I’ve been paying for Mounjaro for more than a year, and have lost a fair bit of weight. Now it’s available on the NHS, will I be eligible, even though I’m now under the BMI threshold for a new prescription? It costs me a lot but I’m worried I’ll put weight back on if I stop.
Dr Ellie Cannon replies: Patients who are below the body mass index (BMI) threshold set by the NHS will not be prescribed weight-loss jabs.
The NHS has very strict guidelines on who can access these drugs, Mounjaro and Wegovy. Patients must have a BMI of at least 40 – which is considered severely obese – as well as four obesity-related conditions, including high blood pressure, high cholesterol, sleep apnoea, heart disease, osteoarthritis or diabetes.
This is to ensure that patients who need the medicines the most get them first.
Over the next few years, these requirements will be relaxed. Next year, those with a BMI of over 35, along with four obesity-related conditions, will be offered the jabs. Then, in September 2026, those with a BMI of over 40 and just three related conditions will be able to get them.
In contrast, private clinics can offer them to patients with a BMI of more than 30, or over 27 if they also have at least one weight-related condition.
For many, this rollout must seem frustratingly slow. This is particularly true for those who already pay for the jabs and have experienced positive results.
And since the NHS guidelines also recommend that patients remain on the jabs indefinitely, or risk returning to their original weight, this means many currently paying for a private prescription – as much as £250 a month – could be shelling out for the foreseeable future.
However, it is worth knowing that all trials done on these drugs show that users who also improve their diet and take up regular exercise are far more likely to be able to come off the jabs and keep the weight off.
So it is important that anyone who begins taking Mounjaro or Wegovy uses their time on the jabs to improve their lifestyle for the long term. The medicines alone aren’t a solution.
I’m 86 and I have asthma. A few years ago, my doctor gave me steroids and it significantly improved my symptoms. But when I stopped the drugs, my condition went downhill. My GP refuses to give me any more. At my age, I don’t care about long-term effects. What should I do?
Dr Ellie Cannon replies: Steroids can be an effective treatment for asthma, and a prescription should be discontinued only if there is a good medical reason.
The drugs – which can be given by inhaler or taken as tablets – can settle down the immune system and reduce inflammation in the body. Along with asthma, they are often used to treat forms of arthritis.
Steroid tablets are most commonly used in high doses for a week to treat bad flare-ups of a number of conditions. However, some people – including those with severe asthma – may take them daily at very low doses to keep their condition in check.
While effective, steroids can trigger a number of side effects, including the bone-thinning disease osteoporosis, insomnia and swelling of the body. For this reason, doctors prescribe them only when necessary and when the benefits strongly outweigh the downsides.
These complications can also become more likely in older age.
In situations where a patient disagrees with their GP over a prescription, it’s worth having a face-to-face discussion about the side effects they are willing to accept while on the medicine.
Doctors have to take into account how a treatment improves the patient’s quality of life as well as their overall health. If a particular treatment does make a patient’s life markedly better, then there is a good argument for continuing it.
However, it’s important to consider other options too. In the case of asthma, there are specific anti-inflammatory drugs, and new improved inhalers, that can help calm the worst symptoms.
I’m 82 and suffer from skin tags. They itch terribly. I’ve tried all sorts of creams but nothing has worked. What should I do?
Dr Ellie Cannon replies: Skin tags are fleshy skin-coloured growths that can form anywhere on the body.
The most common places they occur are on the eyelids, around the bottom and on the arms and neck.
Usually, they do not cause any symptoms, which is why the NHS tends not to treat them.
Instead, patients who want to have them removed will typically need to pay. Private dermatology clinics offer a number of skin tag treatments including minor surgery or a procedure called cryotherapy, which involves freezing them off.
However, patients who find that their skin tags are causing a lot of symptoms – such as itching – can request a referral from their GP to see an NHS dermatologist, who could perform one of these procedures.
The problem would need to be bad enough that it was affecting the patient’s quality of life. Daily bleeding, due to itching the skin tags, would be one good justification for a referral.
If the issue is not severe enough to warrant a referral, then a GP can prescribe anti-itching creams. Many patients apply these creams before bed in order to help improve their sleep.
Have you suffered a never-ending cough?
I was fascinated to read that scientists believe they have worked out why some people are more prone to a chronic cough – one that lasts longer than eight weeks.
Around one in ten British adults suffer with this uncomfortable issue, which can disrupt sleep.
Last month, researchers at the University of Leicester announced they had discovered that certain people are genetically predisposed to it – they have extra-sensitive nerves in their throats that trigger the coughing.
Often it’s put down to another medical issue – such as heartburn or asthma – but in many cases treating this underlying issue fails to help. Hopefully this discovery could help researchers develop new treatments.
Have you suffered with a chronic cough? Did you find a treatment that helped? Please write in and let me know.
It pays to be savvy about salt
I was pleased to learn that a study has found that putting salt-level warnings on dishes in restaurant menus led to diners making healthier choices.
I’ve previously voiced my scepticism over the effectiveness of including calorie information on menus, because research shows it does not lower the amount of calories people consume, on average, but can distress those with eating disorders.
The researchers at Liverpool University claim that their findings with salt levels prove the warnings do work and should be included on all menus, and I don’t see any harm in this.
In fact, it’s about time we did much more to warn people of the dangers of consuming too much salt, which is linked to high blood pressure and, in turn, heart disease.
