knowledge around article

hypertension

• high blood pressure: pressure in the blood vessels is consistently too high

  • blood pressure reading of 140/90 mmHg (milimetres of mercury) or more

• risk factors:

  • lack of physical activity

  • excessive alcohol consumption

  • smoking

  • some chronic conditions

    • diabetes

    • kidney disease

    • obesity

  • a diet high in sodium, sugar and fat

    • high sugar foods: pastries, soft drinks like fizzy drinks and squash, beer

    • high sodium foods: bread and rolls, ham, bacon, salami, pepperoni, potato chips, crackers, pretzels, cheeses

cardiovascular disease

• cardiovascular diseases - diseases of the heart and blood vessles, e.g:

  • coronary heart disease: when coronary arteries become narrower or become blocked, due to a build up of fatty material, such as cholesterol, causing reduced blood flow to the heart meaning there is a lack of oxygen for heart muscle

  • heart failure

• obesity is a risk factor for cardiovascular disease

  • excess weight around your waist can lead to fatty material building up in your arteries → high blood pressure, high cholesterol, type 2 diabetes

    • these are all risk factors for cardiovascular disease

type 1 diabetes

• pancrease is unable to produce enough insulin, so blood glucose levels can rise to a fatal amount

• lots of urine is produced to excrete glucose, so individual feels very thirsty

• treated with insulin injections when blood glucose rises too high, e.g. at meal times

• advised to limit intake of simple carbs which contain lots of glucose

type 2 diabetes

• body cells no longer respond to insulin produced by the pancreas, so blood glucose levels can rise to a fatal amount

• risk factor: obesity

  • high body mass may mean the body does not respond to insulin produced

• advised to exercise and lose weight, and limit intake of simple carbs that contain lots of glucose

causes for obesity

BMI

what is a healthy range?

what is an unhealthy range?

what are weight loss injections?

• injectable medications for weight loss

• some work by reducing appetite and slowing gastric emptying

• originally developed for patients with diabetes

why do people use weight loss injections?

ethical and satety considerations for weight loss injections: justice

• high demand but limited NHS availability due to cost, so being provided more by private clinics

• access depends on ability to pay which is unfair → inequity in access to treatment

• postcode lottery of access to obesity care

• risk of widening health inequalities

• stewardship of NHS resources:

  • fair prioritisation of limited funding/limited resources

ethical and satety considerations for weight loss injections: autonomy

• media and social media influence, celebrity use of weight loss medication

• informed choice vs social pressure

ethical and satety considerations for weight loss injections: non-maleficence

• variable regulation in private clinics

• importance of follow-up and monitoring to prevent harm to patient

what is Mounjaro?

• brand name for tirzepatide

• drug made by Eli Lilly

• lowers blood sugar levels

• an injection taken once a week, dosage increases every 4 weeks

  • there are different types of injections: one-dose pen, multi-dose pen

• drug sustains weight loss over 3 years, trial finds

how does Mounjaro work?

it lowers blood sugar levels by:

• activates receptors to increase the level of incretins in the body, which stimulates more insulin secretion from the pancreas after food intake

  • body produces more insulin → lower blood sugar levels

• reducing the amount of glucose produced by the liver

• slows down how quickly food is digested

how can Mounjaro be accessed?

• it was approved by the National Institute for Health and Care Excellence for treating obesity on the NHS in Decemeber 2024

• as of June 2025, people with the greatest clinical need for treatment can access Mounjaro for obesity via their GP in England

  • prioritisation is based on BMI and the number of weight related health conditions they have, e.g. type 2 diabetes

• as of June 2025, you are unlikely to be prescribed Mounjaro for weight loss on the NHS unless your BMI is over 40 and you have 4 weight related conditions

who can take Mounjaro?

• adults over 18 with type 2 diabetes

• only prescribed for people who have a BMI of 35kg/m² , and other conditions related to obesity

  • BMI over 40 and illnesses such as hypertension, type 2 diabetes, etc.

why is the rollout period of Mounjaro for the eligible population in England so long?

being gradually rolled out over a 12-year period due to:

• high costs

• lack of support services