According to a nationwide survey carried out by the British Nutrition Foundation (BNF) in June 2020, 27 per cent of the 2,067 respondents felt they had been eating less healthily during lockdown, 29 per cent stated they were less active than usual and 43 per cent said they wanted to lose weight.
Many people who want to lose weight struggle to do so in the long-term. However, there has been an additional motivating factor in the last year, following research revealing that being overweight or living with obesity increases the risk of more severe outcomes from Covid-19. While tackling childhood obesity has been a key part of its strategy for many years, the Government is now aiming to provide more help and support to adults who need – and want – to lose weight too.
In July 2020, the Department of Health released its Tackling Obesity: government strategy report. It revealed that around two-thirds of adults are above a healthy weight and half are living with obesity, while one in three children leaving primary school are already overweight or obese.
The Department of Health plans to ban the advertising of foods that are high in fat, sugar or salt on TV and online before 9pm. There are also plans to restrict volume promotions such as ‘buy one get one free’ on these foods and to restrict their placement in prominent locations to encourage purchasing online as well as in-store. The ‘traffic light’ food labelling system will be reviewed, along with the labelling of takeaway meals and calorie labelling on alcohol.
One in three children leaving primary school are already overweight or obese
The Government also intends to increase behavioural interventions through primary care, in the same way that GPs and other healthcare professionals offer stop smoking services. The Better Health campaign from Public Health England (PHE), which launched in July 2020, provides a range of evidence-based tools and resources to support people in their quest to lose weight. This includes a free NHS 12-week weight loss plan app and discounts with several well known weight loss providers.
PHE called on community pharmacy teams to help support the Better Health campaign, recognising their unique ability to reach vulnerable groups and tie public health messaging in with their own services.
As with all pharmacy services, it is important to make every weight management contact count, and to target people most at risk. This includes older people and BAME communities, who are most prone to Covid-19 complications.
A study published in the journal Clinical Endocrinology in November 2020 revealed that age is no barrier to successful weight loss. The study of more than 240 patients attending a hospital-based obesity service at University Hospitals Coventry and Warwickshire found no difference in weight loss between those under 60 years of age and those aged 60-78. The University of Warwick-led study concluded that obese patients over the age of 60 can lose the same amount of weight as younger people using only lifestyle changes – focusing on diet, psychological support and encouragement of physical activity.
“There are a number of reasons why people may discount weight loss in older people,” says lead author Dr Thomas Barber of Warwick Medical School. “These include an ‘ageist’ perspective that weight loss is not relevant to older people and the misconception that older people have a reduced ability to lose weight through dietary modification and increased exercise.
“Older people may feel that hospital-based obesity services are not for them. Service providers and policymakers should appreciate the importance of weight loss in older people with obesity, for the maintenance of health and wellbeing and the facilitation of healthy ageing.”
Research shows that simply having a conversation about obesity can lead to weight loss, which in turn leads to other health benefits. According to the charity Obesity UK, after a brief conversation about weight, 14 per cent of people with obesity lost at least five per cent of their body weight, and another 12 per cent lost at least 10 per cent. However, many healthcare professionals and people living with obesity are apprehensive about initiating these conversations.
In July 2020, Obesity UK published Language Matters: Obesity, the first ever guide to helping doctors and other healthcare professionals use more appropriate and supportive language when interacting with people living with obesity. They may face stigma in many areas of their lives, including in healthcare, which can have adverse consequences such as avoiding healthcare settings, physical activity and exercise, and may lead to disordered eating and poorer mental health.
Research by the Institute for Employment Studies in November 2020 revealed that women living with obesity are often paid less than other workers and experience lower hiring success, fewer opportunities for promotion and a higher likelihood of being dismissed.
The Language Matters: Obesity document tackles weight stigma and encourages more supportive, positive conversations in healthcare settings. “The launch of the Government’s obesity strategy is an excellent opportunity to emphasise that as we implement these new strategies, we should not be blaming people living with obesity,” says Dr Charlotte Albury, research fellow in health behaviours at the University of Oxford, who was project co-lead on the guide. “We should have an awareness that the language we use when talking about this condition and the people who live with it can stigmatise – or support.”
Obesity UK’s Language Matters: Obesity report offers useful guidance for community pharmacists who want to learn more about the best ways to approach – and speak to – customers about their weight. This may be part of a specific weight management programme or a brief intervention at the pharmacy counter. Key points from the report include:
While some adults find that behavioural interventions alone help them lose weight, others may ask pharmacy teams about the latest products, including weight loss medicines, dietary supplements, functional foods and even weighing scales and smartphone apps. The new Omron Viva device, for example, measures not just weight but also body fat percentage, visceral fat, skeletal muscle and resting metabolism. It also links to the Omron connect app so users can track their body metrics and better understand their heart health.
According to Adele Costabile, associate professor (reader) in nutrition and life sciences at the University of Roehampton, consumers are often less likely to maintain their weight goals when they rely on willpower alone. “The very nature of yo-yo dieting is down to a lack of support for consumers, since their eating habits are influenced by emotional and psychological stress, further encouraging the intake of calorie-dense comfort foods,” she says. “This means the more we can develop functional ingredients that help consumers to control their mood, hunger and cravings, the more likely they are to achieve successful and sustainable weight loss.”
The Government’s obesity strategy is an excellent opportunity to emphasise that we should not be blaming people living with obesity
Steven Riley, director of marketing and consumer sales at Optibiotix Health, says weight management brands that offer high quality support for both pharmacists and consumers are making great strides. “While not every brand offers a support programme per se, at Optibiotix, we prefer a personal yet professional approach,” he says. “We engage with our distribution partners, including pharmacists, across the entire marketing stack, enabling them to understand the science behind our solutions so they can go on to market them effectively. At the other end of the scale, we offer consumers excellent support through our consumer website. They can engage with us, understand how our solutions work, and get in touch with us through our website or on social media. For example, they can understand how our ‘2-2-go’ weight management meal plan works and download general guidance on our products.”
As obesity in adults continues to rise, weight management treatments on the NHS are increasing too. In October 2020, Novo Nordisk announced that Saxenda (liraglutide 3 mg) had been recommended by the National Institute for Health and Care Excellence (NICE) for use on the NHS in England for adults with a BMI of 35 kg/m2 or more who have pre-diabetes and a high risk of cardiovascular disease, based on risk factors such as high blood pressure and cholesterol. The pre-filled injection pens can be prescribed by specialist NHS weight management services and are also available privately. For instance, LloydsPharmacy launched its own private medicated weight loss service in July 2020, offering a 12-week course of Saxenda for eligible adults, alongside pharmacy support and digital health coaching.
“Weight management is a Pharmacy Quality Payment for us, so we have all been trained and are qualified to provide advice. We talk to customers about exercise, diet and lifestyle, and help them work out their BMI. Weight loss products have not been popular, so we no longer stock these. We’ve seen an increasing number of customers asking for advice about weight loss, and this has increased even more during the pandemic, with customers stuck at home and putting on weight.”
Lila Thakerar, Shaftesbury Pharmacy, Harrow
“Customers rarely ask about how to manage their weight. However, the pharmacy can use alternative methods to trigger conversations by holding a healthy lifestyle promotion. Speak to your local health board and ask what promotional material you can use. By holding promotions like this, we can not only assist the NHS in their campaigns but also build close relationships with our patients, who will feel more comfortable to speak to us about other health issues.”
Ellis Nugent, Well Pharmacy, Llantwit Major, South Wales
“The weight management category goes through phases of popularity. In the run up to Christmas and in early summer, we see increased demand. Customers will often ask for a quick fix, but we talk to them about the importance of looking at their diet and lifestyle. We help them to work out their BMI to find out if they need to lose weight, and can recommend Lipotrim if appropriate. We use posters to promote healthy living and encourage customers to ask for our advice.”
Yasmeen Afsar, Well Pharmacy, Hartlepool