Does the way the public has responded to weight loss drugs suggest a brighter future for the NHS, and a potential reduction in the need for knee replacement? YKC’s Dave Duffy takes a positive look at a slimmer future.

Recently, my colleague Nick London looked at the potential benefits of weight loss drugs for osteoarthritis sufferers. I won’t repeat his post, but as the clamour for these drugs increases, we’re seeing a shift in patient attitudes we simply haven’t seen before.

Around 95% of the prescriptions for Wegovy, Mounjaro and similar are being privately provided and paid for by patients. I can’t think of another example in the UK where patients have been so willing to pay for a treatment, rather than wait and hope that the NHS meets their needs. And in the case of weight loss, the NHS can’t satisfy need. It will be prescribing these drugs in relatively limited numbers, but the money simply isn’t there to offer the jabs to everyone who wants/needs them.

Does this set a precedent? Is there a model to be followed in the case of other treatments? Is co-payment a ‘get out of jail free’ moment for an NHS pharmacy budget that can’t keep pace with the cost of new medications?

NHS patients are already co-paying for prescriptions and dental treatment – so is an approach similar to the banding used for the latter the answer for pharmaceuticals? Possibly, but it’s what happens once these drugs are in widespread use where things have the potential to get really interesting.

Unintended consequences

Obesity sits behind many health problems, from heart disease and type 2 diabetes to some cancers and osteoarthritis. If weight loss happens across a sufficiently large proportion of the population, we should see a drop in the need for treatments for all of these. That will have a huge impact on NHS budgets, waiting lists and more – and it will be a drop subsidised by patients themselves.

The benefits aren’t limited to patients and health services either. United Airlines estimated that if passengers lost 10% of their weight, the airline would save $80 million a year on fuel. You can imagine many other industries, from fashion to automotive, wondering what a lighter customer profile could do for their balance sheets.

A driver of social good

For the first time in history, the people who need these drugs have been, in the main, very willing to pay for them, not least because the drugs are relatively affordable for many.

In theory, that should in time free resource for those people who really need the drugs but can’t afford them. We know that people from low socio-economic backgrounds tend to be the most obese and most likely to have an acute need for weight loss. Imagine the impact on the NHS of removing large numbers of such patients from waiting lists. Imagine the impact on the country of a fitter, healthier population that won’t be plagued by the same obesity-related issues as the current generation.

It’s hard not to get just a little excited about the potential of a humble weight loss drug to be a driver of enormous health and social good.

The end of knee replacements?

If you’d been suffering from a stomach ulcer in the 1970s, you could have expected to undergo a procedure known as a vagotomy, which helped reduce acid secretion in the stomach. If you’ve never heard of a vagotomy, it’s hardly surprising. The advent of non-surgical treatments such as H2 blockers meant that vagotomies have virtually disappeared from the surgical landscape.

More recently, gastric surgery was the rather drastic answer to obesity. In 2010, the BBC reported a ten-fold increase in bariatric surgery. By 2018/19, as noted in the BMJ, 3% of all operations on the NHS were for gastric bands. By 2023, that had dropped to 1%.

Evidence suggests weight loss drugs are likely to send gastric band surgery the way of vagotomies, dodos and lamplighters.

Which brings us to knee replacement surgery. If the UK gets slimmer, the load it places on its joints lessens, which reduces the symptoms of osteoarthritis. The need for knee surgery inevitably reduces. It’s unlikely to disappear, though. Osteoarthritis is caused by multiple factors of which obesity is just one, and no one has yet found a way of regenerating cartilage on a significant scale. Mind you, they once said that about the weight loss jab and yet here we are.

So this is a story of hope for patients and a cautionary tale for surgeons like me. As history continues to show, if the right medication comes along, it can completely change the surgical landscape – and leave us all needing to adapt.

If you’re suffering from the pain of osteoarthritis, we can help. Please contact us, or phone us on 03453 052 579.

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