PSS, not wider societal benefits such as work productivity.

Are you within the prescribing range? Your BMI needs to be obese > 30 to be prescribed initially. Unless you have other specific health issues then they sometime prescribe to those with a BMI > 27 after a consultation.

It could take one month, it could take 6 or even more. If you only have 1st to lose, even if they prescribed it, I don't think it would be an appropriate or sustainable way to lose just 1st.

I don’t have a moral stance on this ( or skin in the game, pun intended). However, I have looked in an amateur way, at the mechanism by which at least one of these drugs works. They ‘suppress the appetite’ not by some pseudo psychological process, but by lengthening the time that food takes to pass through the gut and be expelled, that is by altering the basic processes of digestion.

That sounds like a recipe to disaster to me.

I agree with you but a lot of people just don't want to hear it.

It's the ones who say "I've done everything, made better food choices, really exercised hard and I've lost no weight". I just don't get that.

Yes, 30.5. I don’t want to take it for months. I have cut down on portions and carbohydrates but it is stubborn to shift. Ideally I should lose 2 stone , but 1 stone would be a good kick start.