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.

There is approximately 10-15 year gap between research and practice. Chances are, the drug will be available on the NHS in the future, but there is along process of evaluating evidence, doing risk vs cost vs benefit analysis and amending NICE guidelines.
The same process happens with most medications and it is annoyingly long, but sometimes, necessary process. Just remember how much uncertainty and publicity there was around covid vaccine being expedited due to unknown long-term effects. Public wasn’t happy about it and, you can see on this thread that the public isn’t happy about WL injections either.

But that is my point . Perhaps a certain amount of people WILL need to be on it for life ..

In the other hand they will be on insulin , bp medicine, metformin, aspirin and of course many obese people are also on anti depressants because being obese is fucking miserable and limits your lifestyle .

So people here are honestly saying they think it better for those unable to pay privately, they should just keep taking all the medication associated with comorbidities related to obesity rather than one drug to keep them away from that ?

Ok then . All I can say is that you have never suffered the horror of morbid obesity/obesity.

YANBU, I have several health problems including an underactive thyroid, the consultant at the Pain Clinic felt I would be an ideal candidate for the injections. I have been referred by my GP at the consultant’s request to the dieticians at the local hospital. I received a letter saying I had been put on the waiting list and they would be in touch when I reached the top of the list. When I looked on their website the wait is around 3 years, and they hope at some point to offer weight loss medication to a wider group of patients, as per PP they implied that weight loss surgery might be offered at an earlier stage!

I have decided to pay myself for Mounjaro, I have lost and kept off 10kg since last summer and reversed being pre diabetic, but it is very hard, especially as I have a chronic pain condition as well.

I suggest those judging people who are obese read Chris Van Tulleken’s book Ultra Processed People, he is very clear that people who struggle with their weight have tried much harder to lose weight than anyone who has never been overweight can ever imagine. There is much research into obesity that indicates it is almost impossible to overcome it with diet and exercise alone, I can also recommend Why We Eat Too Much by Andrew Jenkinson to explain the science behind this.

I do understand how it works and the effects it has (although I would suggest if your appetite is suppressed to that point you may need a lower dose as you should always manage to eat TDEE minus 500cals including a good amount of protein to maintain health, metabolism and weight loss. Ideally the drug should help override urges to overeat without nausea or totally suppressed appetite)
What I am suggesting is that the input required to encourage patients with no understanding of nutrition and no previous experience of eating well to eat healthily would be huge. A lot of the patients I have worked with do not choose to diet even knowing that their health is impacted and, on this drug, would exist on e.g. one slice of pizza a day then rebound when off it

Cost-benefit analyses of these drugs has already been undertaken as part of the NICE evaluation process. This will have factored in predicted savings associated with delaying or averting obesity-related comorbidities and complications. If they are not recommended for a particular group, that's because the analysis suggests they will not be cost effective at current pricing.

The major problem is that the data show that about two thirds of the weight lost is regained within a year of stopping the drug. Therefore if they are prescribed for a limited period they are postponing rather than preventing the obesity-related issues, therefore not reducing the costs as much as you might think. The alternative would be that they are prescribed indefinitely, but then it's much harder to offset the enormous cost of the drugs.

For the same reason they fund smoking cessation and “exercise on referral” - it’s cheaper in the long run for all the reasons the OP outlined. In fact, most common medical interventions can be avoided if a person made lifestyle changes. So should we stop treating type 2 diabetes, depression, anorexia nervosa, coronary heart disease…

I just looked it up. £200 per week privately!!!

I had no idea it was so expensive, although I expect considerably cheaper to the NHS.

I agree with you though OP.

I totally agree OP. There literally is a magic 'pill' (injection) to solve the obesity crisis and will massively improve the NHS as all the overweight people will obviously be healthier. And yet it's still not available for most people.

That's per month, not per week

@thereiscustardinthejamtart that’s per month

@HighlandCow78

Why should the already underfunded NHS have to fund blatant lack of willpower? I’ll admit that I’m a bit overweight at the minute. I need to get a grip, eat less and move more, so I will. It’s that simple. I don’t feel the need to place the blame, or the bill for my own bad choices on the state.

A 'bit overweight' is not comparable to morbid obesity... and if you really believe that obesity is caused by a 'blatant lack of will power' not are you unkind but also woefully ignorant.

People on these types of threads are obsessed with loose skin.

Its not mandatory to get it removed, people seem to think it is!!

I have it, one day I might decide to do something about it, but right now Im just enjoying a new life!

Key reason currently is cost Ozempic costs the NHS around £80 a month. Wegovy £180 once you are on the higest dose. Average blood pressure medication is around £1 a month, which for the majority of paitents will manage their blood pressure well. Thus reducing risks of cardiovascular issues.

Currently there are shortages of these products, and even those that need them for diabetes are having issues with supply - this has eased the last few months. However it would be unwise for the NHS to suddenly allow these to be mass prescribed as those people who need them to actually keep themselves alive would struggle a lot. Manufacturing would need to be increased a lot before it would be wise to allow it to be prescribed for more conditions.

People keep saying 'it's cheaper in the long run' to fund the injections but this needs to be evidenced. It might be true, but then again it might not. That's why NICE and the SMC undertake extensive evaluations of new drugs, to try to understand whether the cost savings and quality of life improvements are sufficient to justify the cost of the drug. You can't just assume they are cost effective and blow the budget.

Ah! Boots website very misleading 😅

But wouldn’t money be better in treating the cause rather than the symptoms? Maybe that’s better education at school around nutrition and the huge impact ultra processed food has on our health, maybe it’s more mental health support for those that use food as emotional support or don’t have the willpower to make changes, maybe it’s making healthy nutritious food affordable. I know this doesn’t help anyone struggling with their weight right now, but for a developed country we should not be this unhealthy.

About 20% of children under 16 in the Uk are obese - should we accept that because we can just give them a weight loss injection for life once they reach 18?

Mounjaro is started to be prescribed more a few of our patients have been offered it in the past month (community mh) all are pre diabetic or have diabetes and all obese

but most are reluctant to take anymore medication than they have to (they are under conditions to take mh medication)

I think it is started to be prescribed more but it won’t be for people who are a stone or two overweight it will be for those who are long term obese

Do you mind me asking which one you are on and how much you've spent on it so far? I'm really considering it x

I agree@AutumnLeaves5 . There needs to be a massive cultural shift in how food is viewed, and consumed in this Society. The teaching of nutrition in schools is just inadequate.

I think they have probably worked out that it's too expensive. As pps have said BP meds and insulin are probably a lot cheaper! Also, it just isn't statistically true that every obese person will be diabetic and have high BP.

It would be nice if they were available for longterm, morbidly obese people. Not every obese person. That would be ££££££££££££

True.

But the other dynamic is that the price isn't set in stone. The manufacturers are going to ramp up production to a point where they can make as much as they can sell, and at that point there will be a deal to be struck with the NHS - NICE may loosen up their recommendations as evidence of long term benefit and safety improves and that decision will change if the price is right.

And of course in 2031 it will come off patent and become properly cheap. In between now and then there may be a grey market for Chinese imports (it comes off patent in China in 2026), so that might increase the manufacturers' motivation to strike a deal with the NHS.

I'm intrigued by Japan, ok they've never had an overweight population problem but what is so different there?

Bang on 👍

I think it 5 years time it will be more available, and it 10 years time it will be less stigmatised, with more people recognising that there is a real difference in how bodies work, and that obese people are not just stupid or lazy.

Think of the difference between 10 years ago and now with ADHD. There used to be a bunch of people saying that it wasn’t real/ kids were just badly disciplined/ lacked self control/ weren’t getting enough exercise. Now there is more understanding that it’s a medical condition and that medication helps.

How did you get approved it if you were only 16lbs or so away from healthy weight? My BMI was 30 so on the edge of criteria and I was over 3 stone away from healthy weight.