AIBU to seek a consensus on who is a socially acceptable recipitent of Mounjaro?

[Periperi2025]

So it seems that much of mumsnet and society judge users of WLI extremely harshly seeing them as fat and lazy people who should just eat less, move more and use more willpower. But apparently not all of us, some of us after divulging enough medical history as 'okay'..."not you just the other fatties!!"

So, are people with diagnosed endocrine and metabolic conditions, acceptable?

What about people with undiagnosed endocrine and metabolic disorders, it's taken me over a decade to get to the point i am now, which is under endcrinology with a confirmed 'problem' and a working diagnosis but nothing more, my story is sadly far from unusual. You don't know who they are, they don't know who they are (although they may have astrong inkling), quite the conundrum!!

What about people with diagnosed Type 2 diabetes, who once were also just fat people without type 2 diabetes (mostly)?

What about people who are just fat now but statistically likely to develop type 2 diabetes in the future, like the current Type 2 diabetes patients were 10 years ago?

What about the people with severely disordered eating? As a society and a health service we deem it justifible and, hopefully preferrable to treat Anorexia Nervosa, including as inpatients at great expense (£500+ per day in the NHS), compared to treating an obese eating disordered patient with Mounjaro at a cost of approx £9 per day to the NHS for the highest dose. Presuambly in a civilised society we think that both groups of patients deserve a chance at a better quality life and improved life expextancy, and we dont think that Anorexics should just eat more and move less?!

So my AIBU is?
Are all of the above groups socially acceptable recipitents of Mounjaro?

YABU - no there are not all acceptable the gluttunous, lazy, weak willed cheats.

YANBU - of course they are all socially acceptable recipitents given that they meet the prescribing criteria for Mounjaro which has been accessed for Risk vs Benefit via peer reviewed research.

What, you don't think a normal weight person with PCOS or heart failure might not be a tiny bit upset at not having this options open to them to ease their suffering?

My proposal is promoting healthier diets and more active lifestyles. There's more than enough evidence that these things are good for us. WLI is an unaffordable dependency. The NHS won't be around in it's current format to fund it for long, unsustainable and individualistic. We'll regret relying on it in the long run.

I am not overweight and I am not jealous I can’t take a GLP1. You might see a few people who work hard at weight say this - I do work hard at it but I assume it’s the same as someone on a GLP1, watch what I eat and exercise, isn’t this what most people have to do? What’s to be jealous about!

@Digdongdoo I think everyone knows what a healthy diet and active lifestyle looks like. The question I always come back to is why that has failed and continues to fail on such an epic scale? Why has global obesity increased so significantly if everyone knows this and there is evidence it works. There may be evidence it works, but the global obesity epidemic that is only getting worse suggests that in reality it isn't working!

Shouldn't we regret having our head in the sand and being in denial about the clearly failing strategy that you are advocating?

But you proposed it as an alternative to WLI.

There's no evidence at all that it works on a societal level to tackle obesity, and there is evidence that formerly obese people regain the weight at lower rates when using WLI than when attempting to diet. This is known. You're advocating for something on the basis that you'd like it to work. No more than that.

Relying on wishful thinking over treatment with superior evidence like WLIs will hasten the demise of the NHS.

I think NICE/the NHS are far better placed than I am to make cost benefit analysis (and health benefit analysis) on who should be getting WLI on the NHS than I am.

So I think the people it is currently prescribed to is the right population, but that this should be kept under review and we better understand what the long term picture looks like for those taking the drugs, innovation in this space and the future cost changes both for the drugs themselves and the other NHS costs associated with the potential patients.

I have a modicum of sympathy for those who think they should get it on the NHS but don’t (the same as when I hear about the NHS won’t fund a multimillion pound drug to save one life), but I trust them to make the right decision based on the information available to them that I do not have and am not qualified to interpret.

I do understand a lot more than you think.

Research is going on but in the wrong direction. Most Research quoted on these types of threads is about how the obese person can't help themselves because of genetics or metabolism or whatever.

What about doing Research on taste buds & their links to the brain that in return will tell the digestive track to get ready for whatever is coming?
Think about it: 1 glass of diet fizzy drink v 1 glass of sugar fizzy drink.

Diet fuzzy drink: you fool the taste buds that sugar is entering your system... but what happens in your digestive track when the sugar isn't there? How does the brain respond? Asking for more sugar!?
Sugary drink: the taste buds, brain and digestive track have received what they thought they would get.

And then you have to think why you reached for a drink in the first place. Would it not have been better to drink water? As both diet & sugar drinks will make you drink more. One because you fooled your body and the other because sugar does draw water from the body.

Recognising and acting on these types of traps is far better than the lies we tell our bodies through diet and medication.

But there is evidence! Not everywhere has an obesity epidemic like we do. There are obviously changes we could make that would help. It's a modern, western phenomenon and it isn't something we can medicate away. Normalise it, and lifestyle changes won't happen which means the next generations will down exactly the same path. Such short termism is expensive and short sighted.

@Digdongdoo the worldwide prevalence of obesity has more than tripled between 1975 and 2022. Obesity is now recognised as one of the most important public health problems facing the world today. In 2024, the NCD Risk Factor Collaboration (NCD-RisC) published findings that estimate that more than one billion people in the world are now living with obesity, nearly 880 million adults and 159 million children and adolescents aged 5-19 years.

Again, I ask, why is your diet & lifestyle advice that has been in place for 40+ years failing?

My proposal wasn't "diet and lifestyle advice"...

@Digdongdoo I must have misunderstood what did you mean by this?

Digdongdoo · Today 10:25
My proposal is promoting healthier diets and more active lifestyles.

Just expand the quote history for the context. I wasn't on about leaflets or whatever...
There's obviously never going to be a consensus here. Almost everyone thinks that their particular circumstances are most important and unique, but the NHS can't afford it so it would be daft to create that dependence. I wouldn't want to put myself or my kids or grandkids in that position though. We've had more than enough short termism, it's time for radical change. Bu you're welcome to disagree with me, I don't really care.

Most countries in the world were subject to rationing (or enforced starvation) 1939-1945 and beyond. Relatively few of those countries have an obesity epidemic today, and the obesity epidemic in the UK didn't hit in the 1950s or 60s, 70s, 80s or (largely) the 90s.

Epigenetic mechanisms are also reversible. There's believed to be a close link between obesity and epigenetic dysregulations - and there is, I believe, research going on in a number of places around the world into how these dysregulations can be resolved through natural compounds in certain raw foods - ie, following a "diet" which incorporates these foods.

@Digdongdoo I don't want to disagree for the sake of it, I am trying to understand your point of view and those with similar views. You seem to want to advocate continue doing what we've been doing for the last 40 years, which as far as I can tell is a spectacular failure. My definition of failure is the national and global increase in obesity.

Obesity and all the side effects that come with it currently costs the NHS £6.5 billion a year. If every obese person took WLI the cost to the NHS would be £3.5 billion.

Research in the US of 215,000 who had taken WLI published this January showed that after an average of 3.68 years, people taking GLP-1 agonists had a lower risk of developing 42 different diseases than those given their usual medicines.
This included a 22 per cent lower risk of a cardiac arrest, 11 per cent lower risk of heart failure, 9 per cent lower risk of a heart attack and 7 per cent lower risk of ischaemic stroke.
As well as heart and circulatory diseases, people taking GLP-1 agonists were 24 per cent less likely to have liver failure, 22 per cent less likely to have respiratory failure and 12 per cent less likely to develop Alzheimer’s disease.
GLP-1 agonists were also linked to a lower risk of some mental health issues, such as substance use disorders, suicidal ideation and schizophrenia.

I therefore think that the NHS could save itself a huge amount of money by rolling out WLI to all obese people.

So, I'm not disagreeing just to be obdurate or difficult, I just want to try and explain why I think WLI are an incredibly helpful tool in the treatment of obesity.

There’s a lot of normal weight people experimenting with these drugs for various conditions in the US, especially among those of us using it to treat infertility/PCOS.

You can get them for quite a reasonable price from compounders. It seems the market is not quite so developed in the UK but with these price increases that people are talking about, they are sure to pop up to fill the gap in the market.

Research into why the obesity crisis is happening and the reasons behind it is not to prove obese people are helpless, it’s to work out why it’s happening so there’s a basis to identify who is at risk and how to prevent it in the first place.

The next part of your post is making assumptions that fat people are all the same and making bad choices - I only drink water. I avoid UPFs. Many of the people I know are the same, obviously we don’t represent the whole of the group, but some of us are very aware of nutrition and health, and work very hard to not be bigger than we are! I know where my obesity stems from and it’s impossible to get the acknowledgment through the NHS because the way it’s handled is to first blame the patient and assume they’re sitting on their arses guzzling chips. Perhaps if that first port of call wasn’t so judgemental and dismissive we’d be a healthier population.

IMO any "acceptable" recipient of Mounjaro/WLI is anybody willing to self fund it if they don't meet the threshold, and anybody who does meet it to use it through the NHS.

That's interesting. Hopefully someone will start gathering data sets on this soon.

Just out of interest is there the same vitriol around obese people and WLI use in the comment sections of US forums and news articles, or is this more of a British problem?

@Periperi2025 the primary semaglutide patent is set to expire in March 2026, which is what Wegovy & Ozempic is made from. It will be interesting to see what other suppliers will be allowed to do in the European / UK markets thereafter.

You might be genuine or not.
Almost every obese person has a health condition or a reason outside their own responsibility why they are obese.

I don't buy it. Some people in my family are obesBut I agree that a small % of the population has issues that are leading to obesity.

But 1/3 of all adults?

Isn’t it the issue that the pharma companies are basically inventing an expensive solution to obesity, which has been created by corporate greed. No one is going to stop the food manufacturers making or selling UPF because it’s such an integral part of the global economy. These production methods make the richest companies richer and the consequences is obesity but oh… Now pharma companies are cashing in on it too.

The run away train has no brakes and it’s too late. You can’t stop big foods now, and consumers do not want to.

UPF and WLI’s will have to co-exist side by side with all practical reasoning long gone.

@Towelles hasn't the diet industry been doing exactly that for years already? The obesity crisis has worsened and they've got richer! Isn't it possible that WLI might be a game changer?

NICE have established metrics for weighing the benefits of new drugs against the cost. If the drugs provide a similar predicted gain in quality of life years compared to drugs for other conditions they should be prescribed on the NHS. That’s probably what happens currently. The criteria (age, BMI comorbidities etc) should be set to a level where the weight loss drugs offer fair gain compared to drugs for other conditions. The fact that alternative methods of weight loss exist shouldn’t come into it I don’t think. The fact that alternative methods to lower blood pressure exist doesn’t stop us prescribing statins. Yeah sure, provide diet/lifestyle advice alongside.

I wrote a post earlier about this.
Most of those I know who are morbidly obese fall into one of these:
Are ND, known to have higher rates of eating disorders (anorexia, bulimia, binge eating)
Only gained weight when put on a certain drug, often the pill or antidepressants. (One friend went on mirtazapine and went from a size 8 as a 30 yr old to a size 24 within a yr, drs did not care, blamed her for eating too much)
Have had cancer and gone through treatment and on medication for life.
Have a mental health condition like depression.
Have a chronic illness that prevents them from moving as much as they’d like and ties in with the drugs bit as well.
Has a condition like PCOS, diabetes, cushings, thyroid etc.

This could very well make up the majority of morbidly obese adults, considering that no matter what the cause, it’s irrelevant and ignored until there’s an acute crisis.

As an obese woman I can’t tell you the number of times I’ve seen the gp and they’ve blamed everything on my weight, so I can’t access the medical treatments I need for other stuff going on and I suffer, which adds to the lack of exercise and the depression. But if I go to the gp they still take the approach of “have you thought of losing weight?”.

I meet the criteria for prescribed GLP1s but there are hoops to jump through which make it inaccessible.

Approx 1in 10 people have pituitary tumours (some studies indicate up to 30% of the population on post mortem), pituitary tumours are associated with obesity.

Prevalence of hypothyroidism is 3%, disproportinately affecting women, hypothyroidism is associated with obesity.

Approx 1in 10 women have PCOS, probably significantly more as it is underdiagnosed. PCOS is associated with obesity.

1% of uk population are prescribed oral corticosteriods at any given time. Steriods use is associated with obesity.

So assuming no unlucky individuals with 2 or more of the above conditions we are already comfortably at 19% of your 1/3 target, and that is just with 3 specific medical conditions and one drug side effect.