In OTC

Follow this topic

Bookmark

Record learning outcomes

Obesity is a major health problem but potential dieters need good advice on healthy eating and exercise. Victoria Goldman weighs up the latest recommendations

Obesity is a serious public health concern in the UK. In 2012, just a quarter of women and just under a quarter of men were obese and 42 per cent of men and 32 per cent of women were over weight. By 2050, obesity is predicted to affect 60 per cent of men and 50 per cent of women in the UK.

But while the government focuses on anti- obesity campaigns and initiatives, a proportion of the population is aware that they need to lose weight but are struggling to do so. A Mintel report from January 2014 revealed that 55 per cent of the British population – 29 million people – tried to shift the pounds in 2013. However, one in five dieters claimed that they don’t have the willpower to stick to a diet for very long.

According to last year’s National Obesity Forum report on ‘The State of the Nation’s Waistline’, healthcare professionals are regularly asked to support patients who want to lose weight. However, not everyone is willing to discuss the issue. “No-one likes to be told that they are overweight, even by a healthcare professional who has the best interests of the patient’s health at heart,” states the NOF report. “If patients react defensively, then they are less likely to take the advice offered by their GP; it also makes some GPs less likely to raise the topic with patients due to fear of the reaction.”

Customers may ask pharmacy staff about effective weight loss programmes, suitable products and nutritional supplements if they are worried about going to their GP for help. But what advice should pharmacists be offering to customers who are struggling to lose weight or keep the weight off?

“Losing weight is mentally tough, but pharmacists are well placed to offer dietary and lifestyle advice to customers,” says Jyoti Sood, Royal Pharmaceutical Society spokesperson. “The safest way to lose weight is aim for no more than two pounds loss a week. Pharmacists could enrol patients on to weight loss programmes, where customers keep a food diary and come back every week or month to discuss how they are getting on.”

Lifestyle changes

Sticking to a diet isn’t easy and there is no one-size-fits-all solution. According to Mintel, keeping a written or online food diary is the most popular structured approach, followed by using a dieting app. For those who follow a popular scheme, the 5:2 diet is currently the nation’s favourite, followed by low carbohydrate diets (eg, Atkins) and high protein or low fat plans (eg, Dukan).

Sticking to a diet isn’t easy and there is no one-size-fits-all solution

Last September, NICE issued new proposals to tackle obesity. The general rule for maintaining a healthy weight is that energy intake through food and drink shouldn’t exceed energy output from daily activity. NICE recommendations include:

• Walking or cycling to school or work
• Reducing TV viewing
• Cutting down on calorific foods (eg, fried food, biscuits, sweets and full-fat cheese)
• Adopting a Mediterranean diet high in vegetables, fruit, beans and pulses, whole grains, fish and olive oil
• Avoiding drinks sweetened with sugar
• Limiting fast food and takeaways
• Limiting alcohol consumption.

According to Abigail Wilson, registered dietitian and British Dietetic Association spokesperson, pharmacists should advise customers to eat three meals a day and have two small snacks in order to achieve effective weight loss. “Many people who are trying to lose weight simply cook too much food and need to have smaller portion sizes,” she says. “Check that customers understand what foods they are buying, too, as some ‘healthy’ snacks may still be full of fat or calories. It’s important they don’t starve themselves, however, as this slows down the metabolism. Some people also need to look at when and how they eat, rather than just what they eat. A big challenge is helping people who lead a busy lifestyle, as they may not be eating regular balanced meals.”

Food choices

The official NHS recommended daily calorie allowance for people trying to lose weight is 1,900 kcal for men and 1,400 kcal for women. However, research published recently in the Public Health Nutrition journal has suggested that dieters need to pay more attention to food choices, rather than simply the amount of calories they eat. Some high- fat foods, such as nuts and oily fish, may protect against certain chronic diseases, whereas other highly calorific starchy or sugary foods (eg, white rice) are absorbed rapidly, affecting blood sugar levels and triggering food cravings.

“The fact is that some calories will quell a person’s appetite and promote energy utilisation, while others will promote hunger and energy storage,” says James DiNicolantonio, a cardiovascular research scientist in Kansas City, who co-authored the study. “So while some calories send messages to the brain and body that say, ‘I’m full and ready to move,’ other calories send messages that say, ‘I’m still hungry and just want to lie down on the couch.’ Not all calories are the same, and in order to promote healthy weight and better health, we need to take special note of the calories we are choosing to consume.”

Pharmacy advice

If customers are struggling to lose weight despite their best efforts, Ms Wilson suggests that pharmacists look at their medical history. “Some medicines, such as antidepressants, corticosteroids or even migraine medications, may increase someone’s appetite, so that they eat more food and put on weight easily,” she says. “Oestrogen can also lead to weight gain, while antihistamines may slow down the metabolism. Some people may have a thyroid problem that hasn’t been diagnosed or isn’t being treated effectively.”

Pharmacies can stock a selection of over-the-counter slimming products, such as Adios and XLS-Medical, to boost weight loss alongside a calorie-controlled diet and regular exercise. There are also partial meal replacement programmes (eg, SlimFast or Celebrity Slim), and total meal replacement programmes such as Lipotrim. Ms Sood stresses that pharmacists should always stock licensed weight loss aids. “A lot of people are looking for a quick fix,” she says. “So if they come in for any slimming aids, check their medical history and why they want to lose weight before making a recommendation.”

Omega Pharma recently launched XLS- Medical Direct berry-flavoured sachets, which contain the same patented natural fibre complex found in XLS-Medical Fat Binder. “Anyone who purchases an XLS-Medical product can benefit from a range of support tools including health and wellbeing advice from our in-house dietitian,” says an Omega Pharma spokesperson. “Free one-to-one consultations are available to help dieters identify their triggers and create their own healthy meal plan. Tailored, motivational and personalised guidance is also available on our free online 12-week programme.”

If customers ask for laxatives, pharmacists should make sure these medicines are not being used inappropriately or in large amounts. In October 2014, the UK’s eating disorders charity Beat called for tighter regulations on the sale of laxatives, including a minimum purchase age of 16, maximum pack size (blister packs of no more than 10) and sales restricted to pharmacies rather than general retail outlets. This was prompted by the charity’s growing concerns at the number of people admitting that they have been able to obtain unregulated amounts of laxatives in a bid to restrict their body weight.

Pharmacists should also be prepared to offer general dietary advice. Customers trying to lose weight may benefit from taking vitamin and mineral supplements, especially if they are cutting out (or limiting) any particular food groups (eg, dairy products, which are a rich source of calcium). Customers may also be interested in learning about mobile apps (eg, MyFitnessPal) to help them monitor their food intake and activity levels. The Men’s Health Forum recently revealed that using pedometers to monitor physical activity levels, and well as other gadgets, may make weight loss programmes more appealing to men.

Ms Wilson suggests that pharmacists signpost customers to reliable diet and nutrition resources, such as the BDA’s website and her online resource, e-dietitians.com, which is written by registered dietitians.