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Obesity is one of the leading causes of serious health conditions such as heart disease, diabetes and cancer, and it costs the NHS £6.5 billion each year. According to the Government in May 2023, 63.8 per cent of adults aged 18 years and over in England in 2021 to 2022 were estimated to be overweight or living with obesity. This was an increase of 63.3 per cent from 2020 to 2021.
Each of the Home Nations has an obesity strategy in place. In September 2023, the Government updated its plans to tackle obesity in England. Measures include a £20 million obesity mission to explore new treatments and digital technologies that could support people achieve a healthier weight, and working with the NHS and local authorities to improve behavioural weight management programmes and access to weight loss drugs and disreputable surgery.
Community pharmacies continue to play an important role in weight management advice and support. A research report, A vision for community pharmacy, published in September 2023 by the King’s Fund and the Nuffield Trust and commissioned by Community Pharmacy England, focused on how community pharmacies will play a key role in the future in supporting people and communities to stay healthy and well. This would build on existing initiatives such as Healthy Living Pharmacies.
“In the UK, it’s estimated that one in every four adults is obese,” says Neil Raichura, Well digital pharmacist. “With pharmacies being a convenient option for accessing healthcare, patients may prefer to speak with their local pharmacist regarding their long-term conditions, such as obesity, as well as any minor ailments. Making weight management programmes readily available through pharmacies allows patients to seek any necessary support in a friendly and safe environment, at a time that’s convenient for them.”
Sensitive conversations
“All members of the pharmacy team should understand the important role they have to make every conversation count as they support customers in adopting healthier lifestyles,” says Lucy Morris, patient services manager at Numark. “The subject of weight management needs to be approached sensitively – think about to how to give your pharmacy a ‘health promotion’ image, displaying appropriate leaflets to help initiate conversations.”
GP surgeries and community pharmacies can also refer people to the free NHS Digital Weight Management Programme, which offers one-to-one coaching from a weight loss expert, accessed via an app on their smartphone or online. This 12-week personalised programme is aimed at people living with obesity who also have a diagnosis of diabetes, high blood pressure, or both.
In August 2023, the National Institute for Health and Care Excellence (NICE) issued draft guidance on the use of medicines in specialist digital weight management services in England. People being referred to these services will need to meet the criteria for accessing weight management medicines (such as semaglutide or liraglutide): eligible people will have at least one weight-related comorbidity, such as diabetes or high blood pressure, and a body mass index (BMI) of at least 35.0 kg/m2, or at a lower threshold in certain circumstances.
They will have a clinical assessment before starting treatment, and a team of multidisciplinary healthcare professionals will provide care virtually via an app or computer. The medicines must be used alongside appropriate lifestyle changes.
“A low carbohydrate diet has helped many people with type 2 diabetes put it into remission”
Weight management advice
For long-term weight management, the NHS website recommends a healthy, reduced-calorie diet and regular exercise. There is no ideal diet that works for everyone, but the NHS warns against using fad diets such as fasting or cutting out food groups – an effective diet programme should involve advice on portion sizes, food choices and other behavioural changes. Very low calorie diets (containing fewer than 800 calories a day) are not recommended for managing obesity.
The NHS Eatwell Guide shows how the different food groups can be used to achieve a healthy, balanced diet, with starchy food making up one-third of the daily food intake. However, low carbohydrate diets are becoming increasingly popular. “A low carbohydrate diet has helped many people with type 2 diabetes put it into remission,” says GP Dr Hana Patel (www.topdoctors.co.uk/doctor/hana-patel). “It can also help people who are overweight and at risk of developing type 2 diabetes lose weight and improve health markers. Losing even 5 to 10 per cent of your body weight can noticeably improve your blood glucose levels.”
Pharmacist Graham Phillips, owner of the iHeart Pharmacy Group, is the founder of ProLongevity.co.uk. The ProLongevity diet involves remote monitoring with the Freestyle Libre sensors and app, precision nutrition to avoid blood sugar spikes, and one-to-one coaching from healthcare professionals. “The programme is personalised and individualised,” he says. “So it’s more of a commitment for clients and the pharmacy team than a bog-standard one-size-fits-all NHS weight management programme. Most clients sign up for the 12-month service, which gives them 16 weeks of blood glucose monitoring and 16 hours of contact time over 12 months. This provides 10 times more contact than most people will get with their GP in a year.”
Phillips says that in the long-term, ProLongevity could save the NHS huge amounts of money, avoiding the costs of medication and healthcare. “Obviously, many people can’t afford to pay for the ProLongevity programme,” he says. “I would like everyone to be able to access it through a national commissioned service through Healthy Living Pharmacies. If people can’t afford to pay for the service, they can visit the Public Health Collaboration (PHC) website, phcuk.org, for useful resources. I’m a trustee of the PHC, a charity dedicated to improving the nation’s metabolic health.”
We are lucky that we have nutritionists who work with us in our pharmacy, as this is such a big category for us. Common questions are about what supplements customers can take to speed up or maintain weight loss. We also get asked about coping with fatigue, which can be a problem when a customer is losing weight but not eating enough. Supplements brand Nature’s Plus does well for us, and also Solgar and Wild Nutrition. Ayurvedic products do well too, and also mushroom based supplements. If you stock weight loss products such as Alli, make sure you also have supplements alongside it that will provide relevant nutrition. Make sure your staff are well trained in nutrition.
Sarina Mughal, Day Lewis, Knightsbridge
Nutrition and weight management are important categories as they are often part of the healthy living campaigns. However, we haven’t seen much of an upward trend for OTC requests. Recently, we have had requests for the prescription weight loss products, but unfortunately we have encountered supply issues in providing these. Other requests for nutrition are for children’s vitamins, probiotics and vitamin D. Brands that do well for us in this category include Optibac, Ultra D, Floradix and Health Aid. We tend to find that patients often know their products and requests for suggesting a product are less frequent – possibly as patients tend to be influenced by online research activity.
Shilan Shah, Mountford Pharmacy, Barnet
Weight management is not a popular area for us, but supplements and probiotics definitely are, especially vitamin D, zinc, magnesium, and multivitamins. Our customers tend to see a dietician for advice about weight management. Weight management drugs such as Alli are expensive, so customers tend to get these prescribed. With nutrition issues, customers tend to come in with an underlying issue such as tiredness that they want to address with a supplement. For us, Vitabiotics does well, and also HealthAid. Vitamin D supplements are our top seller as customers are advised to purchase these from a pharmacy by their GP.
Lila Thakerar, Shaftesbury Pharmacy, Harrow
Weight loss medicines
Research shows that the use of prescription-only weight loss medicines such as semaglutide and liraglutide may help people living with obesity to live longer, healthier lives, if they can’t lose weight with lifestyle changes alone. These medicines work by regulating appetite so people eat less.
The choice of weight loss injections available on the NHS has increased over the last couple of years, with the recent launch of semaglutide (Wegovy) injections. Ozempic (semaglutide) injections were already prescribed to control blood glucose levels in adults with type 2 diabetes, but weren’t authorised solely for weight loss. Liraglutide (Saxenda) can also be prescribed for weight loss on the NHS.
“There’s a growing trend in the UK, fuelled by social media and TikTok, that demonstrates the benefits of injectables such as Ozempic and Wegovy for weight loss and reducing diabetes,” says Tim Allardyce, registered osteopath, chartered physiotherapist and life coach at surreyphysio.co.uk. “The problem is that people who take the medicines are unlikely to change their dietary behaviour. This leads to a risk that when stopping the injections, you could put on weight quickly.”
Soaring demand for private services has led to supply problems. “We are closely monitoring Wegovy demand and have restricted quantities to create a more steady level of supply, ensuring people living with obesity can start and remain on treatment,” says a spokesperson for maker Novo Nordisk. “As we expect supply to be constrained for the foreseeable future, a proportion of available supply will be allocated for use only within the NHS to allow healthcare professionals to implement NICE guidance. We will continue to work with healthcare professionals to help ensure that patients with the highest unmet medical need are prioritised.”
Some people are buying weight loss injections from disreputable suppliers, fuelling an online black market. In October 2023, the MHRA warned the public not to buy pre-filled pens claiming to contain Ozempic or Saxenda. It had received reports of a very small number of people being hospitalised after using potentially fake pens, with the side effects suggesting that these may have contained insulin instead.
Even when the weight loss medicines are being prescribed by healthcare professionals, it’s important to weigh up the pros and cons before prescribing them. A study publishing in JAMA in October 2023 found that semaglutide or liraglutide may lead to digestive upsets, such as bowel constriction and slowed stomach emptying.
According to Phillips, many people using weight loss injections may look slimmer but may not be healthier. “The drugs have been rolled out without enough knowledge or long-term history of their safety, and we are now starting to see some nasty side effects,” he says.
“When people lose weight on them, we are finding that most of the weight lost is not fat. DEXA scans show that much of the weight they are losing is muscle, which will cause health problems in the long term, especially as people age.”
“The problem is that people who take the medicines are unlikely to change their dietary behaviour. This leads to a risk that when stopping the injections, you could put on weight quickly”
Healthy living
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