Weight management - Module 153
With obesity rates soaring, pharmacies are in the front line in the war on waistlines
In this article you will find out:
how weight and BMI work
• how to lose weight successfully
• the different weight loss options available in the pharmacy, including drugs and food replacement diets
• answers to common questions about weight loss.
Download a pdf version of this module here
Download the Test Your Knowledge questions here
Obesity in the UK is on the rise. Nearly a quarter of adults are classed as clinically obese, according to the Health Survey for England, and rates of obesity have more than doubled in the last 25 years. If this trend continues, it is predicted that by 2050 60 per cent of men and 50 per cent of women could be obese. More worryingly, two thirds of the UK population are already overweight or obese.
"This means you are more likely to meet someone with a weight problem than someone who is a healthy weight," says Dr Matthew Capehorn, clinical director for the National Obesity Forum.
Being overweight or obese puts people at increased risk of health problems. Excess weight has a direct link with many chronic diseases, such as diabetes, cardiovascular disease and stroke.
As well as the potential damage to health, obesity is costing the NHS dearly, and the bill could rise to £6.3 billion a year by 2015, according to the Department of Health (DH).
How weight works
Food is a necessity. The body uses it for energy, for repair and for building new structures. It needs a way to store energy in between meals as insurance for those times when starvation could occur. The body stores fat to allow for that possibility. Every day the body burns a certain number of calories just to maintain normal functions – this amount is called the basal metabolic rate.
The body expects this amount of energy to be consumed throughout the day, and an increase in activity will increase the number of calories required. Any calories in excess of the daily needs will accumulate in fat stores, while any deficit in calorific intake results in the body using its stores of energy. Weight change is therefore due to an imbalance between energy intake and energy expenditure.
One measure often used when deciding if someone is overweight or obese is the body mass index (BMI). This is an indicator that classifies people as being underweight, normal, overweight or obese based on how much they weigh in relation to their height.
However, recent thinking suggests that it is not the best way to account for body weight, as a short person with a muscular build could appear obese based on their BMI. A BMI of 18.5 to 24.9 is classed as normal weight, 25 to 29 as overweight, while 30 and above is obese.
BMI calculation
BMI =
weight (kilograms)
height (metres) x height (metres)
So a man weighing 80kg who is 1.85m tall would have a BMI of 23.
How to lose weight
The simplest principle for losing weight is to take in fewer calories than the body requires. The amount of calories people should consume each day varies depending on four factors – their gender, age, weight and how active they are.
As a guideline, a man should consume around 2,500 calories a day while a woman's intake should be closer to 2,000. Having calculated how many calories an overweight person requires, they need to reduce their daily intake by between 500 to 600 calories to cause weight loss.
This means that after a week they will have saved 3,500 calories, which equates to losing one pound a week, four pounds a month, and one stone every three months.
Your role in weight loss
Pharmacy staff are ideally placed to deliver a weight management service to local communities. Traditionally, pharmacists have provided weight management services, but many more technicians and assistants are getting involved, says Lynne Henshaw, Numark's director of marketing. Patients' weight can be difficult to discuss. But being in the frontline of care means pharmacy staff can build relationships with customers to give them the support they need to address their weight management issues.
One way over the counter staff can help patients lose weight is to advise them to make simple changes to their lifestyle. A useful source of information is Change4Life – a public health programme, which began in January 2009 and is organised by the DH. The campaign aims to encourage people in Britain to lead healthier lives, using the slogan: "Eat well, move more, live longer."
Change4Life covers areas of behaviour change such as eating five portions of fruit and vegetables a day, limiting snacks and swapping sugary or fatty foods for low sugar and low fat alternatives. DH guidance also includes information on the recommended proportions of the main food groups – carbohydrates, protein, fruit and vegetables – and highlights that people need to ensure they have a healthy, nutritionally balanced diet.
Taking exercise to help burn off calories is also an essential part of any weight loss programme. But you should advise people who are not used to exercising to start gradually, working up to at least 30 minutes, five times a week. Individuals with health conditions and who are unused to exercise should check with their doctor before starting a new exercise regimen.
Food replacement diets
Food replacement products are a popular choice for overweight patients. For example, Lipotrim is a total meal replacement diet that involves taking sachets and flavoured bars three times a day for 12 to 14 weeks. Patients who want to pursue this diet should be at least three stone overweight.
Slimfast is another common meal replacement choice, where patients have a shake, soup or bar, followed by a 600 calorie healthy meal in the evening.
Not all of these products are suitable for everyone, such as those under 18 years of age, or who are pregnant, breast feeding or taking certain medication, so it is important to talk to patients to help them select the best product to suit their weight loss needs. Despite the many products available to help shed pounds, people often relapse and fail to stick to their diets because they have unrealistic expectations. Pharmacy staff can play a vital role in motivating individuals to lose weight and maintain that loss.
Offering a weekly check helps build relationships with patients by providing an effective weight management service. It also builds loyalty so patients come back to you for other healthcare needs.
Suggesting that patients keep a food and exercise diary can also encourage them to lose weight; often individuals underestimate how much they are eating and overestimate how much exercise they do, so a diary helps them keep track and identify areas of possible change. You can help identify when patients are likely to lapse from their diet – such as Christmas and birthdays – by suggesting healthy eating options for meals out.
And you should encourage them to reward themselves when they succeed in losing weight. In this way pharmacy staff can help patients live well for a lifetime.
Weight loss drugs
For some patients lifestyle changes alone may not be sufficient, and OTC medication or other dietary programmes offer an alternative approach. Orlistat is a prescribed drug that can help patients to lose weight if they are obese or overweight. It works by interfering with the way in which fat is digested and absorbed into the body.
A lower strength, non-prescription version of this treatment is Alli, which contains 60mg of orlistat. Taken three times daily, immediately before, during, or up to one hour after each main meal, it reduces the absorption of dietary fat. It is recommended for adults over 18 with a BMI of more than 28. Treatment is for six months. It can be used to improve weight loss: for every two pounds lost, Alli will help the patient lose one more.
You should stress to patients that Alli is not a quick fix, and that it is only for use in conjunction with a reduced calorie, low fat diet.
This is very important: because orlistat prevents fat being absorbed, it means patients often have sudden or frequent bowel movements, and fatty or oily stools; so the less fat eaten, the less this side effect occurs.
When to refer patients
Each pharmacist will have their own preferences as to who they would like referred to them and it is important to follow your pharmacy's procedures. Individuals on regular medication, with suspected eating disorders, long-term conditions such as diabetes, and those under 18 years of age should always be referred to the pharmacist. Pregnant or breastfeeding women should also be referred as weight loss may not be appropriate for these patients.
Q&A: Weight loss problems
Q How much weight should my customer lose in a week?
A Anything between one to two pounds a week is a healthy weight loss. Gradual weight loss is more sustainable, and patients are more likely to maintain that loss in the long term.
Q My customer cannot lose weight, even though they appear to be following their diet. What can I do to help them?
A Often people think they are sticking to their diet but during the weekend they give themselves treats. If they binge during a weekend they will gain the calories they have lost during the week. One day of bingeing can cancel out five days of weight loss, so they should stick to their weight loss plan every day.
Q A customer has lost weight but is concerned that their skin is flabby. What should I recommend?
A Exercise, such as sit ups, is good for toning up skin. Some pharmacy products are also recommended for helping to reduce the signs of stretch marks.
Key points
• Weight loss is about consuming fewer calories than the body requires to function. This will vary depending on a person's age, gender and weight.
• Simple lifestyle changes get the best results. For example, advise customers to eat five portions of fruit and veg each day, limit snacks and swap fatty foods for low sugar and fat alternatives.
• The weight loss drug Alli is available over the counter for people who are overweight. This will help patients lose an extra pound for every two pounds they lose. However, they should be advised it is not a quick-fix solution, and that it can have unpleasant side effects if they eat fatty foods (such as oily or fatty stools).
Evaluation
• Weight loss takes a long time and is hard to accomplish. How can you support your
patients in losing weight?
• Several customers should be advised not to lose weight. Talk to your pharmacist about which customer groups they would want you to refer to them.
• The box on p21 contains the BMI calculation. Make sure you can calculate a patient's reading correctly – remember that height is in metres, not centimetres.
