Given the scale of the NHS’s problems, from waiting times at record levels to overloaded A&E units, you might have thought it would avoid adding to its burdens by offering new treatments, particularly where they are not medically necessary.
But yesterday, the medicines regulator the National Institute of Health and Care Excellence (NICE) approved the use of the 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 add to the strain on the already overstretched NHS Budget.
Moreover, it is not clear that the drug is safe in the long term and its manufacturer has yet to share full details of the research it has funded so far.
Side-effects may take years, even decades to emerge, which means that this step amounts to an expensive leap into the unknown.
It is true that NICE, aware of the financial implications, has recommended that – over the next three years – the provision of Mounjaro, which costs £122 a month, should be limited to just 222,000 patients, a small fraction of the 3.4 million people in Britain who are classified as obese.
The select few have been chosen because they have a Body Mass Index (BMI) over 35 and also have at least one medical condition arising from their excess weight.
But once the Mounjaro jab is prescribed it will be difficult, if not impossible, for the NHS to keep a lid on the numbers.
Yesterday, the medicines regulator the National Institute of Health and Care Excellence (NICE) approved the use of the weight loss drug Mounjaro on the NHS
It is not clear that the drug is safe in the long term and its manufacturer has yet to share full details of the research it has funded so far, says Dr Renee Hoenderkamp
A Photo illustration, phentermine and topiramate weight loss drugs
‘Underweight’ patients will rail against the injustice of the BMI figure. Politicians will be intensively lobbied. I will be amazed if the eligibility is not widened dramatically when this policy is reviewed in three years.
For me, that would be a sorry outcome. Indeed, I think the approach of seeking to combat obesity with a drug is wrong-headed and dangerous. Overweight people should not be relying on a state-sponsored jab to ameliorate the negative impact of their lifestyle choices. Instead, they should accept personal responsibility and exercise discipline over their calorific intake.
If official intervention is needed to help achieve such goals, it would be far better for the state to promote healthier living by, for instance, teaching about nutrition and cooking in schools. Or taxing ultra-processed foods more heavily or changing the culture of workplaces, where too often snacking is ubiquitous.
In Japan, where the national rate of obesity is just 5 per cent – helped by a diet based largely on fish and rice – employers are required to measure staff members’ waists once a year. Anyone found to be overweight is put on a weight loss programme and the company is fined if they fail to meet targets.
The humiliation and financial punishment that this entails appears to act as a powerful deterrent and is certainly more effective and less costly than a drug such as Mounjaro.
I am not suggesting that Britain adopts the Japanese method but I do feel strongly that we should be putting more emphasis on self-reliance and less on the search for the pharmaceutical Holy Grail of weight loss. That is what I have tried to do in my own life. I have the sweetest tooth imaginable and I have only avoided weight gain through continual self-discipline, which means that I never have biscuits, chocolates, crisps or anything sweet in my house.
If I want a snack, I have to make do with tinned sardines. I also go to the gym at least three times a week. Part of my motivation is that I have a young daughter, aged just six, and now, in my mid-50s, I want to be a healthy, active mother for her.
In the fight against obesity, resorting to a simple jab might seem an easy solution but it is nothing of the sort. Given the millions who could eventually become eligible, such a policy will require huge subsidies from the public purse at a time when the limits of taxation have already been reached.
Hand in blue glove holding syringe with copy space
And where will this kind of intervention logically lead? Should we all stop brushing our teeth and, when they become rotten, expect the NHS simply to replace them with implants?
The principle – that the NHS will bankroll irresponsible behaviour and thereby encourage it – is a troubling one.
Some might argue that the state giving out vapes to discourage smoking also fits the category of squandering public resources on people who should be held accountable for their own decisions but the crucial difference is that vapes are designed to change behaviours, not reinforce them. The other vital point is that smokers tend to cover the healthcare costs of their habits through the heavy taxes and duties they pay on tobacco.
Nor is there any comparison with patients who injure themselves playing dangerous sports or over-indulging on a night out. The harm was a consequence of misjudgment or misfortune, rather than the central aim of the activity.
We cannot be puritan about this. Life is full of compromises and contradictions. The state is wary of lecturing the obese but, during the Covid pandemic, the authorities were quite happy to be draconian in their interventions, imposing fines even for sitting on a park bench for too long.
Yet in the case of Mounjaro, safety has to be another consideration. Far too little is known about the drug – and what is known is troubling.
In laboratory tests, mice who have been given the drug have shown a propensity to develop thyroid cancer, as well as pancreatitis, a condition which is painful enough in itself but can also lead to pancreatic cancer. In addition, because Mounjaro works by reaching into the brain, psychosis and depression may be long-term side-effects.
Other weight loss drugs could also carry high risks. Mice administered the drug semaglutide – which is the active ingredient of the widely used Ozempic – were found not just to lose fat but also lean muscle, including from the heart.
The loss of heart muscle, in turn, could result in users becoming intolerant of physical exercise, thereby countering any benefits from the drug.
The incoming Health Secretary in the USA, Robert Kennedy Junior, wants to restrict the use of Ozempic, pointing out that ‘they make this drug in Denmark but in Denmark they do not recommend it for diabetes or obesity. They recommend instead dietary and behavioural changes’.
Although Kennedy is seen by his critics as a dangerous maverick, he is right about the need to prioritise diet and behaviour. Drugs are no solution.
It should be remembered that anyone taking Mounjaro has to remain on it for life, for as soon as someone comes of it, their appetite returns.
In effect, users become locked into a pharmaceutical cage, the very opposite of the freedom that is Mounjaro’s promise.
It’s yet another reason that the NHS should not be doling it out to those who cannot or will not help themselves.
Renee Hoenderkamp is a GP.
