Caring about Your Patients: Combating Obesity - The Pharmacist’s Role
A Growing Epidemic
Over recent decades, obesity has grown into a global health crisis where 38% of U.S. adults and more than 17% of children are currently obese. A 2015 study revealed statistics that are even more alarming: more than 600 million adults and 100 million children worldwide are considered obese.1 When everyone is searching for instant gratification, grabbing food on-the-go instead of taking time to cook a healthy meal, it’s not surprising these numbers continue to rise. But for some, fruit, vegetables, and whole foods are not an option. Food deserts, which are typically located in impoverished areas without access to fresh produce and whole foods, are filled with quick marts that provide processed, unhealthy foods, and have an impact on the obesity epidemic.2 Although the annual rate of increase has slowed compared to previous decades, obesity and comorbidities such as high blood pressure, cardiovascular disease, and type 2 diabetes, continue to be a major public-health concern.
High Healthcare Costs
As a result, related healthcare costs have reached incredible highs. According to a report by McKinsey Global Institute, the annual cost worldwide of obesity-related diseases is up to $2 trillion. In the U.S. alone, expenses are projected to reach $344 billion by the end of this year, and 16-18% of total healthcare costs are expected to be obesity-related by 2030.3 As part of the overall healthcare team, pharmacist intervention could help mitigate those costs. By implementing weight prevention and management services, such as medication therapy management (MTM), multiple comorbidities could be defeated.
In addition to programs created by government agencies to encourage children and adults to exercise and eat healthier foods and community efforts to do the same in schools and workplaces, the World Health Organization (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases established several goals to reach by 2020. The mission is to create an increase in physical activity and curb the rise of obesity and diabetes, thus decreasing the risk of premature mortality from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. One objective focuses on enhancing the role of healthcare systems by developing career tracks for professionals, including pharmacists, centered on noncommunicable diseases. In fact, the American Society of Health-System Pharmacists recommends, “increased counseling by pharmacists to help obese patients manage lifestyle modifications.”4
As trusted members of the healthcare community, pharmacists are ideal candidates to help prevent and manage obesity and related diseases. Understanding patients’ medications and side effects, as well as their medication histories, makes pharmacists well equipped to provide treatment and counseling. Pharmacists have already proven themselves effective in the management of comorbid diseases, such as diabetes and hyperlipidemia. They also receive training and education on “disease state etiology, risk factors, prevention, management, and treatment, which gives them a strong foundation for providing lifestyle management counseling.”5
By taking a comprehensive look at patients, pharmacists can understand what they need. They can evaluate potential diseases and health risks by gathering weight history, identifying triggers, screening for medications that may influence weight gain, calculating and tracking body mass index (BMI) and body fat diagnostics, recommending and establishing a treatment process, and supporting them with routine follow ups.
By following guidelines, pharmacists can determine the appropriate time, and under what circumstances, drug intervention and lifestyle changes are necessary. There are several guidelines for screening patients set by the United States Preventative Task Force; National Heart, Lung and Blood Institute; American Heart Association/American College of Cardiology; and the American Society of Bariatric Physicians. These guidelines “discuss when to screen, how to determine patient risk, and when to consider lifestyle alone or pharmacotherapy and surgical intervention.”6 Before determining if drug therapy is needed, pharmacists must also assess patient risk factors and BMI. A patient with a BMI of 25-29 is considered overweight and may only need to incorporate lifestyle changes. Patients with a BMI of 27-29 with two or more identified risk factors qualify for drug therapy. Those with or without present risk factors with a BMI over 30 are classified as obese and are automatically eligible for drug therapy.
Seena Haines, Pharm.D., FAPhA, FASHP, believes using drug therapy to treat obesity should be a short-term solution. She said, “I look at it as helping to give patients motivation to get over the hump, begin to see weight loss, and then identify ways to establish ongoing lifestyle changes.”7 By guiding patients using pharmacotherapy and behavioral modifications, such as improving nutrition and increasing exercise, pharmacists have the ability to make a significant impact on obese patients.
In June 2017, the American Medical Association (AMA) created a new policy to equip medical students and physicians to prevent, diagnose, and manage obesity by increasing awareness of resources developed by the healthcare education community to guide professionals in the treatment of obesity. AMA Board Member, Jesse M. Ehrenfeld, M.D., said, “We must ensure that all physicians and physicians-in-training have the tools and information they need to better understand obesity, so they can provide their patients with the best care possible.”8 The same can be said for pharmacists who wish to aid other healthcare professionals in combating obesity. Collaborating with other healthcare providers is one way pharmacists can make an impact. In fact, the results of various cooperative programs and studies suggest that including the expertise of pharmacists increases the success of preventing and managing obesity and related diseases.
So, how can your pharmacy make an impact? If you are thinking about adding services to help obese patients, or those at risk for obesity, ensure your staff is properly trained. The newest set of standards created in 2016 by the Accreditation Council for Pharmacy Education aims to prepare pharmacy students to offer patient services, such as weight-loss and lifestyle management. Future pharmacists should “be knowledgeable about both national and community-based public health programs and able to implement activities that advance public health and wellness.”9 To improve your operation, seasoned pharmacists should participate in continuing education classes to stay up to date. Consider collaborating with physicians to gather patient information and offer ongoing lifestyle counseling between your patients’ physician visits to enhance adherence. Most importantly, make your patients aware of the services you offer. Typically, pharmacists are not regarded as weight-loss prevention and management counselors, so use marketing to your advantage.
Together, healthcare professionals can work to combat obesity and, in turn, lower medical costs and weight-related diseases. Pharmacists can serve a critical, multifaceted purpose in increasing patient health and wellness and improving overall health outcomes.
Ordway, Denise-Marie. “Obesity and Weight-Related Deaths in 195 Countries over 25 Years: A New Study.” Journalist’s Resource. June 16, 2017. Web. 11 Dec 2017.
“USDA Defines Food Deserts.” Nutrition Digest. 2010. Web. 07 Sept 2018.
Jordan, Melanie A. and Jonathan Harmon. “Pharmacist Interventions for Obesity: Improving Treatment Adherence and Patient Outcomes.” Dovepress. July 8, 2015. Web. 11 Dec 2017.
Bonner, Loren. “Pharmacists Have Role in Prevention and Management of Obesity.” APhA. May 1, 2015. Web. 11 Dec 2017.
Jakubek, Kelly. “AMA Adopts Policy to Help Physicians, Students Prevent, Manage Obesity.” AMA. June 14, 2017. Web. 11 Dec 2017.