As an NHS GP, I can now prescribe weight-loss jabs – but a quick fix for obesity is not what we need | Helen Salisbury

A The medicine that removes your appetite by making you feel satisfied and a little nauseous does not seem very attractive, but it is a price that many people are ready to pay for the chance to lose weight. Although widely available in private, until this week, only doctors of specialized clinics have been authorized to prescribe shooting (Mounjaro) to treat obesity on the NHS and it was almost impossible for GPS to bring their patients into these clinics. People from top to bottom of England will undoubtedly rejoice in the announcement that their own doctor can now prescribe it.

All celebrations can be premature, because the prescription criteria in the first phase of the deployment are so closely drawn that few patients will be eligible. You need a body mass index (BMI) over 40, which corresponds to a weight of 102 kg (16th) for a woman in average height or 123 kg (more than 19th) for a man. (The BMI criterion is slightly lower if you come from a high -risk group.)

To be eligible, patients should not only be at risk of complications from their obesity, but already suffering them. They must have existing diagnoses of four specific conditions out of five: type 2 diabetes, high blood pressure, abnormal levels of fat in the blood (dyslipidemia), obstructive sleep apnea and damage to blood vessels. Individually, all these conditions are quite common and they are more likely if you are obese. However, in our GP practice of 12,500 patients, we only identified two who meet these criteria. Anticipating a request for information, we asked our reception staff to tell the patients that we will contact them if they qualify.

In the second phase of the deployment, expected next summer, the BMI threshold will be lowered, although the list of conditions will remain the same, it seems that many more of my patients will be eligible. I have patients who are really stuck with a very serious obesity, with a BMI over 50, who, I think, would benefit from this medication, but I cannot prescribe it because they do not have the specified diagnoses.

One of the reasons for the slow rhythm of deployment mandated by the NHS England is probably a fear of overwhelming GP services. Six hours of training are advised before starting to prescribe, and patients must be seen monthly and monitored for adverse effects as the dose is increased, then every six months. As the criteria relax and the number of eligible patients is developing, this will be added to many additional meetings. In addition to injections, patients should also have “enveloping care”, which will provide diet and exercise advice.

We expect our integrated care committee on how it will be provided to our patients, but food advice is important. Many obese people are nevertheless malnourished because the food they eat are often rich in fat and sugar and low in essential nutrients. If, in response to the abolition of appetite, they eat much less poor quality foods, they can encounter significant problems with the lack of protein, vitamins and minerals. Dehydration can also be a problem because thirst is reduced and hungry. The rapid reduction in weight causes loss of bone and muscle mass as well as fat, therefore an exercise is necessary to prevent fragility.

The shooting is not cheap: at the maximum dose, it costs £ 122 per month per month, or £ 1,464 per year. This could be considered a good deal if you compare it with the cost of processing the conditions related to obesity, and we must take into account the improvements in the quality of life that the damage of healthy weight will bring. However, there are big questions to answer for the duration of the weight loss and what is happening when they stop.

The weight gain of the rebound is almost universal after a period of diet, but it seems to be even faster after taking medication such as shooting; A study revealed that patients can expect to return to their original weight in the under two years after stopping. This seems inevitable, because a large part of the diet learns to change your response to the hunger signals from your body; If you have taken a medication that abolishes these signals, then when you stop and your appetite comes back, you may respond exactly as you have done in the past.

In terms of the population, I fear that by focusing on this technical and pharmaceutical correction to our obesity problem, we are heading towards the wrong path. More than a quarter of the adult population in England is obese, and making them drugs all perpetuated cannot be the answer. If the government is serious about its very attractive passage from prevention treatment, we need more daring and more imaginative plans to fight obesity. We need restrictions on the availability of fast food and fewer calories.

Taxing sugar and fats would be a means of modifying the country’s diet, and we should also examine the quality of school meals. Beyond food regulations, we have to buy back fields at school, offer exercise opportunities free of charge and encourage active transport by making roads pleasant and safely. The current obesity crisis comes from a complex mixture of social and commercial determinants of health and these are not problems that can be resolved with a simple injection.

• Helen Salisbury is a general practitioner in Oxford

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