Community pharmacists can ease the burden on the NHS and improve lives by offering personalised weight management support, writes Sarah Welsh…

As the pace of life increases and sedentary jobs more commonplace, the number of overweight adults in the UK continues to rise with 26% classified as obese. Unfortunately, being overweight is a cross generational issue, with one in 10 reception aged children and one in five year six children classed as obese. As a frontline service, community pharmacists are ideally positioned to offer patients help managing their weight.

Tipping the scales

The obesity pandemic has been a problematic issue for the NHS for some years now, costing the £5.1bn a year and rising. Carrying excess weight can impact on individuals’ physical and mental health, and after smoking, obesity is one of the main causes of early morbidity. In fact, around 30,000 people die due to obesity every year.

The government has attempted to tackle this serious issue affecting UK adults and children by implementing a range of strategies from introducing a soft drinks industry levy to clearer labelling on packaging. Healthy living advice, behavioural change therapy and preventative health initiatives are also part of the strategy for change.

When it comes to obesity the most worrying demographic is children, which is why the government has encouraged schools to focus on providing education on the importance of healthy eating and regular exercise.

Aside from the regular physical education lessons, many schools are now offering incentives to children who get more active by walking to school such as house points to put towards a class outing or party . The introduction of the universal free school meals for reception, year one and year two children has also helped with nutritional intake for many school age children.

It seems that deprivation has a huge impact on the prevalence of obesity as 13% of reception age children living in the most deprived areas were obese compared to 6% of those living in the least deprived areas. The numbers are more disturbing for year six children where 26% of those living in the most deprived areas are classed as obese compared to 11% of children from deprived areas.

In the 1980s just 6% of men and 8% of women were obese, so the numbers are clearly rising at an alarming rate. If intervention isn’t successful then the future could look very bleak for the UK according to a Foresight obesity report, which has projected that by 2050, 60% of the UK population could be obese, creating a cost to the economy of £45.5bn.

Spreading the word

Community pharmacists can help the government its obesity strategy and take the pressure off the NHS by improving people’s health. They can provide patients with the tools to manage their weight in the form of information, advice and support.

Educating patients can be the catalyst for change as research has found that both adults and children’s perception of their own weight is often inaccurate. According to the Health Survey for England - 2016, 87% of obese adults and 50% of overweight adults thought they were too heavy, with 9% of adults who weren’t overweight or obese saying they were too heavy.

More concerning were the results regarding parents’ perception of their children’s weight, with 41% of mothers of obese children thinking their child was the correct weight or too light, and 55% of fathers saying their child was the right weight or underweight when they are in fact obese.

The most common method of measuring obesity is the Body Mass Index (BMI). In adults, a BMI of 25kg/m2 to 29.9kg/m2 means that a person is overweight, if a person’s BMI is 30kg/m2 or higher they are considered to be obese. However, BMI does not distinguish between muscle mass and body fat, so in order to measure abdominal obesity, waist circumference should be measured and categorised as high and very high, according to gender. For men a waist circumference of less than 94cm is desirable, 94-102cm considered high and 102cm very high. In women a desirable waist circumference is less than 80cm, 80-88cm high and more than 88cm is considered high.

Community pharmacists are in the ideal position to help patients to monitor and reduce their weight by offering personalised one to one information and support. According to the Kent Community Health NHS Foundation Trust, patients who receive one to one support in weight loss programmes with pharmacy advisers achieve an average 3% weight loss, which is in line with national guidance.

“We offer patients a weekly meeting where they get weighed and we calculate their BMI and fill in a health questionnaire,” explains Amish Patel, managing director of Hodgson Pharmacy. “We take the opportunity to talk to patients about adopting a healthy lifestyle, offering advice and support.”

It’s important that community pharmacists educate patients on the potential life-threatening conditions that obesity can cause such as type 2 diabetes coronary heart disease, breast cancer and bowel cancer and stroke. It’s not just the physical changes that patients need to be warned about either as obesity can lead to psychological issues such as depression and low self-esteem too.

Training

Community pharmacists interested in supporting patients in their weight loss journey can seek training from their local NHS Foundation Trust or council. For example, Kent Community Health NHS Foundation Trust offers weight loss training for pharmacy advisers to provide a programme called One You, supporting people to lose weight.

“Our Pharmacy programme provides support for adults with a BMI between 25 and 35,” explains Jo Treharne, head of campaigns at Kent Community Health NHS Foundation Trust. “Clients with a BMI above 35 are supported by our core service in a group setting.”

The One You programme aims to help patients reach and maintain a healthy weight with no bars or gimmicks, ‘Just sensible, practical support and advice’. The service offers group sessions and one on one appointments to suit individuals’ needs.

“Successful weight loss requires the right combination of good nutrition, physical activity and behaviour modification,” says Treharne. “One You Weight Loss provides a free 12 week weight loss programme which applies all these principles to successfully help patients achieve and maintain a healthy weight long term.” 

“The programme supports adults who are overweight or obese to reduce the risk of poor outcomes through a flexible and engaging approach to weight management. Evidence suggests that small changes to diet, being physically active and learning to think differently will help people achieve their weight loss goals and can also have a positive impact on health. Patients can access the programme via self-referral or health professional referral.”

Although community pharmacists can offer help and advice to parents with children who are overweight or obese, there are usually programmes specifically designed for families which pharmacists can refer patients to.

Ready, Steady, Go is a weight management service for children aged 4-11 and their families living in East Sussex, which has been designed to support children whose weight is likely to cause them health problems in the present or future. It involves eight, one hour sessions for children, their parents and carers as well as other family members. These sessions focus on healthy eating and physical activity, and covers a range of topics which can influence a child’s weight, such as sleep and screen time. Families can self-refer into Ready, Steady, Go or be referred by a health professional.

Getting physical

The government has allocated funding from the soft drinks industry levy for sport programmes inside and outside of schools. Many schools now take 10 to 15 minutes out of the school day to allow students to walk a daily mile. These basic initiatives, which are fun and non-competitive, encourage children to move more.

Community pharmacists can encourage parents to incentivise their children to be more active with pedometers or step counting apps on their phones, walking to school one day a week if they usually use the car, as well as offering rewards and taking part in fun family physical activities such as trampolining, cycling and sports.

The health benefits of leading a physically active lifestyle are well known with evidence to suggest that regular exercise can reduce the incidence of many chronic diseases. Therefore it’s essential that community pharmacists explain the benefits to patients, such better health and improved academic performance as exercise make them more alert and focussed.

Obesity is an extremely complex challenge for health professionals to face as there is no single cause or solution. The multi-faceted nature of obesity means that biological, physiological, psycho-social, behavioural, and environmental factors all influence its prevalence.

Community pharmacists can help the government tackle this social challenge by re-educating patients about proper eating habits and the importance of exercise. From food labelling and fruit and vegetable intake to the importance of sleep and exercise, community pharmacists can work with patients to improve the quality of their lives while relieving the costly burden to the NHS.

Visual prompts

Many people’s eating habits are long established and very little thought goes into the nutritional content of meals. Community pharmacists can use visual aids within the pharmacy to highlight poor food choices and encourage uptake of weight management services.

Memorial Pharmacy in Sittingbourne, Kent uses visual aids to support their weight management programme, One You. It has posters in prominent positions around the pharmacy encouraging patients to be food smart.

One poster highlights the fat content for common foods like French fries, cheese burgers, pizza and compares with healthy food such as apples and grapes. The concept is simple, but effective – showing patients the vast difference between certain food groups. The pharmacy also uses visual prompts to suggest food swaps for smarter options and highlights food laden with hidden sugars.

These simple measures not only make people stop and think about food in a more mindful way, but help to open dialogue between community pharmacists and patients wanting to change their eating habits and lifestyles.

Picture: MarsBars (iStock)