Weight management pharmaceutical services

WEIGHT MANAGEMENT
PHARMACEUTICAL CARE
SERVICES
Ma. Lourdes Licsi - Mojares, R. Ph.
Ph. D. in Pharmacy

INTRODUCTION
 Being Overweight and Obese rank
5th among the leading risks for
global deaths.
 According to the WHO, at least
2.8M adults die each year, as a
result of being overweight or
obese.

OBESITY in the PHILIPPINES
 A 2011 survey by the FNRI,
showed that 22.3% of Filipino
adults are overweight and 6.1% are
obese.
 The prevalence of overweight
Filipinos is expected to increase
significantly by 2015.

OBESITY WORLDWIDE
 In 2011, more than 40 million
children under the age of five were
overweight.
 Once considered a high-income
country problem, overweight and
obesity are now on the rise in low-
and middle-income

OBESITY WORLDWIDE
 More than 30 million overweight
children are living in developing
countries and 10 million in
developed countries.

OBESITY: DEFINITION
 Overweight and obesity are
defined as abnormal or excessive
fat accumulation that may impair
health.
 Body mass index (BMI) is a simple
index of weight-for-height that is
commonly used to classify
overweight and obesity in adults

BODY MAS INDEX: DEFINITION
 It is defined as a person's weight
in kilograms divided by the square
of his height in meters (kg/m2).
 a BMI greater than or equal to 25 is
overweight
 a BMI greater than or equal to 30 is
obesity.

BODY MAS INDEX: DEFINITION
 BMI of 40, or between 35 and 40, or
greater than 50 is considered as
morbidly obese (wherein Bariatric
Surgery is the first-line treatment
option).

OBESITY: BMI CHART
CLASSIFICATION
BMI (kg / m2)
HEALTHY
WEIGHT
18.5 to 24.9
OVERWEIGHT 25 to 29.9
OBESITY I 30 to 34.9
OBESITY II 35 to 39.9

OBESITY: BMI
 BMI provides the most useful
population-level measure of
overweight and obesity as it is the
same for both sexes and for all
ages of adults.

OBESITY: WAIST
CIRCUMFERENCE
 Applicable for the assessment of
health risks associated with
overweight and obesity in adults.

WAIST CIRCUMFERENCE
MEASUREMENT:
BMI
CLASSIFICATIO
N
WAIST CIRCUMFERENCE
LOW HIGH VERY HIGH
OVERWEIGHT NO
INCREASE
D RISK
INCREASE
D RISK
HIGH RISK
OBESITY I INCREASE
D RISK
HIGH RISK VERY HIGH
RISK

WAIST CIRCUMFERENCE
MEASUREMENT:
 For Men:
 waist circumference of lt 94 cm. –
low
mt 102 cm = very high
 For Women:
 Waist circumference of lt 80 cm =
low

BMI and WAIST CIRCUMFERENCE:
COMBINED
BMI
CLASSIFICATIO
N
WAIST CIRCUMFERENCE CO-
MORBIDITIES
PRESENT
LOW HIGH VERY
HIGH
OVERWEIG
HT
1 2 2 3
OBESITY I 2 2 2 3
OBESITY II 3 3 3 4
OBESITY III 4 4 4 4

PATIENT COUNSELING:
1 General advice on healthy weight
and lifestyle
2 Diet and physical activity
3 Diet and physical activity ;
consider medications
4 Diet and physical activity ;
consider medications;
consider surgery

PATIENT COUNSELING:
EARLY YEARS (UNDER 5S)
MOVEMENTS OF ANY
INTENSITY
1. “TUMMY TIME”
2. REACHING FOR AND
GRASPING OBJECTS,
PULL/PUSH
3. PARENT AND BABY
SWIM
LESSONS
STRENGHT TRAINING 1. FLOOR-BASED PLAY
2. WATER-BASED PLAY

PATIENT COUNSELING:
PHYSICAL ACTIVITY
(UNDER 5S – CHILDREN CAPABLE OF
WALKING)
UNSTRUCTURED
, ACTIVE PLAY
ACTIVITIES INVOLVING
MOVEMENTS OF ALL MAJOR
MUSCLE GROUPS
STRUCTURED,
ACTIVE
PLAY
1. ENERGETIC PLAY
(CLIMBING, BIKE RIDING)
2. ENERGETIC BOUTS OF
ACTIVITY
(RUNNING AND CHASING
GAMES)
3. WALKING/SKIPPING TO SHOPS,
A FRIEND’S HOME, A PARK, TO
AND FROM SCHOOL

PATIENT COUNSELING:
PHYSICAL ACTIVITY (5 TO 18
YEARS)
MODERATE
INTENSITY
BIKE RIDING
PLAYGROUND ACTIVITIES
VIGOROUS
INTENSITY
FAST RUNNING
SPORTS (BALL GAMES, SWIMMING)
ZUMBATOMIC ® (5 to 11 years)
ZUMBA® FITNESS (12 to 18 years)
STRENGTH
TRAINING
SWINGING ON PLAYGROUND
EQUIPMENT
HOPPING AND /OR SKIPPING (JUMP
ROPE)
GYMNASTICS
TENNIS

PATIENT COUNSELING:
PHYSICAL ACTIVITY (14 TO 69
YEARS)
MODERAT
E
INTENSITY
1. BRISK WALKING
2. JOGGING
3. CYCLING (INDOOR)
VIGOROU
S
INTENSITY
1. RUNNING
2. SPORTS (BALL GAMES , SWIMMING)
3. GROUP EXERCISES (TAE BO, HI-LOW,
STEP)
4. ZUMBA® (FITNESS, GOLD, SENTAO,
AQUA)
STRENGT
H
TRAINING
1. WEIGHT TRAINING
2. CARRYING / MOVING HEAVY LOADS
(DOING GROCERIES)

PATIENT COUNSELING:
PHYSICAL ACTIVITY (65+ YEARS)
MODERATE
INTENSTIY
1.BRISK WALKING
2. BALLROOM DANCING (SOCIAL)
VIGOROUS
INTENSITY
1.CLIMBING STAIRS
2. RUNNING
3. ZUMBA® GOLD
STRENGTH
TRAINING
1. ZUMBA® SENTAO
2. CARRYING AND MOVING HEAVY
LOADS (GROCERIES)
3. STEPPING AND JUMPING
ACTIVITIES
BALANCE AND
COORDINATION
1. TAI-CHI
2. YOGA

PHARMACOLOGICAL
INTERVENTION: CHILDREN
 Drug treatment is generally NOT
recommended for children
younger than 12 years.
 Exception: in life threatening co-
morbidities. Prescribing should be
started and monitored only in
specialist pediatric settings.

PHARMACOLOGICAL
INTERVENTION: CHILDREN
 In children younger than 12 years,
treatment with ORLISTAT is
recommended only if physical co-
morbidities (orthopaedic
problems, sleep apnea) severe
psychological comorbidities are
present.

PHARMACOLOGICAL
INTERVENTIONS:
CHILDREN
 ORLISTAT (XENICAL, ALLI)
1. Should be prescribed for obesity in
children ONLY by a multicisciplinary
team with expertise in;
a. drug monitoring
b. psychological support
c. behavioral intervention
d. interventions to increase physical activity
and to improve diet

PHARMACOLOGICAL
INTERVENTIONS:
CHILDREN
2. It should be prescribed for young
people ONLY if the prescriber is
willing to submit data to the
proposed National Registry on the
use of this drug in young people.

PHARMACOLOGICAL
INTERVENTIONS: CHILDREN
3. After drug treatment has started
in specialist care, it may be
continued in primary care, if local
circumstances and / or licensing
allow.

PHARMACOLOGICAL
INTERVENTIONS: CHILDREN
 ORLISTAT (XENICAL, ALLI,
LESOFAT)
3. If it is prescribed for children, a 6-
12 month trial is recommended,
with regular review to assess
effectiveness, adverse effects and
adherence.
4. Withdrawal should be considered

PHARMACOLOGICAL
INTERVENTIONS:
ADULTS
1. Should be prescribed only as part
of an overall plan for managing
obesity in adults with;
a. BMI of 28 or more with
associated risk factors
b. BMI of 30 or more

PHARMACOLOGICAL
INTERVENTIONS:
ADULTS
2. Drug therapy should be continued
beyond 6 months ONLY if the person
has lost at least 5 of their initial BW
since starting the treatment.
The decision to use longer than 12
months (weight maintenance) should
be made after discussion of potential
benefits and limitations with the

PHARMACOLOGICAL
INTERVENTIONS:
ADULTS
3. The co-prescribing of Orlistat with
other drugs aimed at weight
reduction is NOT recommended.

SURGICAL INTERVENTIONS:
BARIATRIC SURGERY IN ADULTS
1. Recommended as a treatment
option for people with obesity ;
a. BMI of 40 or more, between 35
and 40 and other significant
disease that COULD BE
improved if they lost weight.
b. Patient is generally fit for
anesthesia and surgery

BARIATRIC SURGERY IN ADULTS
c. All appropriate non surgical
measures
have been tried, but failed.
d. Patient has been receiving or will
receive intensive management in
a
specialist obesity service.

BARIATRIC SURGERY IN CHILDREN
1.Should be undertaken ONLY by a
multidisciplinary team that can
provide pediatric expertise in;
a. pre-operative assessment
b. providing information on the
different procedures
c. regular post-operative
assessment

SURGICAL INTERVENTION:
BARIATRIC SURGERY IN CHILDREN
d. Management of co-morbidities
e. Psychological support before and
after surgery
f. Providing information on/or
access to plastic surgery
g. Access to suitable equipment and
staff trained to use them

OBESITY and OVERWEIGHT:
CO-MORBIDITIES
 In Children:
1. hypertension
2. hyperinsulinaemia
3. dyslipidemia
4. type 2 diabetes
5. psychosocial dysfunction
6. exacerbation of conditions
(asthma)

CO-MORBIDITIES
 In Adults:
1. Type 2 Diabetes
2. Hypertension
3. Cardiovascular diseases
4. Dyslipidemia
5. Osteoarthritis
6. Sleep Apnea

CAUSES
The fundamental cause of obesity
and overweight is an energy
imbalance between calories
consumed and calories expended.

CAUSES
Globally, there has been:
1. an increased intake of energy-
dense foods that are high in fat

CAUSES
2. an increase in physical
inactivity due to the increasingly
sedentary nature of many forms of
work, changing modes of
transportation, and increasing
urbanization.

HEALTH CONSEQUENCES
 Cardiovascular diseases (mainly
heart disease and stroke), which
were the leading cause of death in
2008
 Diabetes
 Musculoskeletal Disorders
(especially osteoarthritis - a highly
disabling degenerative disease of
the joints)

WEIGHT MANAGEMENT:
DEFINITION
 A set of practices and behaviors
that are necessary to keep one's
weight at a healthful level.
 It reflects a change in thinking
about treatment of obesity and
overweight.

WEIGHT MANAGEMENT:
DEFINITION
 A long-term approach to a healthy
lifestyle.
 It includes a balance of;
1. healthy eating
2. physical activity / exercise
to equate energy expenditure and

WEIGHT MANAGEMENT:
EVIDENCE
 Most evidence suggests that the
main reason for the rising
prevalence of overweight and
obesity is a combination of;
1. less active lifestyles
2. changes in eating patterns

“CHOOSING HEALTH” White
Paper (2004)
 Commitment:
To halt the year-on-year rise in
obesity among children under 11 by
2010, in the context of broader
strategy to tackle obesity in the
population as a whole.

NSF for Diabetes (DH 2000)
 Sets targets for;
1. Reduction of overweight and
obesity
2. Promotion of healthier eating

NHS CANCER PLAN (DH
2000)
 Sets targets to;
1. increase access fruits and
vegetables
2. the consumption of fruits and
vegetables

OUR HEALTH, OUR CARE, OUR
SAY:
(WHITE PAPER 2006)
 It emphasizes greater service
integration with a wider access to
services closer to patients’ homes.

OUR HEALTH, OUR CARE, OUR
SAY:
(WHITE PAPER 2006)

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE DESCRIPTION
(Pharmacy Staff)
1. Initiate discussions with adults
(who appear to be overweight)
about the risks of overweight and
obesity.

PATIENT COUNSELING:
 Advises to patient must be tailored
to address personal barriers;
1. cost
2. personal tastes
3. availability
4. time
5. views of family / community
members

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE DESCRIPTION (Pharmacy
Staff)
3. A risk assessment will be
undertaken to those who consent.
4. Appropriate advice and support
will be provided to those at risk of ill

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
Staff)
5. People at risk from overweight /
obesity and co-morbidities will be
referred to their general practice for
further assessment, support and
disease management.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
Staff)
6. People who fall within the national
criteria for vascular risk assessment
will be referred for screening.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 AIMS and INTENDED SERVICE
OUTCOMES
1. To raise awareness among
individuals and their families of the
health problems associated with
overweight and obesity, so they can
take more responsibility for their
own health.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
OUTCOMES
2. To improved diet and nutrition,
promote healthy weight and
increase levels of physical activity
in overweight or obese people.

STRATEGY:
FOR SENIOR MANAGERS/ BUDGET
HOLDERS
 1. on-site catering should promote
healthy food and drink choices ( by
posters, pricing and positioning of
products).
 2. provide policies, facilities and
information that promote physical
activity (secure bicycle parking,,
sign posting, improved decor to
encourage use of stairs.)

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
OUTCOMES
3. To reduce obesity levels in people
who have a BMI greater than 30 (or
> 28 in patients with Asian
ethnicity).

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
OUTCOMES
4. To retain XX% of people for full
duration of the agreed personal
program and to support them in
achieving a 5% to 10% weight loss.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
OUTCOMES
5. To improve choice and access to
overweight and obesity
management services in primary
care.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
OUTCOMES
6. To provide targeted advice and
referrals to people with chronic or
longstanding overweight / obesity.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
1. Pharmacy staff will identify adults
who appear overweight and
proactively initiate a discussion
with the person about weight
management, using literature that
highlights the health risks of
overweight and obesity.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
2. Where consent is given;
a. BMI and waist measurements will
be taken.
b. Relevance of the resulting
classification, its long-term problem
/effects in health will be explained.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
2. Where consent is given;
c. Referral from other health care
professionals (via Medicines Use
Review Service) and self-referral will
be the alternative routes to access
the service.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
3. People who consent to a
consultation about weight and other
risk factors for vascular disease will
be invited to do so with a pharmacy
staff member.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
4. The consultation will assess
lifestyle, co-morbidities and
willingness to change.

HELPFUL GUIDELINES DURING
PATIENT CONSULTATIONS:
 Assess the patient’s view of their
weight and diagnosis, and
possible reasons for weight gain.
 Explore eating patterns and
physical activity levels.
 Explore disbeliefs about eating,
physical activity, weight gain that
are unhelpful, if the patient wants
to los weight.

 Be aware that certain ethnic and
socio-economic backgrounds may
be at greater risk of obesity.
 Find out what the patient has
already tried and how successful
/unsuccessful it has been, and
what they learned from the
experience.

 Assess readiness to adopt
changes.
 Assess confidence in making
changes.
 Patients and their families should
be informed on the reasons for
tests, how tests are performed,

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
5. Using the results of the
consultation, an assessment of
whether the person is eligible to
receive further support from the
pharmacy will be made.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
6. For those people who are eligible
for further support from the
pharmacy, will be offered to
encourage;
a. increased physical activity
b. improved eating behavior

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
7. Relevant information on the ff.
topics will be provided:
a. overweight and obesity, health-
related risks.
b. realistic targets for weight loss

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
8. Discussion with the person will be
documented and a copy of the
agreed goals and actions will be
given to the person.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
9. Follow-up consultations will be
provided for ongoing support and
motivation, and to monitor progress
(up to 6 months).

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
10. The person’s spouse / partner
should also be encouraged to los
weight ( if they are both overweight /
obese)
11. Pharmacies will offer user-
friendly, non-judgmental, client-

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
12. The part of the pharmacy used for
provision for consultation will
provide a sufficient level of privacy
and safety.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
13. Pharmacy contractor has a duty
to ensure that pharmacists and staff
involved in the provision of the
service have;
a. relevant knowledge
b. appropriately trained in the operation
of the service ( sensitive, client-
centered communication skills)

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
14. Pharmacy contractor has a duty
to ensure that pharmacists and staff
involved in the provision of the
service are aware of and operate
within protocols.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
15. Pharmacy must maintain
appropriate records to ensure
effective ongoing service delivery
and audit.
Records will be confidential and
should be stored securely and for a
length of time in line with NHS
record retention policies.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 SERVICE OUTLINE
16. Pharmacists may need to share
relevant information with other
health care professionals and
agencies, in line with local and
national confidentiality
arrangements, including, where
appropriate, the need for the
permission of the person to share

REQUIRED SKILLS /TRAININGS
FOR THE
HEALTHCARE PROFESSIONAL
 Health benefits and potential
effectiveness of interventions to
prevent obesity, increase activity
levels, improve diet, reduce energy
intake.
 Best practice approaches in
delivering such interventions,
including tailoring support to meet

REQUIRED SKILLS /TRAININGS
FOR THE
HEALTHCARE PROFESSIONAL
 Use of motivational and
counseling techniques.
 Need to address barriers to health
professionals providing support
and advice (concerns about
effectiveness of interventions,
patient’s receptiveness, impact of
advice with patients).

PHARMACEUTICAL CARE
DELIVERY:
 Interventions to increase physical
activity should focus on activities
that fit easily into patient’s
everyday life.
 Interventions should be tailored to
patient’s individual preferences
and circumstances.

PHARMACEUTICAL CARE
DELIVERY:
 Interventions should aim to
improve patient’s belief in their
ability to change;
1. verbal persuation
2. modelling exercise behavior
3. discussing positive effects

PHARMACEUTICAL CARE
DELIVERY:
 Ongoing support (including
appropriate written materials)
should be given “in person” or by
phone, mail or internet.
 Interventions may include
promotional, awareness –raising
activities.

PHARMACEUTICAL CARE
DELIVERY:
 Discuss weight, diet and activity with
people at times when weight gain is
more likely.
 All actions aimed at preventing
excess weight gain and improving
diet and activity levels in children
and young people should actively
include parents and caregivers.

WHEN TO CONSIDER REFERRAL
TO A SPECIALIST:
 The underlying causes of overweight
and obesity needs to be assessed.
 The patient has complex disease
states (which cannot be managed in
primary or secondary care).
 Conventional treatment has failed in
primary or secondary care.

WHEN TO CONSIDER REFERRAL
TO A SPECIALIST:
 Drug Therapy is being considered
for a person with BMI of more than
50.
 Specialist interventions may be
needed (very low calorie diet)
 Surgery is being considered.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
 QUALITY INDICATORS
1. The pharmacy has appropriate DH
provided health promotion materials
available and a suitable area within
the pharmacy for display of these
materials.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
2. The pharmacy reviews its SOP’s
and referral pathways for the
service on an annual basis.
3. The pharmacy participates in an
annual organized audit of service
provision.

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
4. The pharmacy cooperates with any
DH-led assessment of service user
experience.
5. The pharmacy can demonstrate
that pharmacists and staff involved
in the provision of service have
undertaken CPD relevant to this

PHARMACEUTICAL CARE
SERVICES FOR WEIGHT
MANAGEMENT
6. The pharmacy can demonstrate
robust quality assurance for any
processes or equipment used.
6/9/2013

REFERENCES:
 NHS Community Pharmacy Contractual Framework
Enhanced Service – Weight Management Service
(adults and children)
 National Institute for Health Care and Expertise
Obesity: Guidance on the Prevention, identification,
assessment, and management of overweight and
obesity 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/

REFERENCES:
 Fact Sheet 5: Physical Activity Guidelines for Older
People (69+ years)
 Fact Sheet 4: Physical Activity Guidelines for Adults
(19 to 69 years).
 Fact Sheet 3: Physical activity Guidelines for
Children and Young People (5 to 18 years)
 Fact Sheet 2: Physical activity Guidelines for
Children below 5s
 http://www.zumba.com/

END OF THE REPORT….
THANKS…

Weight management pharmaceutical services

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