Times letters: Weight-loss jabs and the fight against obesity

Sir, While there is rightly much excitement about the potential of weight-loss drugs, they can never be the only solution to our obesity crisis (“Weight loss jab reduces heart deaths by a fifth”, May 14). Getting access to this new generation of medication, as part of a holistic package of support, is the first hurdle our policymakers need to address, as weight management services are badly fragmented, and those seeking support face record waiting lists.

In the short term, access to weight-loss treatments should be prioritised for those with the greatest clinical need. But more than this, preventing obesity by addressing the underlying causes of it is essential to help more people to maintain a healthy weight and reduce their risk of developing serious health conditions such as Type 2 diabetes. Our policymakers must wake up to the fact that changes are needed to both the environment we live in and the food we eat, so as to help people to live healthier lives.
Colette Marshall
Chief executive, Diabetes UK

Sir, As your reports indicate, we must change how we treat chronic diseases, focusing not only on specific disease processes with clever medicines but simultaneously reducing excess weight (“New drug ‘can help obese shed 4 stone’ ”, May 14). The results of new trials with semaglutide provide hope that new classes of drugs can do just that — ie help people to control their cravings to lose weight while also directly reducing risks for a range of conditions, including heart disease. Millions of people stand to benefit from this treatment but the cost of these drugs is prohibitive and supplies are too limited. As more such drugs become available and costs reduce, such medicines could help many countries to reduce levels of multimorbidity to allow more people to lead healthier, happier lives.

Obesity prevention must be a parallel target, however, as prevention remains better than treatment and the drugs do not normalise health.
Naveed Sattar
Professor of cardiometabolic medicine, Glasgow University

Sir, We have been using this group of medications (GLP-1 receptor agonists) to treat Type 2 diabetes for the past 17 years and they have been shown to be very effective. We then discovered that they also cause weight loss by working on the appetite areas of the brain. These new studies are demonstrating that GLP-1 receptor agonists work on blood vessels of the heart and brain to reduce the “sticky substance” (atheromatous plaques) that clogs them, and therefore reduce the chances of heart attacks and strokes. The study presented at the European Congress on Obesity in Venice suggests that this effect is weight loss-independent and takes place because these medications have an anti-inflammatory effect. We now need to get on and start using them in the NHS to prolong lives or make lives healthier for people who live with the disease of obesity and its complications.
Alexander Miras
Clinical professor of medicine, Ulster University

Sir, Similar, or better, improvements in morbidity and mortality are there for the taking, in the form of exercise, diet and other lifestyle changes. The money, time and effort required for these interventions is not borne by the state but by the individual. In most cases, the cost is free, or very little. Some, such as stopping smoking, even save the individual money. The principle, however, is that the individual chooses and the individual pays. Why should semaglutide (about £900 per patient per year) be any different? Individuals should make their choices and bear the consequences, good or bad.
Dr Graham Moyse
Newly ret’d GP, Broadstone, Dorset

Fears over assisted suicide safeguards

Sir, Melanie Reid (“We all have human right to choose a good death”, May 13) has a misplaced faith in the “safeguards” surrounding assisted suicide. How many thousands of people in times of despair after a devastating diagnosis or accident have felt suicidal? At such a moment it is the duty of our health professionals to improve quality of life and prevent suicide. Assisted suicide, presented as a new treatment option, brings with it fundamentally flawed “safeguards”.

Attempts to restrict the provision of lethal drugs to those who fulfil arbitrary criteria has repeatedly failed as the criteria cannot be objectively measured: how can we measure whose suffering is great enough to qualify? Prognosis is one method to limit eligibility. Yet any doctor will tell you that prognosis is guesswork at best, especially when it comes to weeks or months. Another proposed “safeguard” is for doctors to detect coercion — yet doctors are trained to trust what their patients tell them and rarely detect financial or emotional coercion. Our fear of bad care shows we must challenge care, not the law.
Baroness Finlay of Llandaff
Professor of palliative medicine; director of Living and Dying Well

Referendum voting

Sir, Neither Matthew Parris (May 11) nor the letters mentioned turnout or effective majority. Had the EU referendum been subject to say a 75 per cent majority of the electorate (as per some corporate decisions) then the distinction between an opinion poll and a result on which to make a major policy decision would have been clear. As it was, one third “yes”, and one third “no”, and one third didn’t vote, to my mind was a resounding “Don’t know”.
Christopher Morley
Bradford, W Yorks

Sir, Sir Leigh Lewis says that the result of the 2016 EU referendum led to huge consequences for the whole population, which will be borne by a generation or more. Exactly the same can be said about the 1975 European Community referendum. I myself was too young to vote in that election, but I still had to bear its consequences for almost my entire working life. I was grateful to David Cameron for giving me the opportunity to save others from a similar fate.
Alec Gallagher
Potton, Beds

Luring innovators to work in the UK

Sir, William Hague makes a good, if obvious, point about the impact of a few innovators in driving a country’s economic growth (“We must roll out red carpet for next big idea”, comment, May 14). It was ever thus: many of our most famous companies carry the names of their founders. Of course, Britain still does produce great innovations. We just sell them, usually to Americans, who value them more highly than we do, due to their deep capital markets with a more expansive attitude to risk. We need to match those strengths if we are to compete more effectively as innovators capable of creating great companies.
Richard Paul
Harrogate, N Yorks

Sir, Further to William Hague’s piece, to create the climate in which the UK can truly flourish in an increasingly technological future, the rationale behind early study (up to GCSE) of Stem subjects requires attention. At present this stage is often perceived, especially by students, as an end in itself, with only the highest achievers in (say) physics taking their studies further. To remedy this, GCSEs, especially in Stem subjects, should be radically altered so as to be seen as “tasters”, showing how rewarding further study (both academically and technically) can be.
Dr Peter B Baker
Prestwood, Bucks

VAT on school fees

Sir, I disagree with Simon Bowes (letter, May 13) that in preparation for VAT being levied on private school fees that the option that parents would consider is sending their children to independent schools for the two A-level years only. In fact, given that there is so much pressure on universities to champion diversity over ability and reduce the number of students that they take from the private sector, a parent might well contemplate sending their children to take their GCSEs at a private school and then switching to the state sector for their A-levels. This might improve their chances of entry to top-flight universities even if the grades were below those which could have been achieved at a private school.
Martin Short
London W11

Avoiding promotion

Sir, In response to your report “What makes millennials steer clear of the top job?” (May 13), one of the imponderables of my vocation in teaching is the regularity with which the best classroom exponents are promoted to roles that, although educational, are increasingly bureaucratic. The more advanced the position, the less time any teacher spends teaching. I much admire those who have placed ambition to one side and continued to do what they came into the profession to do. Having been through the self-doubting process of not making it further than middle management, I am glad that the past 15 years have been a replica of my first 15 years. Hats off to those who climb the greasy pole — but bigger cheers to the many who retain their enthusiasm and commitment to the classroom as they approach retirement.
Jim Dewes
Hartley Wintney, Hants

Maternity ordeal

Sir, One would think that, over time, childbirth and maternity care (news, May 13; letter, May 14) would improve. It hasn’t. My grandmother suffered in childbirth with her tenth child in 1922, my mother had a dreadful experience giving birth to me in 1950, I could write a book about the horrendous experience I had with my first child in 1971, and both my daughter and daughter-in-law suffered dreadfully in 2001 and 2011. Nothing really changes does it?
Linda Miller
Dereham, Norfolk

Army housing

Sir, Brigadier Tom Foulkes should be careful what he wishes for (letter, May 14). Hounslow Cavalry Barracks famously had the worst accommodation in the UK. Twenty years ago great efforts were put into getting modern units built. The result was state-of-the-art housing for other ranks. It became a very popular posting. The cost was enormous, and soon after the barracks were closed.
Paul Lynch
London W4

City in the sky

Sir, Manchester is a prime example of near-identical tall buildings (letter, May 13) built like dominoes that are stacked so close together that they suffocate the city. They have tiny balconies all overlooking each other and resemble human versions of bird perches. Even worse, every piece of greenery has been removed: it has become a cement city in the sky. I can only assume that this ugly mess was approved by a planning department motivated more by council rate collections per square box/flat than the aesthetics of the city.
Damien Seymour
Alderley Edge, Cheshire

Gone farming

Sir, While I was a teacher in a middle school, one of my pupils, a farmer’s son, was regularly absent (letters, May 11, 13 & 14). I was told this was due to “tupping”, and that he had been helping take care of livestock with his father. I started to suspect his excuse when tupping seemed to be going on for well over half the year.
June Keeble
Storrington, W Sussex

Sir, In the early 1950s I lived in Fife and it was expected that in the Scottish potato harvest season there would be children off school at the “tattie howking”. I don’t think it was even counted as truancy.
Helen Fox
Poole, Dorset

Final edition

Sir, My dream “ final” edition of The Times would include the headline “Britain rejoins EU” (letters, May 13 & 14). The sports back page would hail Kilmarnock’s European Cup Final win, and this letter would hit the treasured bottom-right corner.
Dr David Jeffrey
West Malvern