Weight management pharmaceutical services

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Weight Management Pharmaceutical Services
Obesity and Overweight: Definition, causes, prevention
Obese and Overweight patient counseling guidelines
Exercise, Physical activities for obese and overweight people

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  • In addition, 44% of the diabetes burden, 23% of the ischaemic heart disease burden and between 7% and 41% of certain cancer burdens are attributable to overweight and obesity.
  • Which means more health problems ahead. If this trend continues, it is highly likely that more will suffer from high risk diseases that could lead to death.
  • Childhood obesity is associated with a higher chance of obesity, premature death and disability in adulthood. But in addition to increased future risks, obese children experience breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects.
  • Overweight and obesity are linked to more deaths worldwide than underweight. For example, 65% of the world's population live in countries where overweight and obesity kill more people than underweight (this includes all high-income and most middle-income countries).Many low- and middle-income countries are now facing a "double burden" of disease.While they continue to deal with the problems of infectious disease and under-nutrition, they are experiencing a rapid upsurge in noncommunicable disease risk factors such as obesity and overweight, particularly in urban settings.It is not uncommon to find under-nutrition and obesity existing side-by-side within the same country, the same community and the same household.Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant and young child nutrition At the same time, they are exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor foods, which tend to be lower in cost but also lower in nutrient quality. These dietary patterns in conjunction with lower levels of physical activity, result in sharp increases in childhood obesity while undernutrition issues remain unsolved.
  • However, it should be considered a rough guide because it may not correspond to the same degree of fatness in different individuals.BMI MAY BE LESS ACCURATE MEASURE OF ADIPOSTY IN ADULTS WHO ARE HIGHLY MUSCULAR, SO INTERPRETATION IN THIS GROUP MUST ME WITH CAUTION. SOME POPULATION GROUPS HAVE CO-MORBIDITY RISK FACTORS THAT WOULD BE A CONCERN AT DIFFERENT BMIs (LOWER IN ASIAN ADULTS AND HIGHER FOR OLDER PEOPLE).CLINICAL JUDGMENT MUST BE USE
  • THE APPROACH SHOULD BE ADJUSTED, AS NEEDED, DEPENDING ON THE PATIENT’S CLINICAL NEED AND POTENTIAL TO BENEFIT FROM LOSING WEIGHT.IN OBESE CHILDREN,ASSESSMENT OF COMORBIDITY SHOULD BE CONSIDERED WTH A BMI AT OR ABOVE THE 98TH CENTILE.
  • For infants who are NOT YET WALKING.PHYSICAL ACTIVITYSHOULD BE ENCOURAGED FROM BIRTH, PARTICULARLY THROUGH FLOR AND WATER-BASED ACTIVITIES IN SAFE ENVIRONMENTS.
  • CHILDREN OF PRESCHOOL AGE SHOULD BE PHYSICALLY ACTIVE DAILY FOR AT LEAST 180 MINS (3 HOURS) SPREAD THROUGHOUT THE DAY.SHOULD MINIMIZE BEING SEDENTARY FOR EXTENDED PERIODS, EXCEPT TIME SPENT IN SLEEPING.
  • STRENGTH TRAINING – FOR THE MUSCLES AND BONESCHILDREN SHOULD ENGAGE IN MODERATE TO VIGOROUS INTENSITY ACTIVITY FOR AT LEAST 60 MINS. UP TO SEVERAL HOURS A DAY. STRENGTH TRAINING SHOULD BE INCORPORATED AT LEAST 3 DAYS A WEEK.
  • MODERATE INTENSITY – CAUSE ADULTS TO GET WARMER, BREATHE HARDER AND HEARTS TO BEAT FASTER, AND STILL CARRY ON A CONVERSATION.VIGOROUS INTENSITY – ADULS GET WARMER, HEARTS BEAT FASTER, MAKING IT MOR EDIFFICULT TO CARRY ON A CONVERSATIONSTRENGTH TRAINING – WORKS AGAINST RESISTNCE TO STRENGTHEN THE MUSCLE. MUST INVOLVE ALL MAJOR MUSCLE GROUPSOVER A WEEK, ACTIVITY SHOULD ADD UP TO AT LEAST 150 MINUTES (2.5 HOURS) OF MODERATE INTENSITY ACTIVITY, IN BOUTS OF 20 TO 30 MINS,. ON AT LEAST 5X A WEEK. OR 75 MINS. OF VIGOROUS INTENSTIY SPREAD ACROSS THE WEEK OR COMBINATIONS OF MODERATE AND VIGOROUS INTENSITY ACTIVITY.ADULTS SHOULD TAKE STRENGTH TRAINING ON AT LEAST 2 DAYS A WEEK. AND SHOULD MINIMIZE THE AMOUNT OF TIME SPENT BEING SEDENTARY FOR EXTENDED PERIODS.
  • 75 minutes OF VIGOROUS ACTIVITY SPREAD ACROSS THE WEEK, OR A COMBINATION OF MODERATE TO VIGOROUS ACTIVITYMUSCLE STRENGHTENING ACTIVITIES ON AT LEST 2 DAYS A WEEK. OLDER ADULTS AT RISK OF FALLS SHOULD INCORPORATE BALANCE AND COORDINATION ACTIVITIES ON AT LEAST 2 DAYS A WEEK.
  • TREATENT SHOULD BE STARTED IN A SPECIALIST PEDIATRIC SETTING, BY MULTIDISCIPLINARY TEAMS WITH EXPERIENCE WITH THIS AGE GROUP.
  • PRE-OPERATIVE ASSESSMENT – RISK BENEFIT ANALYSIS, PREVENTION OF COMLICATIONS, SPECIALIST ASSESSMENT FOR EATING DISORDERSPOST-OPERATIVE ASSESSMENT – SPECIALIST DIETETIC AND SURGICAL FOLLOWUP.
  • EQUIPMENT – SCALES. THEATRE TABLES, PRESURE RELIEVING MATRESS, ZIMMER BED FRAMES, HOISTS AND SEATING.ALL YOUNG PEOPLE SHOULD HAVE HAD A COMPREHENSIVE PSYCHOLOGICAL, EDUCATION, FAMILY AND SOCIAL ASSESSMENT BEFORE AND AFTER SURGERY.A FULL MEDICAL EVALUATION INCLUDING GENERIC SCREENIG SHOUD BE MADE BEFOR ESURGERY TO RULE OUT RARE, TREATABLE CAUSES OF OBESITY.
  • LIFE THREATENING CO-MORBIDITIES IN CHILDREN INCLUDE SLEEP APNEA AND INCREASED INTRACRANIAL PRESSURE).THE REQUIRED TESTS FOR CHILDREN: BP MEASUREMENT, FASTING LIPID PROFILE, FASTING INSULIN AND GLUCOSE LEVELS, LIVER FUNCTION, ENDOCRINE FUNCTION
  • Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education.
  • Raised BMI is a major risk factor for noncommunicable diseases such as:The risk for these noncommunicable diseases increases, with the increase in BMI.
  • It is preferred to the term "dieting," because it involves more than regulation of food intake or treatment of overweight people. People diagnosed with eating disorders who are not obese or overweight still need to practice weight management. Some health care professionals use the term "nutritional disorders" to cover all disorders related to weight.Before 1980, treatment of overweight people focused on weight loss, with the goal of helping the patient reach an "ideal weight" as defined by standard life insurance height-weight charts. In recent years, however, researchers have discovered that most of the negative health consequences of obesity are improved or controlled by a relatively modest weight loss, perhaps as little as 10% of the patient's body weight. It is not necessary for the person to reach the "ideal" weight to benefit from weight management. Some nutritionists refer to this treatment goal as the "10% solution." Secondly, the fact that most obese people who lose large amounts of weight from reduced-calorie diets regain it within five years has led nutrition experts to emphasize weight management rather than weight loss as an appropriate outcome of treatment.
  • Both of these factors must be tackled to produce reductions in obesity. Even a modest loss of 5 to 10% body weight in an obese of overweight persons can result in health and well being benefits.
  • This is monitored through a national public service agreement target.
  • NSF = NATIONAL SERVICE FRAMEWORK
  • This White Paper is an important newstage in building a world-class healthand social care system. It meets thehealth challenges of the new century,and adapts to medical advances whileresponding to demographic changes inour society and increasing expectationsof convenience and customer servicefrom the public who fund the healthservice. These proposals, part of theGovernment’s wider reformprogramme, will allow us to acceleratethe move into a new era where theservice is designed around the patientrather than the needs of the patientbeing forced to fit around the servicealready provided.This White Paper builds on theseprinciples and the significant progress,achieved through increased investmentand reform, within the NHS over thelast few years. There are 79,000 morenurses and 27,000 more doctors thanin 1997 with more in training. Waitinglists and waiting times are dramaticallydown, helped in part by giving patientsmore choice and encouraging newproviders within the NHS. Theflexibility and freedoms offered tofoundation hospitals have helped themimprove care and service.Deaths from cancer have fallen by14 per cent, from heart disease by31 per cent. Acute and emergency carein our hospitals has been transformed.Thousands of people in everycommunity owe their lives to theextraordinary medical advances ofrecent decades and to the dedicationof NHS staff.
  • THIS IS PARTICULARLY IMPORTANT FOR PEOPLE FROM BLACK AND MINORITY ETHNIC GROUPS, PEOPLE IN VULNERABLE GROUPS (LOW-INCOME FAMILIES), PEOPLE AT LIFE STAGES WITH INCREASED RISK FOR WEIGHT GAIN (PREGNANCY, MENOPAUSE, SMOKING CESSATION).
  • LITERATURE AND PROMOTIONAL MATERIALS AVAILABLE IN THE PHARMACY WILL SUPPORT THESE INTERVENTIONS.
  • PEOPLE WHO DO NOT WISH TO DISCUSS FURTHER WILL BE INVITED TO RETURN FOR FURTHER SUPPORT, SHOULD THEY CHANGE THEIR MIND AND THE WILL BE GIVEN COPY OF THE DH WHY WEIGHT MATTERS CARD.
  • INCLUDING’PRESENTING SYMPTOMS AND UNDERLYING CAUSES OF OVERWEIGHT AND OBESITYEATING BEHAVIORRISK FACTORS and CO MORBIDITIES – TYPE 2 DIABETES, HTN, CVD, DYSLIPIDEMIA, OA, SLEEP APNEALIFESTYLE – DIET AND PHYSICAL ACTIVITY PSYCHOSOCIAL DISTRESSFAMILY HISTORY, ENVIRONMENTAL, SOCIAL AND FAMILY FACTORSMOTIVATION / WILLINGNESS TO CHAGEPOTENTIAL OF WEIGHT LOSS TO IMPROVE HEALTHPSYCHOLOGICAL PROBLEMSMEDICAL PROBLEMS AND MEDICATIONSURPRISE, ANGER, DENIAL OR DISBELIEF MAY DIMINISH PATIENT’S ABILITY OR WILLINGNESS TO CHANGE. STRESSING THATOBESITY IS A CLINICAL TERM WITH SPECIFIC HEALTH IMPLICATIONS, RATHER THAN A QUESTION FO HOW YOU LOOK, MAYHELP TO MITIGATE THIS PROBLEM.
  • ANOTHER CONSULTATION SHOULD BE OFFERED TO FULLY EXPLORE THE OPTIONS FOR TREATMENT AND DISCUSS TEST RESULTS.TESTS SHOULD INCLUDE, LIPD PROFILE, FBS, BP MEASUREMENT.
  • IF PERSON EXHIBITS ANY SYMPTOMS INDICATIVE OF UNDIAGNOSED PATHOLOGY, THEY WILL BE REFERRED TO THEIR GP. PEOPLE WHO FALL WITHIN THE NATIONAL CRITERIA FOR VASCULAR RISK ASSESSMENT WILL BE REFERRED FOR SCREENING.
  • THESE INTERVENTIONS WILL BE TAILORED TO THE INDIVIDUAL’S PREFERENCES, SOCIAL CIRCUMSTANCES, DEGREE OF OVERWEIGHT / OBESITY, ANY PREVIOUS INTERVENTIONS AND LEVEL OF RISK.
  • IN LINE WITH THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) B. MAX LOSS OF 0.5 TO 1 KG / WEEK AIM TO LOSE 5 TO 10% OF THE ORIGINAL BW THE IMPORTANCE OF DEVELOPING SKILLS FOR BOTH LOSING AND MAINTAINING LOST WEIGHT REALISTIC TARGETS FOR PHYSICAL ACTIVITY AND HEALTHY EATING HEALTHY EATING SELF CARE VOLUNTARU ORGANIZATION AND SUPPORT GROUPS
  • AT THE END OF THE SUPPORT PROGRAM, FINAL MEASUREMENTS WILL BE TAKEN AND RECORDED AND ONGOING GOALS WILL BE AGREED WITH THE PERSON.
  • AT THE LEVEL REQUIRED FOR THE PROVISION OF THE MEDICINES USE REVIEW SERVICE.
  • BUT THESE SHOULD BE PART OF A LONG –TERM, MULTI-COMPONENT INTERVENTION.
  • CPD – Center for Professional Development
  • Weight management pharmaceutical services

    1. 1. WEIGHT MANAGEMENTPHARMACEUTICAL CARESERVICESMa. Lourdes Licsi - Mojares, R. Ph.Ph. D. in Pharmacy
    2. 2. INTRODUCTION Being Overweight and Obese rank5th among the leading risks forglobal deaths. According to the WHO, at least2.8M adults die each year, as aresult of being overweight orobese.
    3. 3. OBESITY in the PHILIPPINES A 2011 survey by the FNRI,showed that 22.3% of Filipinoadults are overweight and 6.1% areobese. The prevalence of overweightFilipinos is expected to increasesignificantly by 2015.
    4. 4. OBESITY WORLDWIDE In 2011, more than 40 millionchildren under the age of five wereoverweight. Once considered a high-incomecountry problem, overweight andobesity are now on the rise in low-and middle-income
    5. 5. OBESITY WORLDWIDE More than 30 million overweightchildren are living in developingcountries and 10 million indeveloped countries.
    6. 6. OBESITY: DEFINITION Overweight and obesity aredefined as abnormal or excessivefat accumulation that may impairhealth. Body mass index (BMI) is a simpleindex of weight-for-height that iscommonly used to classifyoverweight and obesity in adults
    7. 7. BODY MAS INDEX: DEFINITION It is defined as a persons weightin kilograms divided by the squareof his height in meters (kg/m2). a BMI greater than or equal to 25 isoverweight a BMI greater than or equal to 30 isobesity.
    8. 8. BODY MAS INDEX: DEFINITION BMI of 40, or between 35 and 40, orgreater than 50 is considered asmorbidly obese (wherein BariatricSurgery is the first-line treatmentoption).
    9. 9. OBESITY: BMI CHARTCLASSIFICATIONBMI (kg / m2)HEALTHYWEIGHT18.5 to 24.9OVERWEIGHT 25 to 29.9OBESITY I 30 to 34.9OBESITY II 35 to 39.9
    10. 10. OBESITY: BMI BMI provides the most usefulpopulation-level measure ofoverweight and obesity as it is thesame for both sexes and for allages of adults.
    11. 11. OBESITY: WAISTCIRCUMFERENCE Applicable for the assessment ofhealth risks associated withoverweight and obesity in adults.
    12. 12. WAIST CIRCUMFERENCEMEASUREMENT:BMICLASSIFICATIONWAIST CIRCUMFERENCELOW HIGH VERY HIGHOVERWEIGHT NOINCREASED RISKINCREASED RISKHIGH RISKOBESITY I INCREASED RISKHIGH RISK VERY HIGHRISK
    13. 13. WAIST CIRCUMFERENCEMEASUREMENT: For Men: waist circumference of lt 94 cm. –lowmt 102 cm = very high For Women: Waist circumference of lt 80 cm =low
    14. 14. BMI and WAIST CIRCUMFERENCE:COMBINEDBMICLASSIFICATIONWAIST CIRCUMFERENCE CO-MORBIDITIESPRESENTLOW HIGH VERYHIGHOVERWEIGHT1 2 2 3OBESITY I 2 2 2 3OBESITY II 3 3 3 4OBESITY III 4 4 4 4
    15. 15. PATIENT COUNSELING:1 General advice on healthy weightand lifestyle2 Diet and physical activity3 Diet and physical activity ;consider medications4 Diet and physical activity ;consider medications;consider surgery
    16. 16. PATIENT COUNSELING:EARLY YEARS (UNDER 5S)MOVEMENTS OF ANYINTENSITY1. “TUMMY TIME”2. REACHING FOR ANDGRASPING OBJECTS,PULL/PUSH3. PARENT AND BABYSWIMLESSONSSTRENGHT TRAINING 1. FLOOR-BASED PLAY2. WATER-BASED PLAY
    17. 17. PATIENT COUNSELING:PHYSICAL ACTIVITY(UNDER 5S – CHILDREN CAPABLE OFWALKING)UNSTRUCTURED, ACTIVE PLAYACTIVITIES INVOLVINGMOVEMENTS OF ALL MAJORMUSCLE GROUPSSTRUCTURED,ACTIVEPLAY1. ENERGETIC PLAY(CLIMBING, BIKE RIDING)2. ENERGETIC BOUTS OFACTIVITY(RUNNING AND CHASINGGAMES)3. WALKING/SKIPPING TO SHOPS,A FRIEND’S HOME, A PARK, TOAND FROM SCHOOL
    18. 18. PATIENT COUNSELING:PHYSICAL ACTIVITY (5 TO 18YEARS)MODERATEINTENSITYBIKE RIDINGPLAYGROUND ACTIVITIESVIGOROUSINTENSITYFAST RUNNINGSPORTS (BALL GAMES, SWIMMING)ZUMBATOMIC ® (5 to 11 years)ZUMBA® FITNESS (12 to 18 years)STRENGTHTRAININGSWINGING ON PLAYGROUNDEQUIPMENTHOPPING AND /OR SKIPPING (JUMPROPE)GYMNASTICSTENNIS
    19. 19. PATIENT COUNSELING:PHYSICAL ACTIVITY (14 TO 69YEARS)MODERATEINTENSITY1. BRISK WALKING2. JOGGING3. CYCLING (INDOOR)VIGOROUSINTENSITY1. RUNNING2. SPORTS (BALL GAMES , SWIMMING)3. GROUP EXERCISES (TAE BO, HI-LOW,STEP)4. ZUMBA® (FITNESS, GOLD, SENTAO,AQUA)STRENGTHTRAINING1. WEIGHT TRAINING2. CARRYING / MOVING HEAVY LOADS(DOING GROCERIES)
    20. 20. ZUMBA® FITNESS
    21. 21. AQUA ZUMBA®
    22. 22. ZUMBA® TONING
    23. 23. ZUMBA® IN THE CIRCUIT
    24. 24. PATIENT COUNSELING:PHYSICAL ACTIVITY (65+ YEARS)MODERATEINTENSTIY1.BRISK WALKING2. BALLROOM DANCING (SOCIAL)VIGOROUSINTENSITY1.CLIMBING STAIRS2. RUNNING3. ZUMBA® GOLDSTRENGTHTRAINING1. ZUMBA® SENTAO2. CARRYING AND MOVING HEAVYLOADS (GROCERIES)3. STEPPING AND JUMPINGACTIVITIESBALANCE ANDCOORDINATION1. TAI-CHI2. YOGA
    25. 25. ZUMBA® GOLD
    26. 26. ZUMBA® SENTAO
    27. 27. PHARMACOLOGICALINTERVENTION: CHILDREN Drug treatment is generally NOTrecommended for childrenyounger than 12 years. Exception: in life threatening co-morbidities. Prescribing should bestarted and monitored only inspecialist pediatric settings.
    28. 28. PHARMACOLOGICALINTERVENTION: CHILDREN In children younger than 12 years,treatment with ORLISTAT isrecommended only if physical co-morbidities (orthopaedicproblems, sleep apnea) severepsychological comorbidities arepresent.
    29. 29. PHARMACOLOGICALINTERVENTIONS:CHILDREN ORLISTAT (XENICAL, ALLI)1. Should be prescribed for obesity inchildren ONLY by a multicisciplinaryteam with expertise in;a. drug monitoringb. psychological supportc. behavioral interventiond. interventions to increase physical activityand to improve diet
    30. 30. PHARMACOLOGICALINTERVENTIONS:CHILDREN ORLISTAT (XENICAL, ALLI)2. It should be prescribed for youngpeople ONLY if the prescriber iswilling to submit data to theproposed National Registry on theuse of this drug in young people.
    31. 31. PHARMACOLOGICALINTERVENTIONS: CHILDREN ORLISTAT (XENICAL, ALLI)3. After drug treatment has startedin specialist care, it may becontinued in primary care, if localcircumstances and / or licensingallow.
    32. 32. PHARMACOLOGICALINTERVENTIONS: CHILDREN ORLISTAT (XENICAL, ALLI,LESOFAT)3. If it is prescribed for children, a 6-12 month trial is recommended,with regular review to assesseffectiveness, adverse effects andadherence.4. Withdrawal should be considered
    33. 33. PHARMACOLOGICALINTERVENTIONS:ADULTS1. Should be prescribed only as partof an overall plan for managingobesity in adults with;a. BMI of 28 or more withassociated risk factorsb. BMI of 30 or more
    34. 34. PHARMACOLOGICALINTERVENTIONS:ADULTS2. Drug therapy should be continuedbeyond 6 months ONLY if the personhas lost at least 5 of their initial BWsince starting the treatment.The decision to use longer than 12months (weight maintenance) shouldbe made after discussion of potentialbenefits and limitations with the
    35. 35. PHARMACOLOGICALINTERVENTIONS:ADULTS3. The co-prescribing of Orlistat withother drugs aimed at weightreduction is NOT recommended.
    36. 36. SURGICAL INTERVENTIONS:BARIATRIC SURGERY IN ADULTS1. Recommended as a treatmentoption for people with obesity ;a. BMI of 40 or more, between 35and 40 and other significantdisease that COULD BEimproved if they lost weight.b. Patient is generally fit foranesthesia and surgery
    37. 37. SURGICAL INTERVENTIONS:BARIATRIC SURGERY IN ADULTSc. All appropriate non surgicalmeasureshave been tried, but failed.d. Patient has been receiving or willreceive intensive management inaspecialist obesity service.
    38. 38. SURGICAL INTERVENTIONS:BARIATRIC SURGERY IN CHILDREN1.Should be undertaken ONLY by amultidisciplinary team that canprovide pediatric expertise in;a. pre-operative assessmentb. providing information on thedifferent proceduresc. regular post-operativeassessment
    39. 39. SURGICAL INTERVENTION:BARIATRIC SURGERY IN CHILDRENd. Management of co-morbiditiese. Psychological support before andafter surgeryf. Providing information on/oraccess to plastic surgeryg. Access to suitable equipment andstaff trained to use them
    40. 40. OBESITY and OVERWEIGHT:CO-MORBIDITIES In Children:1. hypertension2. hyperinsulinaemia3. dyslipidemia4. type 2 diabetes5. psychosocial dysfunction6. exacerbation of conditions(asthma)
    41. 41. OBESITY and OVERWEIGHT:CO-MORBIDITIES In Adults:1. Type 2 Diabetes2. Hypertension3. Cardiovascular diseases4. Dyslipidemia5. Osteoarthritis6. Sleep Apnea
    42. 42. OBESITY and OVERWEIGHT:CAUSESThe fundamental cause of obesityand overweight is an energyimbalance between caloriesconsumed and calories expended.
    43. 43. OBESITY and OVERWEIGHT:CAUSESGlobally, there has been:1. an increased intake of energy-dense foods that are high in fat
    44. 44. OBESITY and OVERWEIGHT:CAUSES2. an increase in physicalinactivity due to the increasinglysedentary nature of many forms ofwork, changing modes oftransportation, and increasingurbanization.
    45. 45. OBESITY and OVERWEIGHT:HEALTH CONSEQUENCES Cardiovascular diseases (mainlyheart disease and stroke), whichwere the leading cause of death in2008 Diabetes Musculoskeletal Disorders(especially osteoarthritis - a highlydisabling degenerative disease ofthe joints)
    46. 46. WEIGHT MANAGEMENT:DEFINITION A set of practices and behaviorsthat are necessary to keep onesweight at a healthful level. It reflects a change in thinkingabout treatment of obesity andoverweight.
    47. 47. WEIGHT MANAGEMENT:DEFINITION A long-term approach to a healthylifestyle. It includes a balance of;1. healthy eating2. physical activity / exerciseto equate energy expenditure and
    48. 48. WEIGHT MANAGEMENT:EVIDENCE Most evidence suggests that themain reason for the risingprevalence of overweight andobesity is a combination of;1. less active lifestyles2. changes in eating patterns
    49. 49. “CHOOSING HEALTH” WhitePaper (2004) Commitment:To halt the year-on-year rise inobesity among children under 11 by2010, in the context of broaderstrategy to tackle obesity in thepopulation as a whole.
    50. 50. CHOOSING HEALTH:
    51. 51. NSF for Diabetes (DH 2000) Sets targets for;1. Reduction of overweight andobesity2. Promotion of healthier eating
    52. 52. NSF for Diabetes (DH 2000)
    53. 53. NHS CANCER PLAN (DH2000) Sets targets to;1. increase access fruits andvegetables2. the consumption of fruits andvegetables
    54. 54. OUR HEALTH, OUR CARE, OURSAY:(WHITE PAPER 2006) It emphasizes greater serviceintegration with a wider access toservices closer to patients’ homes.
    55. 55. OUR HEALTH, OUR CARE, OURSAY:(WHITE PAPER 2006)
    56. 56. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE DESCRIPTION(Pharmacy Staff)1. Initiate discussions with adults(who appear to be overweight)about the risks of overweight andobesity.
    57. 57. PATIENT COUNSELING: Advises to patient must be tailoredto address personal barriers;1. cost2. personal tastes3. availability4. time5. views of family / communitymembers
    58. 58. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE DESCRIPTION (PharmacyStaff)3. A risk assessment will beundertaken to those who consent.4. Appropriate advice and supportwill be provided to those at risk of ill
    59. 59. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE DESCRIPTION (PharmacyStaff)5. People at risk from overweight /obesity and co-morbidities will bereferred to their general practice forfurther assessment, support anddisease management.
    60. 60. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE DESCRIPTION (PharmacyStaff)6. People who fall within the nationalcriteria for vascular risk assessmentwill be referred for screening.
    61. 61. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES1. To raise awareness amongindividuals and their families of thehealth problems associated withoverweight and obesity, so they cantake more responsibility for theirown health.
    62. 62. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES2. To improved diet and nutrition,promote healthy weight andincrease levels of physical activityin overweight or obese people.
    63. 63. STRATEGY:FOR SENIOR MANAGERS/ BUDGETHOLDERS 1. on-site catering should promotehealthy food and drink choices ( byposters, pricing and positioning ofproducts). 2. provide policies, facilities andinformation that promote physicalactivity (secure bicycle parking,,sign posting, improved decor toencourage use of stairs.)
    64. 64. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES3. To reduce obesity levels in peoplewho have a BMI greater than 30 (or> 28 in patients with Asianethnicity).
    65. 65. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES4. To retain XX% of people for fullduration of the agreed personalprogram and to support them inachieving a 5% to 10% weight loss.
    66. 66. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES5. To improve choice and access tooverweight and obesitymanagement services in primarycare.
    67. 67. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT AIMS and INTENDED SERVICEOUTCOMES6. To provide targeted advice andreferrals to people with chronic orlongstanding overweight / obesity.
    68. 68. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE1. Pharmacy staff will identify adultswho appear overweight andproactively initiate a discussionwith the person about weightmanagement, using literature thathighlights the health risks ofoverweight and obesity.
    69. 69. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE2. Where consent is given;a. BMI and waist measurements willbe taken.b. Relevance of the resultingclassification, its long-term problem/effects in health will be explained.
    70. 70. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE2. Where consent is given;c. Referral from other health careprofessionals (via Medicines UseReview Service) and self-referral willbe the alternative routes to accessthe service.
    71. 71. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE3. People who consent to aconsultation about weight and otherrisk factors for vascular disease willbe invited to do so with a pharmacystaff member.
    72. 72. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE4. The consultation will assesslifestyle, co-morbidities andwillingness to change.
    73. 73. HELPFUL GUIDELINES DURINGPATIENT CONSULTATIONS: Assess the patient’s view of theirweight and diagnosis, andpossible reasons for weight gain. Explore eating patterns andphysical activity levels. Explore disbeliefs about eating,physical activity, weight gain thatare unhelpful, if the patient wantsto los weight.
    74. 74. HELPFUL GUIDELINES DURINGPATIENT CONSULTATIONS: Be aware that certain ethnic andsocio-economic backgrounds maybe at greater risk of obesity. Find out what the patient hasalready tried and how successful/unsuccessful it has been, andwhat they learned from theexperience.
    75. 75. HELPFUL GUIDELINES DURINGPATIENT CONSULTATIONS: Assess readiness to adoptchanges. Assess confidence in makingchanges. Patients and their families shouldbe informed on the reasons fortests, how tests are performed,
    76. 76. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE5. Using the results of theconsultation, an assessment ofwhether the person is eligible toreceive further support from thepharmacy will be made.
    77. 77. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE6. For those people who are eligiblefor further support from thepharmacy, will be offered toencourage;a. increased physical activityb. improved eating behavior
    78. 78. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE7. Relevant information on the ff.topics will be provided:a. overweight and obesity, health-related risks.b. realistic targets for weight loss
    79. 79. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE8. Discussion with the person will bedocumented and a copy of theagreed goals and actions will begiven to the person.
    80. 80. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE9. Follow-up consultations will beprovided for ongoing support andmotivation, and to monitor progress(up to 6 months).
    81. 81. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE10. The person’s spouse / partnershould also be encouraged to losweight ( if they are both overweight /obese)11. Pharmacies will offer user-friendly, non-judgmental, client-
    82. 82. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE12. The part of the pharmacy used forprovision for consultation willprovide a sufficient level of privacyand safety.
    83. 83. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE13. Pharmacy contractor has a dutyto ensure that pharmacists and staffinvolved in the provision of theservice have;a. relevant knowledgeb. appropriately trained in the operationof the service ( sensitive, client-centered communication skills)
    84. 84. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE14. Pharmacy contractor has a dutyto ensure that pharmacists and staffinvolved in the provision of theservice are aware of and operatewithin protocols.
    85. 85. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE15. Pharmacy must maintainappropriate records to ensureeffective ongoing service deliveryand audit.Records will be confidential andshould be stored securely and for alength of time in line with NHSrecord retention policies.
    86. 86. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT SERVICE OUTLINE16. Pharmacists may need to sharerelevant information with otherhealth care professionals andagencies, in line with local andnational confidentialityarrangements, including, whereappropriate, the need for thepermission of the person to share
    87. 87. REQUIRED SKILLS /TRAININGSFOR THEHEALTHCARE PROFESSIONAL Health benefits and potentialeffectiveness of interventions toprevent obesity, increase activitylevels, improve diet, reduce energyintake. Best practice approaches indelivering such interventions,including tailoring support to meet
    88. 88. REQUIRED SKILLS /TRAININGSFOR THEHEALTHCARE PROFESSIONAL Use of motivational andcounseling techniques. Need to address barriers to healthprofessionals providing supportand advice (concerns abouteffectiveness of interventions,patient’s receptiveness, impact ofadvice with patients).
    89. 89. PHARMACEUTICAL CAREDELIVERY: Interventions to increase physicalactivity should focus on activitiesthat fit easily into patient’severyday life. Interventions should be tailored topatient’s individual preferencesand circumstances.
    90. 90. PHARMACEUTICAL CAREDELIVERY: Interventions should aim toimprove patient’s belief in theirability to change;1. verbal persuation2. modelling exercise behavior3. discussing positive effects
    91. 91. PHARMACEUTICAL CAREDELIVERY: Ongoing support (includingappropriate written materials)should be given “in person” or byphone, mail or internet. Interventions may includepromotional, awareness –raisingactivities.
    92. 92. PHARMACEUTICAL CAREDELIVERY: Discuss weight, diet and activity withpeople at times when weight gain ismore likely. All actions aimed at preventingexcess weight gain and improvingdiet and activity levels in childrenand young people should activelyinclude parents and caregivers.
    93. 93. WHEN TO CONSIDER REFERRALTO A SPECIALIST: The underlying causes of overweightand obesity needs to be assessed. The patient has complex diseasestates (which cannot be managed inprimary or secondary care). Conventional treatment has failed inprimary or secondary care.
    94. 94. WHEN TO CONSIDER REFERRALTO A SPECIALIST: Drug Therapy is being consideredfor a person with BMI of more than50. Specialist interventions may beneeded (very low calorie diet) Surgery is being considered.
    95. 95. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT QUALITY INDICATORS1. The pharmacy has appropriate DHprovided health promotion materialsavailable and a suitable area withinthe pharmacy for display of thesematerials.
    96. 96. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT QUALITY INDICATORS2. The pharmacy reviews its SOP’sand referral pathways for theservice on an annual basis.3. The pharmacy participates in anannual organized audit of serviceprovision.
    97. 97. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT QUALITY INDICATORS4. The pharmacy cooperates with anyDH-led assessment of service userexperience.5. The pharmacy can demonstratethat pharmacists and staff involvedin the provision of service haveundertaken CPD relevant to this
    98. 98. PHARMACEUTICAL CARESERVICES FOR WEIGHTMANAGEMENT QUALITY INDICATORS6. The pharmacy can demonstraterobust quality assurance for anyprocesses or equipment used.6/9/2013
    99. 99. REFERENCES: NHS Community Pharmacy Contractual FrameworkEnhanced Service – Weight Management Service(adults and children) National Institute for Health Care and ExpertiseObesity: Guidance on the Prevention, identification,assessment, and management of overweight andobesity in adults and children http://www.nice.org.uk/guidance/CG43/ http://www.dg.gov.uk/obesity/ http://www.doh.org// Club New You - Xenical http://www.wikipedia.org/
    100. 100. REFERENCES: Fact Sheet 5: Physical Activity Guidelines for OlderPeople (69+ years) Fact Sheet 4: Physical Activity Guidelines for Adults(19 to 69 years). Fact Sheet 3: Physical activity Guidelines forChildren and Young People (5 to 18 years) Fact Sheet 2: Physical activity Guidelines forChildren below 5s http://www.zumba.com/
    101. 101. END OF THE REPORT….THANKS…

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