Pictured: Helga Mangion presenting her session ‘Providing effective weight management services for obese patients’ at the Pharmacy Show on 18 October.
Helga Mangion, the NPA’s Policy Manager, is passionate about…effective weight management services for obese patients. Here she writes about the obesity epidemic and how community pharmacy can help.
In 2020, the Prime Minister personally set out the government’s strategy on tackling obesity.
It was at a time when the Covid-19 pandemic had taken a grip all over the world and when exercise was probably at its lowest for years!
Then, in July 2021, the NHS Digital Weight Management Programme was launched. This involved the provision of free online support via GP and primary care teams for adults living with obesity.
It did not include community pharmacy.
Alongside this, the government also provided £30 million of new funding to Local Authorities, to roll out expanded management services for adults living with obesity.
So, how can community pharmacy get involved and provide effective weight management services for obese patients?
Obesity is a condition that pre-disposes other long-term conditions, including diabetes, hypertension and cardiovascular disease. We also know that obesity increases the risk of severe illness from Covid-19.
Obesity is prevalent in deprived areas. It follows that if we tackle health inequalities we can also help address the obesity issue and vice-versa.
Often the terms ‘overweight’ and obesity are used interchangeably, however, it is important that we appreciate the difference between the two, as the treatment, management and therefore outcomes for both are different.
For instance, the obese person will suffer from stigma, low self-esteem and often-poor mental health. This may not be the case with someone who is merely overweight as a result of enjoying the extra mince pie or two at Christmas.
A number of pharmacies already provide services to overweight patients, some in association with commercial companies. They often consist of a range of meal replacement options, coupled with calorie counting and public weighing, where the individual is congratulated and supported in a public manner.
But in the instance of obesity, this pathway is not suitable for the obese person who is already suffering from stigma and embarrassment. The obese person would be better suited to a one-to-one, tailored approach.
Back in 2009, I was invited to provide a business case for a multi-disciplinary primary care obesity service, during a meeting with my local practice based commissioning group. As the newly appointed obesity lead, I was able to gain a better understanding into how and why community pharmacy should be involved in providing obesity services and commissioned to do so.
A similar service was commissioned at the time, with both GPs and pharmacies provided the multi-disciplinary weight management service for obese people. It was a very successful service, which saw up to 100 patients within the first three months. There were positive outcomes on the health and wellbeing of the patient, including some who had their hypertensive medication reduced or withdrawn altogether.
The service involved one-to-one consultations in a setting of the patient’s/customer’s choosing for example the GP surgery or community pharmacy. Initially this was over 12 weeks. The first consultation was the most critical as not only was this the set-up consultation, but it also ensured that rapport and trust were built up between the healthcare professional and the individual.
Key parameters such as blood pressure, BMI, and activity level were taken, in addition to a discussion on the individual’s motivation and barriers. Thus, a tailored diet and exercise programme was devised, so that the individual would lose up to five per cent of their own body eight by 12 weeks.
Follow-up appointments would then take place initially every two weeks until week eight, which would then be followed by monthly follow-ups. Optional follow-ups were also offered at month six, month nine and month 12.
There were two routes into this service - the GP surgery and the community pharmacy. It thus transpired that the service through the GP surgery was often through inter-referral within the surgery, whilst the service through the community pharmacy was often as a result of a self-referral; that is a person visiting their local pharmacy to collect their monthly repeat from their trusted healthcare professional. Posters highlighting the service were often key to starting that initial rather difficult conversation.
The service was received well by both patients and healthcare professionals. Qualitative evidence gathered as part of the evaluation, showed that the patients within this study felt supported and encouraged by the fact that the consultations were on a one-to-one basis and that the feedback was personalised and private. It was a joy to hear some of the patients express their immense delight in not only achieving their target, but that there self-confidence was once again renewed and they were enjoying life once again after years of seclusion and isolation.
In summary, a gradual and supportive approach is what is required to provide an effective weight management service for the obese patient. Some of the services that are currently being delivered through health authorities are similar to the service I’ve described.
In most areas, services will include 12-week sessions, with dietary advice, physical activity guidance and support to help people start and maintain healthier habits.
So what needs to be true for the community pharmacy to be able to deliver this service?
Firstly, it would be important to review and consider the following:
1. The pharmacy team
- Is every member of staff aware of the difference between being overweight and obese?
- Is every member of staff aware of the stigma associated with obesity?
- What is the training that is required?
2. The consultation room
- Is the consultation room set up to provide this service?
- Room size and space
- Chairs without arms
- Appropriate weighing scales and blood pressure monitors
- Height and weight measurement tools
3. Do you have the names of your local commissioners
- Is such as service being commissioned in your area?
A key enabler to this service could be digital technology, where the community pharmacy could be the IT Hub of support.
All pharmacies in England are Heathy Living Pharmacies, so having been highlighted as having a key role in prevention, how about we enhance our preventative role through recognising the signs that could lead to obesity, and then intervene? For instance - signs that could lead to obesity include mental health, chaotic lifestyles, specific medicines, as well as specific diseases. Community pharmacy, being at the heart of its community, could also provide similar services for obese children and support their families.
And ultimately, community pharmacists are the medicines experts, so how about considering pharmacological interventions in addition to or following on from the non- pharmacological interventions? When working in collaboration with the local primary care team, the population as a whole feels the benefit.
There is a place and role for community pharmacy to provide obesity services, and we at the NPA are here to support you with this. Community pharmacists and their teams are already providing a raft of public health services that contribute to the top public health priorities including the Covid-19 pandemic.
Let us, as a profession rise to the challenge and continue to demonstrate that community pharmacists are indeed key to addressing the next pandemic - the obesity pandemic!
This blog is a summary of Helga Mangion’s session ‘Providing effective weight management services for obese patients’ at the Pharmacy Show on 18 October.