Fran Joel, CEO of Healthwatch Doncaster discusses the pros & cons of the weight loss jab.

Fat Jab: miracle cure or ticking time bomb?

If you want to lose weight then you need to eat less, do more.

Now I’ll pause for a moment while so many of you out there shout, “No, it’s not. You don’t understand.” If this was on social media, the trolls would already be out in force.

And that’s the response I am looking for, not because I want to “fat shame” anyone, but because I want you to understand the depth of feeling I have on this subject. But I will stick with that sentence and ask that you come on this journey with me.

Now, I am not stupid, and I knew that a blanket statement like that would be met with, “But I have XYZ” and “It’s not that simple.” I agree wholeheartedly with that, and it’s not a contradiction: the two can and do fit side by side.

Before I continue, let me explain a little about me. I am a lifetime dieter. For 30-plus years I have battled with my weight. I also have PMOS and I am an ADHDer, to name but a few of my “lived” experiences.

And yes, despite this, I will stick with the same line: to lose weight you need to eat less, do more.

I know that, for me, that “simple” statement is bloody hard. The way my body works because of PCOS — apparently PMOS now, but I’ve spent long enough calling it PCOS and I’m not changing it now — means my body processes food differently. I am always on the verge of being insulin resistant and, at this point in time, I am type 2 diabetic. Oh, what joys. A body that wants to work against me. So, whilst a “healthy calorie deficit” of around 600 calories would get around a 1–2lb-a-week loss for many, I would need to be around a 1,000-calorie deficit. And that is a tough call. I then must consider how I eat and what I eat. It’s a minefield and, sometimes, my body just decides, no! And I have to work out what is going on.

I am aware that there are sections of people who fall into this category.

As I said, I am also an ADHDer. My brain wants the dopamine hit and cake! Well, cake hits the spot, and it’s now or not now. So I understand that I also have to work against my brain.

And now, because obviously my body didn’t think I had enough to deal with, I’m a 50-year-old woman, so let’s throw in the menopause as well. It’s a perfect storm that I live with every day.

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The fresh-faced, straight-out-of-university brigade who have studied nutrition, or the PT with the six-pack. They’re going to tell us what to do, as if we’re new to this. They don’t have a clue. I have been doing this for over 30 years. You weren’t even a twinkle in your father’s eye and I was already on my first diet.

The first of many.

Not one of these PTs has ever been fat. Yet they lecture “us” on what we should be doing and what we are doing wrong. Then they have the nerve to tell me I need to be aware of how much protein I’m eating. They’ll teach me about macros.

Move over!

I reckon I could win Mastermind with my specialist subject being diets.

I know the calories of virtually every item on the supermarket shelf and, to be honest, quite a few restaurant meals.

I can tell you the amount of protein in almost anything and exactly which “snacks” will get me to my protein target.

There isn’t much dieting information you can offer that I don’t already know.

Eating with diabetes? Fine. I’m not an expert on that one yet.

Give me a few months.

I’ll add it to my CV.

I have intermittently fasted. I’ve done keto, Slimming World, Weight Watchers, SlimFast, low carb, Atkins, low fat, high protein and more.

And now I am on the fat jab.

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The fat jab.

Oh, I am a fan. I didn’t think I would ever give it a go, but with the diabetes diagnosis and the need to sort my health out, I took that option.

It is quite simply a miracle jab. It really does do what it says on the box. Within six weeks I had lost two stone in weight.

I started this part of the weight journey on 6 May and I am now 2 stone 8lb down and the lowest weight I have been for over 10 years.

But the weight loss isn’t even the best bit.

The lack of food noise is bliss.

The lack of pooing? Who cares. The stomach pains when I eat something heavy, such as cheese? Worth it. Because the noise has stopped. The calorie deficit just happens. I don’t need to count every tiny last detail. Even down to the ridiculous: “Oops, I swallowed my chewing gum. How many calories is that?” — 2–5 for sugar-free, if you are wondering.

I have space.

And there is something else happening that nobody really wants to talk about.

We are lying. We are lying about being on it. People are losing weight and, when someone asks how they’ve done it: “Oh, I’ve just been eating less.” “I’ve cut the rubbish out.” “I’ve been walking.” Because saying, “I’m on the fat jab,” comes with another judgement. “That’s cheating.” Cheating? You’ve spent years telling us to lose weight. You’ve told us to eat less. You’ve told us to sort ourselves out. Now something actually helps us do it and apparently we’ve done that wrong as well. Apparently it only counts if we suffer enough while doing it. So we lie. Because being fat has always come with shame. Failing at a diet comes with shame. And now successfully losing weight comes with shame if you didn’t do it in the approved way. Work that one out.

So, I have just praised this miracle “cure”, and yet my opening question asks whether it is a ticking time bomb.

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How can both be true?

Let’s look at diets and why this becomes a lifelong journey. Is the jab the first “diet” to work? Heavens, no! I think over the last 30-plus years I have lost the equivalent of a couple of people in weight. And this is where the problem lies.

Weight is an issue; the effect it has on your life is all-consuming. And please don’t be fooled by any “fat” person who tells you they are happy being who they are, so don’t shame them: they are lying. Do you know what it’s like not to be able to fit on a swing when you take your kids to the park? Do you know how it feels to fill the seat on an aeroplane or a bus? When the sanitary bin is so close to the loo, you have to squeeze and touch the thing with your thighs. The number of things it stops you from doing is bigger than anyone will openly admit. But they all feel it. We are a section of the world that lies to ourselves every second of every day because to admit it would mean we would have to face those demons inside, and who wants to do that?

But why, if this drug is great, do I think it is a time bomb? Let’s look at the history of diets. Every diet is the same. Same outcome. There comes a time in every fat person’s life when they decide to go on a diet. Actually, they decide that every Monday, as they can’t keep going like this, and by Monday evening they have “failed”. So, well, that’s okay. Don’t be hard on yourself. Well, actually, it’s Brenda’s birthday next week and, well, there’s a meal out. I’ll start after that.

And on it goes. The noise. The lies. The excuses. The negotiations with yourself. You can spend your entire life thinking about being on a diet even when you aren’t actually on one. It becomes a way of life.

Now let’s take you through a diet. Something triggers Diet Mode — maybe a holiday, a wedding, a photograph, a health scare — and off we go.

Now let’s say we sign up to the latest weight-loss class and either you go and get weighed or you put details online.

Then come the “before” photos. For all of those who aren’t aware, you get into your underwear and take photos front on, side on and back, and store them. I now have a 30-year “gallery” of me consistently getting fatter.

Think about that.

For me, one of the triggers to diet was my son.

He was ten years old and going to senior school. He was overweight and I knew that if he went into secondary school as the fat kid, he wasn’t going to integrate as well. He might not try the new PE games. He might hold himself back.

I knew that world.

I didn’t want it for him.

So I decided I would diet and bring him with me.

My motivation was set.

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Diet Mode activated.

And, like every other diet I have ever done, it worked. I felt brilliant. I was the weight I wanted to be. I felt amazing. Then comes the next bit. Motivation gone. I’m slim now. It’s okay. I only need to maintain. And my head tells me: Skinny people eat kebabs. I know this. I’ve seen them. I am skinny. I too can eat that kebab. One won’t hurt. And one doesn’t. But eventually I put all the weight back on. And then, every time, I add at least another stone. That is my reality.

And now my children are adults. And I’m watching them. I’m watching the two most important people in my world have their own issues with weight. I’ve seen them lose it. I’ve seen them put it back on. And I’m watching them slowly get fatter. That hurts in a place I don’t really have words for. Because somewhere inside me is the knowledge that I passed this on. Whatever combination of biology, behaviour, family, food, genetics, learned habits or anything else is involved, I look at my children and see the same cycle. The fat kid. The diet. The weight loss. The regain. And I can’t fix it for them. Because after more than 30 years, I haven’t yet managed to fix it for myself. That is why this matters to me. Not because I want to fit into a smaller dress.

Because I want this f**ing cycle to end.

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And Then Comes the Jab

With all my other diets I had to find the motivation. I had to do it manually. Diet Mode. And when that motivation disappeared, the weight came back. But with the jab, the weight loss has been almost effortless in comparison. The noise is gone. I don’t need the same motivation. I don’t need to fight myself from the moment I wake up. So what happens when this miracle drug goes? What happens when the silence ends? The NHS isn’t going to pay for everyone to stay on it forever. At some point, for many people, access will end. And then the noise comes back. And I know what happens next. I’ve spent more than 30 years watching it happen. The weight comes back. Except this time I think it will come back at speed. And here is my prediction. I think people will put the weight back on and I think many will go beyond where they started. I would not be surprised to see another two stone on top. That two stone is my prediction. But it isn’t a prediction plucked from thin air. It comes from 30 years of losing weight, regaining it and ending up heavier than when I started.

Again.

Again.

Again.

And this time people haven’t even had to build the motivation muscles they used during every previous diet. Then the drug goes. The noise returns. And with no way back onto the drug through the NHS?

You’re on your own.

That is the ticking time bomb.

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And Now Let’s Talk About Who Makes Money

All the other diets are “designed” to fail.

Yes, I said it.

Let’s work this through.

Pick one. Slimming World. Weight Watchers. Where would they be if everyone joined, lost the weight, went away slim and stayed slim forever? They need you to keep paying. They need repeat customers.

It is a business.

Still not convinced? Let’s compare it to internet dating. Internet dating wants you to keep coming back too. If it worked for everybody, everyone would be living their best life with the man or woman of their dreams and nobody would need the dating site anymore. The business would cease to exist. And that’s a dreadful business model. “But I know a couple who met on Tinder!” Of course you do. And what perfect marketing they are.

You too can find the love of your life. So you give it another go. The dream sells the product. And weight loss sells exactly the same dream. This time it will work. This time I will keep it off. This time will be the last time. And when we fail? We don’t shout about that. Shame keeps us quiet.

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It is a business.

So who benefits from “us” staying on the jab?

I’ll pause while you think about that.

The people selling it, for starters.

But they’re not alone.

There is an entire industry growing around us.

And I know because I’m buying it.

Pick up my phone. Hair loss. Bone loss. Muscle loss. Loose skin. Protein. Vitamins. Collagen. Fear. Fear. Fear. And conveniently, underneath every new thing I’m apparently supposed to be frightened about, someone has something to sell me. I have collagen on subscription now. Vitamins. Supplements. More “things”.

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My life is now someone’s pay cheque.

There is money to be made when I’m fat. There is money to be made while I’m losing weight. There is money to be made from the jab. There is money to be made from frightening me about what the jab might do. There is money to be made selling me the things that supposedly stop those things happening. And if I put the weight back on? Wonderful. There is money to be made helping me lose it all over again.

The market is enormous. So why should any of them stop?

Let’s stop for a moment on this. Currently, I get my fat jab on prescription. But when it’s pulled from me? Well, I’ll buy it. I’m hooked. An addict. I’m already spending more on all the “added” extras I apparently need. I get a minimum of five emails a day telling me what I need to buy now. So yes, the NHS has “cured” me and, at the same time, made me an addict. Nice job!

Now stop! And just follow that through. I have the disposable income; I am “privileged”. But not everyone is, so what happens to those who can’t afford it now they are an addict? What do addicts do? They lie. They buy that first, then the shoes for the kids. They find the black market. They rack up debt with debt sharks. Sounds extreme?

Maybe it won’t happen to all, but I have already spoken to people on the drug hounding their GPs to keep prescribing it. Let’s face it, the “magic dose”: yes, in one jab you got four measures and the magic one, just in case, and people had worked out how to get that out. These were already being passed to friends. Then the industry put a stop to that. Yes, no more magic dose.

People now are buying high-milligram ones and “guessing” at half doses, self-administering what works for them. No, these aren’t “perhaps this will happen”; it already is.

This is a medication!

So there is already a “secret” community of fat jabbers living in this world, and it’s growing. Don’t believe me? Well, that’s because you aren’t on the jab and haven’t been welcomed into the “club”.

And there is a divide: those that can afford it and those that can’t. The “haves” and the “have-nots”.

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Inequalities are growing — good plan, NHS.

Have any of you ever thought about the unintended consequences?

I have said this for years: until you address the reason someone eats too much, you will never break the cycle. You are treating the fat. You are not treating the cause.

And what do I mean by this? In most cases, the root cause is the “mental health” issue.

Because for so many people, food isn’t simply food. It’s comfort. It’s reward. It’s the thing you give yourself because somewhere deep inside you don’t believe you deserve anything else. It’s what you learnt to reach for as a child when you were frightened, lonely or traumatised. It’s the only companion that never told you to go away. It’s the feeder in your life. It’s the marriage. The divorce. The grief. The depression. The loneliness. The lack of self-worth.

And we have spent decades treating the fat while leaving the wound underneath it completely untouched.

Then we act surprised when the weight comes back.

And now we have even larger problems to add in: the cost of living, the shops on the doorstep, the lack of knowledge of how to cook, how to shop. And because the parents are on the fat jab, they haven’t sorted themselves out and the generational trauma is growing. Where does this stop?

I do believe that this drug could actually aid this. Yes, back to it being a miracle drug. The noise being silenced has given me the space to address the issues, to look at how I got back here after the “last diet I’ll ever have to have”. That was the “last” diet, yet here I am again. I know that was a set of circumstances: two foot operations left me unable to walk or do much for three months at a time, then having to learn how to walk with fused big toes. The lack of confidence to be able to move the same as I always had, and then the death of my father — it just all became too much.

The fat jab has quietened the noise and given me the space to learn how to eat. I am working hard to understand how to eat, given the diabetes; the space to understand what “slim” people actually think like; and, with this space, I am changing the way I “talk” to myself. It’s not easy, but!

I’m working hard to cure the reason, the “thing underneath”. I’m lucky. I am self-aware. After 30-plus years, I know that I need to fix the cause. I can access support on how to eat with diabetes. I can learn how to work with my brain. I have moved into the country for that. I am reading books on food. I am growing my own veg. I can afford to shop at local places and I know how to cook. I can pay for therapy to address the issues that I know cause this.

But again, who’s looking out for and supporting those who do not have the financial ability?

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Two-tier Britain is growing.

I’m 50 years old. If I stay obese, if I carry too much weight, I will have health issues. I will live the rest of my life in ill health. Again, I am not prepared to sugar-coat it just because it might hurt someone’s feelings:

Acid reflux

Early joint wear

Fatty liver leading to liver failure

Furring of blood vessels leading to strokes and heart attack

Type 2 diabetes

Kidney failure

Early dementia – yes you read that right

Sleep apnoea

Fatigue

Chronic pain

Gallbladder issues — I have already had mine out and so has my daughter

Certain cancers

And early death.

How many pills do we need to “cure” the above?

Let’s stop being woke and say it as it is. Sure, be body confident. We don’t need to be that skinny Instagram woman, but we do need to be a healthy weight and celebrate the diverse bodies we have. Look at the women’s rugby team: body shapes of all different kinds, but not by adding another lie to the list that it’s healthy.

Don’t try and fool people that being obese is okay. It’s not. It’s a “crisis” and it is happening now.

And the NHS will carry the bill.

Could we solve this obesity crisis with the fat jab? Absolutely. But not if all we do is make people thinner. Can you imagine if the drug was given and then the support to solve the issues? The mental health would be improved; the later-life issues of living for many years in ill health…

If we use this moment to fix the underlying problem, people don’t just lose weight. Their mental health improves. Their physical health improves. People who have spent years too unwell to work get back to work. People who believed their health meant they couldn’t start a family start one. Later-life illness reduces. Operations that would have been needed don’t happen. Appointments don’t happen. Medication isn’t needed. Complications don’t happen. People live healthier lives. The economy gains people back. Families change. Children stop inheriting the same patterns. Lives change.

That isn’t the fluffy extra bit.

BUT — who’s going to make that call? Who’s going to “fund” the support needed?

Will the NHS? No, not at all, because they have to balance the books. Money comes before people; it comes before health. Who’s going to go against the market? Who’s going to take back control of how we live? No, the NHS hasn’t got a chance. They will say the “right” words, they will tick the box, and then my life and my health will be given a price tag.

Neighbourhood health wants to prevent, not cure — yeah, bollocks. They start with a chequebook, a price, and then reduce it down.

And that is what makes me angry.

Because here I am. Fifty years old. Thirty-plus years of dieting. A 30-year gallery of “before” photographs. More weight lost than some people weigh. A lifetime of Mondays. A lifetime of Diet Mode. A lifetime of food noise. And now, finally, something has shut it up.

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Don’t waste this.

Don’t make me thinner, pat yourself on the back and send me away. Don’t wait until the funding stops, the noise comes back and the weight piles on. Don’t let me come back two stone heavier and then start treating the diabetes, the knees, the heart, the mental health and everything else that comes with it The fat jab is a miracle cure. And the fat jab is a ticking time bomb. Both of those things are true. The difference between them is what we choose to do while the noise is silent.

And most of all:

Don’t you dare tell me I failed.

Because I have spent my whole adult life trying.