Pharmacist in Obesity Management

Body Mass Index (BMI) is the traditional method to determine whether a person is considered obese. It is quite simple to calculate BMI by a comparison of a person’s height and weight. BMI = Weight in kilograms / (Height in metres x Height in metres). A person is considered overweight if the BMI is between 25.0 and 29.9, and if the BMI is greater than 30, then considered as obese (WHO, 1997; NICE, 2007).

The BMI, however has limitations as it does not take into account whether the person’s weight is fat accumulation or muscle mass, for instance of athletes (Garn et al, 1986). Body composition is the amount of lean body mass and body fat that makes up total body weight. The practical method to measure body fat is using bioelectrical impedance technology, designed as home use body fat monitor. Below is the table of normal range body fat percentage (Gallagher et al, 2000):Another method to determine obesity is through the use of the waist-to-hip ratio. Waist circumferences in females should not exceed 35 inches or 89 cm, and in males they should not exceed 39 inches or 99 cm (Bray, 2004). Measurement of waist circumference (central obesity) is a simple indicator of an increased risk of cardiovascular disease (Janssen et al, 2004)

What cause Obesity? Metabolic disorders are very rare. It is usually a combination of over eating, over drinking and being under active. If energy intake exceeds energy output, then the excess is stored as fat. The simple explanation is an imbalance energy, but patients often resist reducing intake and increasing exercise in a manner sufficient to induce sustainable weight loss. As a result, overweight patients undergo numerous approaches with varying degrees of success, including expensive gadgets, portion control, meal plans, support groups, surgery, and pharmacotherapy. (Hofbauer, Nicholson, Boss, 2007). Keeping the BMI and fat percentage within normal range will reduce the risk of weight related diseases.

Obesity Epidemic The World Health Organization estimated that 1.6 billion adults (over age 15 years) were overweight in 2005. Currently, over 50% of the adult population are classified as overweight and 17% of men and 21% of woman are classified as clinically obese. By the age 55-64 years, these figures have increased to 26% of men and 29% of women. Source: Health Survey for England 2005 – updating of trend tables to include 2005 data. The Information Centre it is not just a disease that affects the adult population, childhood obesity is now rapidly increasing and becoming a major cause for concern. Between 1995 and 2005, the prevalence of obesity and overweight among boys and girls are increased.

Source: Health Survey for England 2005 – updating of trend tables to include 2005 data. The Information Centre Health Problems Related to Obesity Obese people are 2-3 times more likely to die prematurely than someone of normal body weight. Obesity is known to be a contributing factor in health problem, includes: heart disease, hypertension, stroke, type 2 diabetes, abnormal blood cholesterol/ triglyceride levels, the metabolic syndrome, cancer, osteoarthritis, sleep apnea, reproductive problems, and gallstones. (National Heart Lung and Blood Institute, 2007).

THE ROLE OF PHARMACISTS IN OBESITY

Patients need for more counseling Many chronic diseases caused by obesity has been a major issue recently as they needs long term treatment that raise the cost of healthcare and medication. In handling this condition, it needs to solve the problem from the root for obese patients and prevent the obesity itself for general public. Patients need for more counseling on diet and exercise. A study conducted by Malone et al in 2003, evaluated the impact of pharmacist support on obese patient persistence with orlistat. The result showed that patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.

Another study by Heaton et al in 2006, also supported the evidence of the importance of patients counseling by pharmacists, especially those who are in community pharmacies. They tried to determine the percentage of physician the percentage of physicians who reported counseling patients on diet/nutrition, exercise, weight reduction, or smoking cessation during their office visits. The result of the study showed that patients are insufficiently counseled and educated about the need for lifestyle changes that can affect their risks for common chronic diseases.

Pharmacists should do intervention in obesity and weight management programme since they interact with large numbers of the public on a regular basis. Patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacists. Is pharmacist intervention/counseling effective? A survey in 2004 identified factors that influence the frequency of counseling obese patients by community pharmacists. Obesity counseling by pharmacists was positively correlated with their perceived comfort with counseling obese patients, confidence in achieving positive outcomes, and effectiveness of obesity management options (Dastani et al, 2004).

Offering weight management services provides an opportunity to increase public awareness of pharmaceutical care and attract patients to pharmacy programs. Recent study that conducted in The Auburn University Pharmaceutical Care Center’s Healthy Habits, describe the implementation and evaluate outcomes of a weight management pharmaceutical care service in a stand alone pharmaceutical care center on a college campus. The result of the study showed that pharmacists have established the role in obesity management by helping patients to decrease total body weight, BMI, and risk of weight-related complications. (Lloyd et all, 2007).

Establishing Role of Pharmacist in Obesity Pharmacists are set to have a major impact on improving public health. It is being important on the Government agenda and nationwide priority. Health minister Rosie Winterton said “To date, pharmacists have been a major untapped resource for health improvement… but we would like pharmacists to do even more.” (Health Minister Rosie Winterton MP, 2004)

The NHS in England is spending over �38 million a year on drugs to fight obesity, a new study shows. prescribing data was analysed for two anti-obesity drugs, orlistat and sibutramine between 1998 and 2005. The results showed a 36-fold rise in orlistat usage and a four-fold rise in sibutramine medication. (Srishanmuganathan, 2007) Community pharmacists can play a big role in obesity. Pharmacies are being accessible and ideally positioned health care providers to general public. That is the potential success in providing pharmaceutical services on counseling and promoting healthy lifestyle. Not only this aim will prevent obesity , but also other lifestyle-related diseases.

DISCUSSION

Pharmacists can be an essential resource for the public and obese patients attempting to manage their weight, particularly in provide information and educate them about proper weight-loss programs. Pharmacists can encourage patients to utilize long-term weight-management goals rather than just some of the quick-fix OTC products. Some of the advice, by oral or leaflet, can be given out as below: Diet Plans The true benefits of dieting can be attained only when permanent changes are made in a patient’s eating habits and those changes are consistent. These includes low-calorie diets and meal-replacement plans. Also, aim to eat at least five portions of fruit and vegetables a day (Early et al, 2007).

Avoid fast food, alcoholic drink and sugar sweetened beverage A recent study concluded that fast foods can increase the risk of weight gain and obesity in regular consumers by encouraging unintentional over-eating. A diet high in fast foods will increase a person’s risk of weight gain and obesity (Rosenheck, 2008). Alcohol drink contains 7 calories/gram, which is only slightly fewer than fat which has 9 calories/gram. The weight of epidemiologic and experimental evidence indicates that a greater consumption of sugar sweetened beverages also are associated with weight gain and obesity (Malik et al, 2006).

Exercise By exercising regularly, calorie output can be increased. Thirty minutes three to five times per week is ideal, though any exercise is beneficial. Other measurement is by using pedometer, walk 10000 steps a day. Start slowly and build up then aim for consistent exercise programme. For obesity with BMI above 40, pharmacists should refer the patients for multidisciplinary action to aid the weight management program, includes physician, physiotherapist or personal trainer and in severe obesity case, psychologist is also needed to establish a willingness to lose the weight. Consult with a dietitian or nutritionist for a personalized nutrition plan and change eating behavior is crucial (Malone, 2005).

Monitoring and Evaluation

All people, whether general public or patients, who need counseling should complete a questionnaire and be measured. The form will be kept completely confidential in the pharmacy for follow upon regular basis. Keep on self assessment is the very important in monitoring. It is suggested that patients have their own tools at home, such as body weight scale, body fat scale, measurement tape, pedometer, etc. Successful result will show a decrease number in obese patients and ideal body weight and shape are maintained in general public who receive counseling or advice.

SUMMARY

Obesity has become global epidemic world wide. In England, during past 10 years, the number of people classified as obese, using BMI, has almost trebled. And it is not just a disease that affects the adult population, childhood obesity is now rapidly increasing. Obesity is known to be a contributing factor in a number of the life threatening diseases. Patients and public need more counseling on healthy lifestyle. Pharmacist role and intervention has been shown to be effective in combating obesity, whether in prevention and improving therapeutic outcomes.

The accessibility and get in touch to general public is the key strength to educate, give information and provide pharmaceutical services on counseling and promoting healthy lifestyle. It needs multi-disciplinary approach between healthcare professionals in targeting significant decrease in obesity prevalence. To evaluate and monitor the patients, review should be carried out on regular basis.

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