Given the scale of the NHS’s problems, from record-high waiting times to overloaded A&E units, one might have thought it would avoid adding to its burdens by offering new treatments, particularly when they are not medically necessary.
But yesterday, medicines regulator the National Institute for Health and Care Excellence (NICE) approved the use of weight loss drug Mounjaro on the NHS.
As a GP, my heart sank at this development, which I fear will not only undermine the idea that people should take responsibility for their own lifestyle choices, but will increase pressure on the already overstretched NHS budget.
Furthermore, it is not clear that the drug is safe in the long term and its manufacturer has not yet shared full details of the research it has funded so far.
Side effects can take years, even decades, to appear, meaning this step amounts to a costly leap into the unknown.
It is true that NICE, aware of the financial implications, has recommended that, for the next three years, the supply of Mounjaro, which costs £122 a month, be limited to just 222,000 patients, a small fraction of the 3.4 million of people. in Britain they are classed as obese.
The chosen few have been chosen because they have a body mass index (BMI) greater than 35 and also have at least one medical condition resulting from their excess weight.
But once the Mounjaro vaccine is prescribed, it will be difficult, if not impossible, for the NHS to control the numbers.
Yesterday, medicines regulator the National Institute for Health and Care Excellence (NICE) approved the use of weight loss drug Mounjaro on the NHS.
It’s not clear that the drug is safe in the long term, and its manufacturer has not yet shared full details of the research it has funded so far, says Dr. Renee Hoenderkamp.
A photo illustration, weight loss drugs with phentermine and topiramate.
“Underweight” patients will protest against the injustice of the BMI figure. Intense pressure will be put on politicians. I would be surprised if eligibility is not dramatically expanded when this policy is reviewed in three years.
To me, that would be a regrettable outcome. In fact, I think the approach of trying to combat obesity with a drug is misguided and dangerous. Overweight people should not rely on a state-sponsored coup to ameliorate the negative impact of their lifestyle choices. Instead, they should accept personal responsibility and exercise discipline over their caloric intake.
If official intervention is needed to help achieve such goals, it would be much better for the state to promote healthier living, for example by teaching about nutrition and cooking in schools. Either tax ultra-processed foods more or change the culture of workplaces, where snacking is too often ubiquitous.
In Japan, where the national obesity rate is just 5 percent (in favor of a diet based mostly on fish and rice), employers are required to measure their employees’ waists once a year. Anyone who is overweight is put on a weight loss program and the company is fined if they don’t meet the goals.
The humiliation and financial punishment that this entails appear to act as a powerful deterrent and are certainly more effective and less expensive than a drug like Mounjaro.
I’m not suggesting Britain adopt the Japanese method, but I firmly believe we should put more emphasis on self-sufficiency and less on the quest for the pharmaceutical Holy Grail of weight loss. That’s what I’ve tried to do in my own life. I have a very sweet tooth and have only avoided weight gain through continued self-discipline, which means I never have cookies, chocolates, chips or anything sweet in my house.
If I want a snack, I have to settle for canned sardines. I also go to the gym at least three times a week. Part of my motivation is that I have a young daughter, only six years old, and now, that I am in my 50s, I want to be a healthy and active mother for her.
In the fight against obesity, resorting to a simple puncture may seem like an easy solution, but it is not so easy. Given the millions of people who could eventually be eligible, such a policy will require huge subsidies from the public purse at a time when tax limits have already been reached.
Hand in blue glove holding a syringe with copy space
And where will this type of intervention logically lead? Should we all stop brushing our teeth and, when they rot, expect the NHS to simply replace them with implants?
The principle – that the NHS will fund irresponsible behavior and therefore encourage it – is worrying.
Some might argue that the state’s distribution of vaporizers to discourage smoking also fits into the category of wasting public resources on people who should be responsible for their own decisions, but the crucial difference is that vaporizers are designed to change behavior, do not reinforce them. The other vital point is that smokers tend to cover the health costs of their habits through the high taxes and duties they pay on tobacco.
There is also no comparison to patients who get injured playing dangerous sports or going out at night. The harm was a consequence of an error in judgment or misfortune, rather than the central purpose of the activity.
We cannot be puritans in this. Life is full of compromises and contradictions. The state is cautious about lecturing the obese, but during the Covid pandemic, the authorities were content to be draconian in their interventions, imposing fines even for sitting too long on a park bench.
However, in Mounjaro’s case, security must be another consideration. Very little is known about the drug, and what is known is worrying.
In laboratory tests, mice given the drug showed a propensity to develop thyroid cancer, as well as pancreatitis, a condition that is quite painful in itself but can also lead to pancreatic cancer. Additionally, since Mounjaro works by reaching the brain, psychosis and depression can be long-term side effects.
Other weight loss medications may also carry high risks. Mice given the drug semaglutide, which is the active ingredient in the widely used Ozempic, were found to not only lose fat but also lean muscle, including heart muscle.
The loss of heart muscle, in turn, could cause users to become intolerant to physical exercise, thus counteracting any benefits of the drug.
The new US Secretary of Health, Robert Kennedy Junior, wants to restrict the use of Ozempic, noting that “this drug is manufactured in Denmark, but in Denmark they do not recommend it for diabetes or obesity.” Instead, they recommend dietary and behavioral changes.”
Although his critics see Kennedy as a dangerous maverick, he is right about the need to prioritize diet and behavior. Drugs are not a solution.
It must be remembered that whoever takes Mounjaro must continue taking it for life, since as soon as someone stops taking it, their appetite returns.
In effect, users are locked in a pharmaceutical cage, the complete opposite of the freedom that Mounjaro promises.
It’s yet another reason why the NHS should not hand it out to those who can’t or won’t help themselves.
Renée Hoenderkamp is a family doctor.