A weighty issue in pharmacy
About 25 per cent of adults in the UK are obese, putting us near the top of the worldwide obesity table. Weight-management advice in pharmacy is more important than ever
A fifth of adults worldwide are predicted to be obese by 2025, according to an international study led by Imperial College in London. The three fattest nations in Europe are expected to be the UK, Ireland and Malta, with 38 per cent of adults in the UK predicted to be obese by 2025.
The HSCIC annual Statistics On Obesity, Physical Activity And Diet report (2016) for England shows that 58 per cent of women and 65 per cent of men are overweight or obese, and prevalence of obesity has risen from 15 per cent in 1993 to 26 per cent today. Even more worrying is the fact that one in five children at reception class age is overweight or obese, with those living in deprived areas of the country twice as likely to be obese.
The report says that orlistat is the main drug prescribed for obesity treatment, with some 519,000 items prescribed at an annual cost of Â£15 million.
Access to advice
Dr Adam Todd, senior lecturer in pharmacy practice at Durham University, has carried out studies into the effectiveness of pharmacy-based weight management services, including the evaluation of a pharmacy service in Stockton-on-Tees.
His research concluded that pharmacy is a viable option for commissioned weight-loss services and produces results similar to those seen in other primary care settings.
â€œCommunity pharmacy provides a different kind of service and can be used in combination with other services,â€ he says. â€œIt can reach groups of patients who wouldnâ€™t otherwise access weight-loss services such as Weight Watchers, which can be costly. They can proactively recruit customers who are already visiting their pharmacy for medication for weight-related conditions, such as diabetes, or consulting them about cardiovascular risk or smoking cessation.â€
A study that looked at the attitudes of pharmacy staff taking part in weight-management services in Scotland found the main perceived benefits were ease of access by customers and the fact it provided a wider public health function to their communities. â€œWe need to be realistic about what we can offer as pharmacists,â€ says Dr Todd. â€œWeâ€™re not nutritionists or dieticians, nor are we a Weight Watchers-type service. But the service we can offer targets those people who otherwise wouldnâ€™t have access to a service, and thatâ€™s why itâ€™s important to offer it.â€
However, despite the obesity crisis, many CCGs have been cutting funding for commissioned pharmacy weight-management services.
Whitworth Pharmacy in Fitzwilliam, Wakefield, runs a free weight-management service for customers. â€œItâ€™s not a commissioned service, although our local health authority is looking at whether it might be in future,â€ says pharmacist and manager Lynn Patterson. â€œItâ€™s a drop-in service and is very flexible and convenient for our customers.â€
Customers have an initial consultation with the pharmacist, when they are weighed, their BP is checked and BMI calculated. They discuss medication theyâ€™re taking, any health issues and agree a weight-loss goal. Blood pressure is measured every week for four weeks and any issues are referred to their GP.
â€œWe keep a record card for each customer,â€ says Ms Patterson. â€œNormally, they come in each week around the same time, but it is flexible. We weigh them and talk through how theyâ€™ve got on that week. It helps keep them motivated and they enjoy the social side, too. Weâ€™ll set a weight-loss goal for them, but itâ€™s about doing it gradually and changing lifestyle through healthy eating and being more active; itâ€™s not a crash diet. If a customer reaches their goal, they can continue coming in. Weâ€™ll talk about what theyâ€™re trying to achieve next.â€
Customersâ€™ record cards are shared with their GPs if there are any problems.
â€œWe work closely with our GP surgery next door,â€ says Ms Patterson. â€œThey have a gym and health trainer who deals with fitness and physical activity. I think itâ€™s really helpful to be able to work with your local GP practice on weight management as it increases chances of success for patients.â€
Customers are mainly recruited by word of mouth. â€œWe also tell customers about our service when we carry out MURs and during our patient participation group, which we run every few months,â€ she says. â€œThe weight management group has a Facebook page where customers can swap advice and recipes.
â€œItâ€™s really worth the initial work you have to put in to get the service started,â€ says Ms Patterson. â€œWe have a constant stream of customers using our service all year round.â€
Whalley Range Pharmacy in Blackburn, a healthy living pharmacy, runs a Lipotrim service for customers. â€œWe have a high footfall in our pharmacy and that makes us well placed to offer a weight-loss service,â€ says pharmacist Sajid Musa. â€œWe also have a big obesity and diabetes problem in our local area. Education around weight is something that really needs to be improved and community pharmacies are in a good position to do this.â€
Many of the pharmacyâ€™s customers start the plan when theyâ€™ve tried and failed with other diets and approaches. â€œLipotrim is simple because there is no calorie counting or portion sizes involved,â€ says Mr Musa. â€œYou just need to commit to it. However, we do emphasise that Lipotrim isnâ€™t a solution for long-term weight loss. Itâ€™s a stepping stone. The key to keeping weight off is lifestyle, diet and activity changes.â€
Customers have an initial assessment for suitability. The pharmacist calculates their BMI and talks about a realistic weight goal. The customer visits weekly to be weighed and discuss how theyâ€™re getting on. Most follow the plan for two to three months. â€œGPs locally know we run the service, but mainly we recruit customers through counter staff and word of mouth or via MURs,â€ says Mr Musa. â€œWe also put up displays and posters at key times of the year.â€
Broadway Pharmacy in Bexleyheath is one of six pharmacies to offer Alphegaâ€™s new Growing Healthy scheme. â€œCommunity pharmacy is ideally placed to offer this type of support and help reduce the growing concern of childhood obesity,â€ says pharmacist Bipin Patel. â€œGetting the whole family involved to make healthy choices and have a balanced lifestyle will make a real difference to their health. We are really excited to be involved in helping families in this way.â€
The pharmacy has also been running a Lipotrim weight-loss programme for the past 18 months, and the new family service is a great way to build on this. â€œWord of mouth is the most powerful advertising, especially when results are visible,â€ says Mr Patel.
â€œI had a father and son join and support each other through the programme and they both managed to reduce their BMI from 35 to 24. Another customer lost 10kg and went from being pre-diabetic to healthy. But it shouldnâ€™t be seen as a short-term fix. Encouraging physical activity and changes to diet will help them long-term.â€
â€œMake the fixture less intimidating by signposting well-known and credible weight-loss brands together to make it easier for customers to research and find what theyâ€™re looking for,â€ says Michelle Constantiou, marketing director at SlimFast.
â€œBoredom is one of the biggest reasons why people fail on diets and plans. Encourage customers to eat little and often â€“ itâ€™s a good way to lose weight and keep it off long-term.â€
Sara Baco, Avicenna Pharmacy, Braintree â€œOne of the main advantages that pharmacy has in this category is that we have the latest products and theyâ€™ve all been tested for safety, which isnâ€™t always the case with what customers find online. January is obviously a significant period for this category. If weâ€™re doing a consultation with someone and theyâ€™re overweight, we always offer to take their measurements. I know BMI is not the most accurate measurement, but if people see they are on the overweight side of the chart they are more likely to do something about it. In terms of fitness, we stock a lot of support products, such as elbow and wrist supports for people who play badminton or tennis. People can go mad when they take up a new activity, so itâ€™s important to talk to people about protecting their joints.â€
Ali Hashemian, Avicenna Pharmacy, Swindon â€œWe donâ€™t stock a huge number of fitness products or slimming aids, though this is something we would like to focus on more. People who are committed to a weight loss goal think of going to a gym or speak to a GP before they would think of pharmacy, but as we develop the service we would hope to see this change. We do perform BMI checks free of charge and people have responded really well to this. We also work with Slimming World. Spending time with people and listening to their queries in a sensitive manner can make all the difference, as unhealthy habits are hard to break and may be something the customer feels embarrassed about. People need concrete guidance to support their motivation to stick to any resolutions they have made.â€
Mithun Makwana, Avicenna Pharmacy, Bristol â€œOur healthy living champion is on hand to help people with any queries about losing weight and making positive lifestyle changes. We do see a spike in queries in January. We have a partnership with Slimming World, which has been really great for our customers who want to lose weight. An adviser comes in once a week to give people advice and help keep their motivation levels up. Our main focus is on helping people make healthy lifestyle changes, but we do also stock products to help people achieve their goals. In terms of slimming aids, XLS-Medical is popular. Alli is probably the most effective product for losing weight, but people have to make significant dietary changes to make it work.â€
Learn how to recommend the most suitable emollient for your customers in this interactive video