[iam-TJ]

Increase in demand - much of which is attributed (by the NHS itself) for people having poor life-styles (meaning tending to obesity [0] and not maintaining physical and mental fitness), and the tendency for people to be kept alive longer existing with chronic conditions that a few decades ago would have naturally expired (dead!).

There's been an endemic problem for the last 30+ years where-by a large proportion of the population has a sense of entitlement to NHS care without at the same time bearing responsibility to keep themselves reasonably fit and healthy.

@ [0]: "Nearly two-thirds of adults in England are overweight or obese. In 2016/17, 617,000 admissions to NHS hospitals recorded obesity as a primary or secondary diagnosis"

[0] https://www.longtermplan.nhs.uk/online-version/chapter-2-mor...

[nosianu]

> Nearly two-thirds of adults in England are overweight or obese.

That means the issue is systemic and one needs to look at things outside of individual control. Yes, often systemic issue can be overcome by individuals - by the top quartile kind of individuals with more luck, better genes, better education (including what they picked up at home while growing up), more money, more suitable lives than the majority, or with outliers in levels of personal discipline. But systems should work for the people that actually live, if you need to blame two thirds of the population(!) it's most likely your system that is wrong.

Yes you can look at most of the individuals that are part of those two thirds and find what seems to be personal choices - but you miss the environment and the pressures from it that lead people into making those choices.

For example, that a lot fewer people know how to cook today than several decades ago (example link: https://www.bonappetit.com/entertaining-style/trends-news/ar...), do yo want to blame each individual? To me this very much looks like a bigger societal issue. It's not like people make such choices after careful consideration, it "just happens" and they "slip" into those behaviors without much deliberation, based on their living situations.

[Auracle]

You can both blame people and society. Modern living makes it easy to be fat, but plenty of us don’t succumb to the temptation of easy meals and overeating.

I’m not sure how you’d even change modern life to get around this, save maybe for incredibly large sin taxes on everything from soda to every restaurant. I’m sure we’ll just end up with a pill sometime soon. Semaglutide comes close.

[dogmatism]

Can I introduce you to semaglutides newer, better cousin, tirzepatide? https://www.nejm.org/doi/full/10.1056/NEJMoa2206038?query=TO...

50% of participants on 10 and 15mg doses lost 20% of initial body weight!

[Auracle]

Believe you me, my stock portfolio knows about it.

[Scoundreller]

> Semaglutide comes close

Until we can mass manufacture that, can we all start taking metformin?

[cameronh90]

We are mass manufacturing it and you can get it in the UK. It does cause GI side effects though which puts some of people off.

However it's fairly new and fairly unknown yet. I suspect it will become a lot more popular over the next few years.

Interestingly, like Metformin, it's also a diabetes drug.

[Scoundreller]

My guess is that it's now approved for obesity, a lot of drug plans in USA approve of it and that's led to a supply issue: https://www.novonordisk-us.com/products/product-supply-updat...

I wonder if metformin does the same thing, but the patent fell off too soon, so there just wasn't much marketing for its benefits to decision-makers.

metformin for 26 weeks lead to a net 6.6kg weight loss in non-diabetic obese patients (I would've preferred BMI reduction as the outcome measure, and a placebo-control arm, but can't have it all):

https://pubmed.ncbi.nlm.nih.gov/23147210/

Semaglutide yielded net 12kg weight loss in 68 weeks

https://www.cfp.ca/content/67/11/842

Obviously it's diminishing returns over time, but shows how much a drug that's been on the market for decades has still been under-utilized.

[cjrp]

617k is roughly 11% of admissions for that year. That alone doesn't explain the situation.

[badcppdev]

The UK has an ageing population. A higher percentage of older people and fewer younger people. Saying that those old people should have died earlier would be disgusting so I'm sure that's not what you meant.

So to be clear there's an increase in demand because British people are living longer. That's a good thing and should result in increased funding.

[iam-TJ]

It's exactly what I mean. There is absolutely no value in hanging on to the last possible moment due to ever increasing levels of interventions.

Living longer is not "a good thing" if that life is costing (not just in financial terms) society and the country so much more and the person can not sustain an independent quality of life.

In 1946-47, when the NHS, National Insurance (state pensions), and related programmes were created the average survival after retirement (60 for women, 65 for men) was 10 years or so (average mortality was 75 for men and little later for women).

So pension funding only needed to last on average 10 years and there was no comprehensive costly life-sustaining interventions to keep people alive that would otherwise have popped their clogs.

Now the average age of mortality in men is 85 and 89 for women, and these are rising. And as these are averages there are a lot of people lasting a lot longer - many spend years sitting in a chair effectively waiting for Death to show up.

So now the same pension funding has to provide for 20 or more years AND there are many costly and life-sustaining health interventions and "social care" that add cost and load on a dwindling number of tax payers.

I'm a farm-boy born n bred, as is my father, who is now 86. He's been amazingly fit his entire life but the last two years he's going rapidly downhill due to onset of mild dementia, but also due to not accepting doctors advice on treatments and medicines (this he's been doing for 40 years!) and subsequently hitting crisis where there have to be expensive emergency interventions.

As far as I am concerned he is abusing the NHS - like those who are obese or mistreating themselves in other ways - and if it were up to me I'd refuse to treat his emergencies if he is not prepared to look after himself by simply taking medicines that would prevent the emergencies.

Personally, I'll kill myself when I can no longer be useful.

Humans need to learn from how the rest of the planet's breathing life-forms treat life... and death, and lose the sentimentality. The planet already has twice as many humans on it as it can naturally sustain.

[Auracle]

Meanwhile in the US there’s been a push to limit the copays for insulin, pushing the cost of all of those almost entirely preventable type 2 diabetics on to everyone else.

[the_why_of_y]

This would only be a problem due to how incredibly, absurdly expensive insulin is in the USA.

https://www.bbc.com/news/world-us-canada-47491964