‘Even a dinosaur can see NHS is a weight-loss drugs laggard’
With weight-loss drugs no longer a niche medicine, Dr David Turner argues that the NHS’s reluctance to fund them more widely risks costing far more in the long run
I have something in common with the NHS – we are both late adopters. I have always been slow to accept new technology. The NHS is generally tardy at funding new treatments.
The reasons for our reluctance to move with the times are very different. For the NHS, it is because of chronic underfunding and the need to keep a tight rein on the purse strings. On my side though, it is merely being a bit of a dinosaur who pretty much hates everything about the digital world, and who would gladly return to the days of four channels on TV and finding your way around with an A-Z map and a road atlas.
What I mean to say by all that, is that it would be hypocritical of me to have too much of a go at the NHS for being behind a laggard. But one area I think the NHS should seriously start to pull its socks up in, is weight-loss management.
Injectable weight-loss treatments have taken off in a big way and although I hate the phrase, the NHS is seriously behind the curve on this one. Some 29% of adults in the UK are now obese, and 64% are overweight or obese.
An estimated 1.6 million adults in England and Wales used weight-loss drugs in the past year. Mostly obtained privately. This is no longer small-print stuff. It is no longer a can (of sugary drink) that can be kicked further down the road. NICE needs to grasp this sizeable bull by the love handles and run – or walk briskly – with it.
Currently, the NHS only funds weight-loss injections in patients with a BMI over 40 with at least four weight-related comorbidities including type 2 diabetes, high blood pressure, obstructive sleep apnoea, dyslipidaemia and cardiovascular disease.
That’s fine, but only around 4% of the population have a BMI over 40, so there are a lot of people who may benefit from – but will not be eligible for – NHS-funded weight-loss medication. Current indications do not include ‘softer’ but equally as important comorbidities related to weight, such as anxiety, depression and osteoarthritis.
It always comes down to money and yes, weight-loss management treatments are expensive. Added to that is the fact that many people who do get down to their target weight will need to stay on the treatment for life to prevent putting it all back on again.
However, if people do lose the weight and keep it off, many will also be able to stop or reduce their treatments for diabetes, blood pressure and high cholesterol, potentially saving money elsewhere in the system. The impending arrival of oral weight-loss medications may further weaken the argument for delay as the treatment will be easier to use and, inevitably, more in demand.
And this is where the argument that the NHS can simply sit tight starts to fall apart. Obesity is not a niche concern nor a problem for the distant future; it is already filling GP waiting rooms. Effective treatments exist and patients are already accessing them in huge numbers – just not through the NHS. By avoiding the solution that is in our face, we are creating a two-tier system and pushing a major public health problem into the private sector; a problem which will eventually land on us to pick up the pieces later when the costs – clinical and financial – have multiplied.
The NHS obviously cannot afford every new treatment the pharmaceutical industry develops, but with obesity so prevalent and increasing, and the huge societal burden of its associated morbidities, DHSC and NICE need to take another look at this and have a rummage down the back of the sofa for some loose change.
You never know – they might find a joystick to an old Atari games console there too.
Dr David Turner is a GP in Hertfordshire
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READERS' COMMENTS [19]
Please note, only GPs are permitted to add comments to articles
I understand you David, but I would have preferred to see decades of investment in dealing with the social causes of obesity (and others like adhd etc) eg UPF, poverty, employment, housing – instead of our economics-ignorant Uniparty MPs propelling us into existing as a supply-side pharmaceutical (and other corporates) drug-addicted society.
And give dinosaurs a break – they lived ecologically on Earth for 180,000, 000 years, and we’ve managed to screw things up in less than 300,000….
It’s not just the cost of the drugs though. It’s the cost of funding a proper service to deliver them – or GPs to deliver them if they choose to. Can’t be part of the all-in GP buffet….
They are not a magic bullet. Weight gain afterwards is a consequence and a lot of that has to do with the muscle loss on the drug and not changing daily eating, resting and exercise habits. Spending the money on public transport, parks, activity and green spaces and cycle lanes would be more worthwhile.
This resonates deeply. GPs are being restricted from prescribing them, when only we can best understand the complexities of obesity. Within our PCNs/ INTs lie the resources to provide real wraparound care and to address health inequality from the social/ commercial determinants of health. Why has this work (and associated £££) been delegated to private contractors when GPs are the ones handling prevention and multiple long term conditions day in- day out.
please see previous post, re-sent telepathically.
Let’s make lots of money at the expense of people’s health by feeding them rubbish, making them drive rather than walk or cycle. Then let’s make more money by injecting them with chemicals to reverse the above. And repeat. The world has gone nuts.
If the brakes come off MJ/Ozempic it would be a disaster.
– obviously the cost will be astronomical, and potentially an existential threat to a “free” NHS
– once any wrap around service has become overwhelmed, guess who will be left holding a very large baby?
– GP will become a glorified weight loss service…..what will be dropped to make room? That’s right…..nothing
– given the huge rise in weight on stopping MJ, inevitably this will become a lifelong hideously expensive drug
– obesity will be rubber stamped as a “disease” (which it patently isn’t), and now it’s our responsibility, not the patient’s
– patients simply don’t value a free drug. They will over-order, flog their MJ for personal profit, they’ll constantly demand dose increases, and then moan about side effects
– any pretence at all”lifestyle change” will be dead in the water. Nobody will want advice on diet/exercise, they will only want the magic drug.
– why worry about letting yourself go when you can pop to the doctor for free drugs?
– and when the press is full of horror stories of pancreatitis, cholecystitis, and “MJ killed my auntie”, solicitors will be rubbing their hands to take us to the cleaners.
– lifestyle drugs are a luxury the NHS cannot afford
Treating symptoms and not cause yet again .
Definitely needs a specialist and comprehensive service addressing lifestyle and psychological factors as well as just giving out the drugs or nothing will change
I can not pay any tax.
Absolutely what David Banner said couldn’t have said it better
Another upvote for David Banner!
Strongly agree; muscle loss and weight regain are significant problems
There are advantages in being slow to run up a blind alley
Private sector doing a good job, why change?
At least two million in the UK have a BMI of 40+.
These drugs save lives and transform lives.
This utter failure of the NHS must surely be a wake up call that the NHS in unfit for purpose.
As devil’s advocate to David Banner
– We prescribe and have prescribed other expensive drugs, without there being a second thought. For example DOACs and SGLT2 drugs before they each came off patent.
And while they are very expensive and I agree likely to be long term drugs, the bill goes down hugely when off patent – in 2031/2032. Just the same scenario has happened with every other expensive new drug on the NHS including dapaglflozin and apixaban recently.
And while I agree the focus is on the licenced benefit of treating obesity, we are all aware of the huge huge benefits that are seemingly seperate to / on top of the weight loss. A drug which reduces all cause mortality over 12 months by 16% after an MI is increadibly valuable.
I’d go as far as sayign that if there were a drug which had the same ‘other’ benefits, without reducing obesity; we as a group would be having far less discussions about it’s benefits, cost-effectiveness and place in the NHS. And while it’s use would have been moderate-big until it lost it’s patent then exploded when it loses it’s patent – there would be far less opposition to it’s use.
I do however think. there is a real opportunity to combine it with the right advice and assistance for weight loss- and those in charge of the purse strings are really missing the boat by not leaning in to that. They are about to explode the use of GLP-1 drug in diabetics without the benefits of physical exercise and nutrition advice.
The muscle loss for GLP-1 use is actually less than the muscle loss when losing the same weight without a GLP-1 drug. The issue might be more people yoyo with their weight by starting and stopping the drug; but if you are going to direclty discourage it’s use for muscle loss – you should be telling all your overweight patients not to lose (too much) weight in any way.
I doubt anyone is telling their BMI 40 patients to only lose 3-5 BMI points then stop losing weight.
The commissioner told us they’d have to close our local DGH to pay for Mounjaro if we prescribed it in line with NICE guidance. You can guess what most replies were from the GPs, who are doing most of the work of the DGH anyway, …
physical activity after MI can reduce mortality by 71%
many of my patients don’t take cardiac rehab seriously
primary prevention risk reduction 50%
how many gym memberships and mediterranean diet food coaches can 230/ pounds per month pay for
just playing devils advocate.
we need way more intervention on the prevention side and the food industry then just another drug licensed or generic