Do any providers under 25 bmi?

[coldcallerbaiter]

Say you are BMI 24.9 or 25.5 etc and hold weight around the middle, are there providers who ignore the over 27 BMI rule? Or do you just have to lie?

I think maybe we will end up with a modified version at some point for non-obese people to manage their weight, just because that would be immensely profitable and so I'm sure drug companies will pursue that avenue. But we aren't there yet. And these drugs are not safe for that purpose right now.

The difference in someone with a history of obesity and someone without is physical and very real. The way the weight loss jabs work now in their current iteration is to correct something that has gone wrong within an obese person's body. Obesity causes (or is caused by?) metabolic differences. There is a reason that the WHO have classified obesity as a disease. A complex, irreversible disease.

Do you understand that a medication can be safe for someone suffering a disease to take, but not safe for someone not suffering that disease? That's the case here.

And the jabs aren't a cure, they manage the symptoms of the disease of obesity. They do allow us to reverse it, while we're taking them. That's the reason a formerly obese person can take the drugs at a BMI of 25 and someone who has never been obese can't. It's a solution to manage a specific problem. It's not for people who have a different problem.

It is possible (although there have been no trials for people who are not obese) that there will be no increased risk.

The point you are missing is there are significant risks taking Mounjaro - after the common unpleasant side effects there are more serious risks of severe and permanent stomach problems, kidney problems/failure, gallbladder problems, pancreatitis, allergic reactions, hypoglycemia, permanent changes in vision, depression and suicidal thoughts.

There are also very real and significant life threatening risks due to obesity. So balancing risks vs benefits, Mounjaro is approved for obesity. Not to get people bikini bods, but to get them to, or closer too, a normal BMI and save their lives.

The risks of Mounjaro are too high vs the benefits for someone with a low/healthy BMI who wants to lose weight for cosmetic reasons.

Did your doctor not query it?

I know GPs are busy but surely there is a reason the pharmacy notifies your GP. If you have never been overweight and visit the GP every year or so they will know.

Just buy it online, I put on my real stats, my BMI is 22 and they would still send it out. I'm not actually interested in buying any i was just interested what vetting they do. None by the looks of it. I used to work in Public Health and had weight management as part of my workload.

The risks of MJ are very, very low. But lying about your BMI to get a drug has the negative effect of making it harder for people who really need it (i.e. who are obese and have health risks) to get it. The more people who don't need it, but lie to get it there are, the more companies will be forced to make it more difficult for people who really need it: maybe doing in-person consults, more documentation etc, which would make it too expensive for those of us who both need it and qualify. So coming in with this question is sort-of pissing in the swimming pool and people won't like it. As a scientist, I think there is no physiological reason someone with a BMI of 25.5 wouldn't benefit as much as I did and the risks are low. But why mess up something which other people really need and you don't need? It's a game for you, it's life and death for us.

There are also very real and significant life threatening risks due to obesity. So balancing risks vs benefits, Mounjaro is approved for obesity

But surely if it was just about getting someone from obese to not obese (where the health risks are now diminished) people would be advised to stop taking it at a BMI outside the obese range, and then wouldn't be prescribed it to get to a BMI lower than that.

People don't stop taking it when the obesity risk ends. They continue to take it and lose weight til they are at least middle of the healthy weight range in most cases. So I can't see what the different is if someone who is overweight takes it and stops middle of healthy weight range. Why are obese people allowed to get to a low BMI but overweight people aren't? Especially in the case of my friend who is (or was, before mounjaro) tormented by food noise and a life long battle with her weight(?)

Your friend also lied about her previous eating disorder in order to get the WLI then, as that's one of the prescription questions for Medexpress at least.
The thing is it may well be that WLI are as safe for people with a healthy BMI as those with an obese one. But that's not been tested yet. It's ultimately taking medicine for an illness you don't have and that's obviously not something NICE are going to get behind.
And the likelihood of a previously obese person with a BMI of 22 becoming obese again and fairly soon is high, much higher than the risk of someone who's always had a BMI of around 22 becoming obese. Our bodies literally function differently and that's why maintenance doses for previously obese people are a different kettle of fish to it being used by people of a consistently healthy weight.

Ask the people who have issued the prescribing guidelines.

Surely 'need' is subjective.

In the case of someone tormented by food noise and a life long battle with their weight, and a history of binge eating disorder and bulimia, they may feel they 'need' mounjaro.

People don't lie to get something if they are not trying to meet a 'need' in my opinion.

I would be interested for them to test for glp1 deficincies in the same way they test for thyroid deficincies.

Before mounjaro I always thought something was wrong with me. I never understood how someone could withstand the constant hunger to be remain thin.

Now I understand that in obesity you have truncated glp1. So I view taking the glp1 agonist as fixing the defincincy. So hopefully they can in future test for that defict more effectively and for those with the depleted glp1 prescribe the drug in they same way we would for an underactive thyroid.

@Bellyblueboy Not everyone goes every year to the GP though? I haven't had a GP appointment for 5 years. The surgery does know my weight but only because the nurse weighs me annually for HRT purposes.

My last weigh-in a few months ago was 0.5 under the authorised BMI for MJ, so I'm not sure if my GP will stop my prescription when informed by MedExpress or make me go in to be weighed (or just be too busy and ignore it).

That would be great. I also think some overweight people and some people with bulimia and other binge eating disorders have a glp 1 deficiency, even if they are not obese, so maybe they too could be prescribed mounjaro and not feel stigmatised

But what if that ‘need’ is just the ‘need’ to look good?

I haven’t been weighed by my GP since I was 9 months pregnant with DC3, 6 years ago.

It comes down to risk vs benefit again. Obesity is more and more being seen a life long condition, not just fat lazy people (not saying you think that) and those that were previously obese are now predisposed to it and more likely (to the point it is probable) to relapse and quickly regain most of the weight, so they are now looking at life long maintenance plans to prevent relapse.

Again, the risk of quickly returning to obesity and its health risks is a bigger risk than remaining on Mounjaro.

Your friends life long battle with her weight is a different ballpark to obesity. Her bulimia which is a MH issue combined with Mounjaro with its side effects, especially the MH ones around depression and suicide is potentially dangerous for her. It could exacerbate her disordered eating and cause extra strain on her MH. There have been no clinical trials for Mounjaro and eating disorders. If it was considered to be approved for MH issues like bulimia it would probably be done with the support of consultant who could supervise her use and monitor closely for worsening MH. I would be very concerned if she was my friend.

If you are that desperate to look good (that you lie and take risks with your health), there is a deeper issue driving that and there may be multiple comorbidities. People in this situation need our support and understanding, not judgment and accusations.

Some obese people on mounjaro are also taking it to look good and not just because of the health benefits. Are they being judged too? If it was all about the health benefits people would stop taking it when the health risks associated with obesity end (ie. In the overweight range), but they don't. It's not just overweight and healthy weight people that want to look nice.

I was concerned but actually this is the first time she has ever lost weight slowly, while eating healthily and exercising moderately. Seeing her so happy not to be plagued with food noise is incredible. She's very happy and I honestly think mounjaro will be prescribed for this group in the future.

The fact is, that people who have been obese are far more likely to put the weight back on. So getting their BMI down to 25 may just mean that they go straight back up to an overweight BMI within weeks. Thats why they don’t have to stop as soon as they reach a healthy weight; their entire physiology is different to someone who isn’t obese.
And yes, if they are driven by a desire to look good they likely do have a deeper issue driving that. The solution isn’t to give them WLI.
As I said above, if you have an issue with the prescribing guidelines, the people to take that up with is the people who issued the prescribing guidelines. The solution isn’t to ignore the prescribing guidelines and lie.

Thanks the replies. Not for me but for a family member. Reason is BMI is used but can mean all shapes but huge hips and smaller waist is not as unhealthy as apple shape. Her BMI is overweight not obese.

My point was that we should be more supportive and less judgmental and harsh towards people in the overweight range that choose to try mounjaro. I still believe that.

And my point is that being ‘more supportive’ shouldn’t mean ‘providing WLI’. Counselling or therapy may be more appropriate.

She has a 37 inch waist but has a BMI of around 25 ish. All the fat went there.

I just started a new one with a BMI of 22.3

I sent a photo and they approved it.

Though I have been on it since over BMI 27

The concern isn't she is happy now. The concern is she has an unresolved MH issue which is an intense preoccupation with weight and food, which she is not getting proper support for. Using Mounjaro in the context of these mental health challenges significantly increases the risk of her compulsive behaviors shifting in the other direction, potentially leading to anorexia.

She has put herself in a very vulnerable position and it is very concerning.

I very much doubt WLI will be prescribed for this group in the future as the risks are too high. If they ever were it would be with significant support and supervision from specialists.

None of this is relevant. The prescribing rules are quite clear.