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Addressing the problem at scale will be a challenge in Northern Ireland within existing service frameworks. Only through an innovative approach will we tackle obesity in a fair and equitable way, says Terry Maguire…

Obesity remains a first world public health crisis that national health services struggle to manage. It causes significant morbidity and mortality and adversely impacts health budgets at a time when budgets struggle to keep pace with expanding demand.

Across the UK, including Northern Ireland, 37 per cent of the population is overweight and 25 per cent is obese. Recently the Department of Health and Social Care announced the establishment of a Regional Obesity Management Service (ROMS) to address the crisis and to bring Northern Ireland into line with other UK regions.

Core to this will be the effective use of Anti-Obesity Medicines (AOMs) mainly the GPL-1s and trizapetide. You might be forgiven for expressing some cynicism at this announcement as it may only be a means to provide our capable health minister with a holding position so he can do nothing other than hold a series of meetings and talk about the issue.

To really address our current obesity problem at scale will be a challenge in NI, certainly within existing service frameworks. Only through an innovative approach, harnessing the opportunities offered by the GLP-1s, and the accessibility of the community pharmacy network, can we meaningfully tackle obesity in a way that is fair and equitable. 

Over 1.5 million UK adults are currently accessing AOMs privately, mostly through online pharmacies. In comparison, approximately 200,000 patients access GLP-1s via the NHS; the majority prescribed it for management of type-2-diabetes; as yet none in NI for treatment of obesity.

With strict criteria and limited access this raises concerns of health inequalities. Delays in, and restrictions on, the roll-out of these medications as recommended by NICE to eligible patients unable to afford private treatment, will likely contribute to the growing health inequalities.

It is important that this does not persist as obesity, as we all know, is strongly linked to deprivation. Community pharmacies are ideally positioned to provide wrap-around support services during monthly face-to-face reviews, aligned with medication supply and ensuring consistent patient monitoring. Goodness we are already doing this at scale for paying patients.  

Indeed, NICE expect that wrap-around support is provided at regular intervals for a minimum of 1 year after stopping GLP-1s so that weight is not regained.  That is not currently part of the private offering.

A recent report by the Tony Blair Institute (TBI) for Global change argues that NHS England’s proposed multi-disciplinary team (MDT) care model which includes consultants/GPs, dieticians, nurses, pharmacists, healthcare assistants and psychologists is very resource intensive, expensive and likely impractical to deliver at scale given the large number of eligible patients and current primary care capacity pressures.

The proposed MDT model for wrap-around care is estimated at more than £1,200; equivalent to the annual cost of the medication itself. TBI advocates for the use of lower cost strategies for a more efficient and wider roll-out including a Pharmacy First approach.

Regulators have been actively monitoring and challenging inappropriate use of weight loss injections especially those purchased on-line and without proper clinical governance to avoid serious adverse events, including hospitalisations and fatalities. This remains a problem for the pharmacy network which needs a good governance model for this service.

Northern Pharmacies Ltd Trust Fund (NPLTF) is a charity set up to promote the development of community pharmacy in N. Ireland in the interests of the population and it might provide a solution.

NPLTF is proposing to part-fund a pilot pharmacy-based obesity management service that will design a model service that will provide behavioural change support on diet and exercise and include AOMs prescribing to patients with a BMI of 35 or over and who suffer from one co-morbidity.

The primary objective of the intervention is to test if a Pharmacy First solution is both effective and cost-effective and addresses the issue of social inequalities currently emerging. The proposed pilot will involve 10 community pharmacies chosen from across N. Ireland who each will enroll 20 patients (200 patients in total).

Patients will be followed up for 24 months. In the initial 12 months they will be provided with intense support to effect behavioral change in diet and exercise and will be prescribed trizapetide.

After 12 months clients will continue to be supported for a further 12 months. NPLT is seeking interested partners to take part in this pilot. Only by undertaking this work will we know if the community pharmacy network is up for addressing the public health challenge that is obesity.

Terry Maguire is a leading community pharmacist based in Northern Ireland.