Regulators looking to cut off maintenance below 25 BMI

[Bigfatsunandclouds]

Oushk have said that they are currently trying to fight with regulators to stop people being cut off from MJ at 25 BMI.

Apparently regulators don't like prescribing below that and that basically means unless you continue to remain at 25 or above you won't be able to be prescribed even for maintenance.

This is worrying as many see this as a lifetime medication after years of obesity but at least to maintain at a lower BMI for a little while to ensure the weight stays off. This seems like utter madness - this is surely going to lead to yo yo use of the meds which seems counterintuitive.

BMI in a lot of cases is a stupid archaic measurement anyway.

Why not? Around 8 million people in the UK take statins and more would be eligible. 10% of UK adults have diabetes and 90% of these are type 2.

Why wouldn’t people take other medication to reduce their risks of ill health?

@HereIGoOnceMore
I agree. I'm thinking oushk have been unlucky in being one of the first to be inspected under the latest rules, in relation to bmi verification at least. How many other pharmacies are insisting on a weight and ID verification video for all new patients plus working their way through thousands of existing customers?

This is going to get very messy when you think even Boots, Superdrug, Asda aren't doing that, let alone the multiple small new start-ups who've jumped on the gravy train. Unfortunately, it's customers like us who get caught up in the crossfire and the fallout.

Maybe once you reach 25 bmi you should then get gastric surgery so that you don’t have to be on this medicine for life.

Bloody hell, that’s drastic.

And dangerous.
And expensive.

Great plan.

@Dominoeffecter
We really need a laugh react

I was going to ask what safeguards are in place for those with a lower bmi to ensure they aren't misusing it or moving into eating disorder territory, because there should be some. So from what you're saying these are in place but perhaps this company haven't been adhering to them?

@FloofyBird They do have checks -maintenance patients have to do a maintenance video call before they can access the maintenance plans. Most, but not all, will be on or below 25 when they decide to enter maintenance. Some choose to do it at a higher bmi though. They also have weight and ID verification video calls which have recently become mandatory. I think they’re currently doing more than most pharmacies so I suspect the inspection maybe picked up on some that fell through these measures or maybe randomly selected older cases that weren’t as stringent. Currently though maintenance patients just do the maintenance video call every 6 months so this might become more frequent in the future. It was Hira who mentioned on a fb post about the regulators not liking prescribing below bmi 25 but this isn’t mentioned in the inspection report so not sure where that’s come from.

I use Zava and since the new rules came out they've required me to send them updated scale and full body photos. They've also asked for scans of recent blood test results as I reported I'd previously had some issues with my kidneys. I'd say they're doing their due diligence very well and hopefully that will be reflected the next time they're inspected.

But most of the long term side effects are positive - large reduction in heart attacks and strokes, reduction in many cancers etc - which look like they will heavily outweigh any increase in pancreatic disease.

We really do or at least this 🤯

Why not? Do you understand that obesity isn't 'cured' by losing weight?

Why? It is expensive, risky invasive surgery with unpleasant side effects. It is also not a permanent fix.

MJ is less risky, cheaper and effective. Indeed many people are using MJ with success having previously had gastric surgery and not lost enough weight or not kept the weight off.

Here's the thing there aren't maintenance guidelines because, in the UK at least, Oushk were the first pharmacy to put forward maintenance options, others followed suit. The regulator may be taking a position that maintenance needs to be done differently. Other pharmacies have been inspected since the new rule (medexpress, curate and chemist4u but none of these are maintenance providers, the best test of this will be the inspection of another maintenance friendly pharmacy such as Cloud, Pharmulous, Swift Dr.

This could be true of any medication anyone is prescribed. Mental health patients just need to do the work. Those on aspirin for heart conditions just need to do the work. Anyone on long term contraception, just need to avoid sex.

Why do we pick on weightloss drugs with this nonsense?

@Nifty50something
To be fair, that used to be the absolute minimum required. Pharmacies are required to independently verify weight, and photos just dont cut it. Oushk are doing weight and ID verification live videos and if that's not good enough, no one can be complacent about the future.

Do people go onto mental health threads to boast about how they maintain their mood without antidepressants? Tbf I suppose some obnoxious twits do. Probably the same ones

Oh, I 100% have my own food issues. I’m not denying that! Many women require something like 1200-1800 calories per day to maintain a healthy weight and we live in a society that normalises a diet of much more than that (huge restaurant meals, constant high calorie snacks available etc). So it’s inevitable that a lot of women will have a constant struggle re weight.

But I think those people on this thread accusing me of being horrible and not understanding the levels of hunger and denial they experience, and so why they need weight loss meds, are doing exactly the same back at me. You don’t know the levels of hunger and denial that I experience, so you can’t confidently claim you get more hungry than me for example.

And as for those people accusing me of coming into the weight loss meds board, I generally have zero idea what part of mumsnet I’m on! I browse Active Threads and click on whatever catches my attention.

But why feel the need to say 'I suffer so you all must suffer too'.

It's weird and unpleasant.

How are people this badly informed still? Bodies that have been obese behave differently to those that have always been a healthy weight. That's why people regain the weight, not because they're thick fatties who think they can start eating pies for every meal and keep the weight off.
The approach to Mounjaro and maintenance has seemed sensible to date, in that it acknowledges that the disease doesn't vanish miraculously once you pass the 25 BMI threshold.

Well eat what you want, reach a bmi of 30, pay a small fortune for the jabs and come join the club.

To be fair, Pre-menopause, in my 20s and 30s, I would have felt similar to @CowboyFromHell . All I had to do was count calories and exercise hard. I tolerated hunger. I maintained my size 8.

Obesity is a metabolic condition. It’s not about being hungry and “doing the work”. But I didn’t know that back then.

From the Oushk live

It appears the GPhC is being really difficult with online pharmacies - some of the points they picked up against Oushk

• Clinical questionnaires/consultation forms are not indepth enough they need to somehow include if a patient is committed to changing their lifestyle (diet and exercise)
• Because it is a high risk medication they are asking for working closer with GPs before prescribing, but Oushk say that is not realistic as pharmacies cannot get access to GPs so to try to navigate that they are going to be asking for lots more information from patients and not quite sure how it is going to work, but things like asking if you have had any recent blood tests to upload them, and annual checks etc. Not sure how that will work in Scotland as we don't have access to ours on NHS app.
• Reorder consultations need to be more indepth - did you have any issues with your pen, do you know how to use it, did you store properly, do you feel you are eating enough, can they offer supplementation, have you changed you diet etc
• The need to prove they are educating patients, so even though they have had some Q&As with nutritionists/PTs etc they haven't logged who attended. So they will probably be creating short nutrition and fitness education courses on their app and patients will need to complete them.
• They hadn't done 100% of the weight verification videos so got penalised for that.
• They were asked if a patient transferred to them they need proof and details of their FIRST order to show they qualified for the treatment initially which they think is unrealistic too
• They had 2 complaints from customers over 18 month about warm pens so got a black mark for that too. also they were unloading a delivery during the inspection so they got a black mark for the fridge temperature being slightly higher just because unloading
• Someone skinny (not quite but BMI 23) arrived to pick up a pen during the inspection and they challenged why they were being prescribed even through they could show the persons whole journey of a year long in their records
• they feel BMI 19.5 is too low for maintenance so they might need to increase to 21
• They don't think the inspector understands obesity or maintenance so she is trying to explain to them and share Eli Lilly information
• They have to change a lot of things within 28 days so consultation forms will be changing soon, and they are going to be asking for waist measurements and if possible something to prove height, but they understand for some patients that will be difficult
• They were challenged on why they were prescribing after 5pm when operating hours are 9-5pm
• They will probably initiate a maintenance video call as soon as each patient hits BMI 25 now to discuss plans rather than when they hit their chosen goal weight (if lower)
• The GPhC seems to be coming from the view point that patients lie (going from some posts on this board don't blame them!) which is making it much harder for online pharmacies to get the proof they need that patients are eligible

Lots going on from the inspection, they never really explained their earlier post in depth (or I missed it because Tesco came with my online delivery!), but were very much, don't worry it won't be a problem and they'll find a way (as usual) but it does sound like the GPhC is going to be making things difficult for pharmacies.

That might be my longest every MN post! 🤣

Thanks for that @WeAllHaveWings