Summer is here, people want to show off a bit more flesh while exercising caution about what they put in their bodies. Pupinder S Ghatora, Pharmacy Business' Young Pharmacist of the Year 2008, examines the issues...

Nutrition is BIG business and, as in most of my articles, it is a market we as community pharmacists are going to have to explore if we are to survive in the current climate, especially in light of the coalition Government's plans to reduce the country’s debt. I have a feeling category M may not be our only worry in the future.

We have found more and more patients asking about vitamins, dietary supplements, muscle building and more. As a result we have had to increase our product ranges to include nutritional supplements.

Health and fitness supplements have become increasingly popular, especially with our student population. A brand that has become quite popular is Maximuscle, they have a huge range of sports supplements ranging from energy drinks to muscle building protein formulas. The margins on these products are also fairly healthy so we often try to mix and match and come up with promotional offers.

Weight loss is another category that has two peaks during the year, once during the new year period and again at summer time. The body mass index (BMI) is used to determine if your weight is in the healthy range.

• You are in the normal range if your BMI is between 18.5 and 25 (kg/m2)

• You are overweight if your BMI is between 25 and 30

• You are obese if your BMI is 30 or higher

• You are morbidly obese if your BMI is 40 or higher

Government figures show that at least one in four men and one in three women are overweight in the UK. The Department of Health predicts that if this trend continues, by 2010 around 6.6 million men will be obese compared to six million women.

Psychologically, being overweight can affect your body image and damage self-esteem. In some cases this can cause social anxiety and depression. Common physical problems include:

• Difficulties breathing

• Difficulties walking or running

• Increased sweating

• Pain in the knees and back

• Skin conditions such as acne

• Gallstones

The following medical conditions are also more common in obese people than in those of normal weight:

• High blood pressure

• High cholesterol

• Cardiovascular disease

• Type 2 diabetes

• Some types of cancer

These conditions are often known as obesity-related diseases and are some of the most common causes of death before the age of 75. This is why obesity increases your risk of mortality.

What can we as community pharmacists do to help our increasingly overweight population? The obesity epidemic, as the Government has called it, costs the NHS millions every year and results in an unhealthier nation. With the reduction in outdoor activity, increasingly busy work lives and access to cheap fast food, it is becoming easier for our population to become more and more obese and unhealthy.

Community pharmacists are ideally placed to help manage this problem with professional advice, medication and referral if necessary. The market for weight loss products and health and fitness is huge, a multi-million pound concern. There are opportunities for community pharmacy to tap into these markets and help make up the shortfall in funding by the Government for our ‘bread and butter’ dispensing and purchase profits.

A healthier lifestyle is a major part of weight reduction. I always advise my patients, no matter what weight loss product they purchase from me, that they must also increase their physical activity and eat healthy.

For patients who have a BMI value over 28, a major step forward in community pharmacy was the availability of Orlistat as a P medicine. Alli, as we know it over the counter, has become a very popular product in our pharmacy and has enabled us to help these people lose weight and keep the weight off. Not just by taking Alli, but also healthy lifestyle advice. The patients I have on Alli have a weekly five minute meeting with me; we do a weigh-in and brief discussion about their progress. We are in the process of producing our own weight monitoring diaries for our patients which they will purchase as part of their treatment regime. They also include tips for healthy eating and a sample exercise plan. They have been tailored to suit the patients and we asked each patient what they would like to see in the booklet and devised it to suit.

This is just one example of the opportunities available to us as a profession. There are numerous other weight loss products we also supply and we are now looking into health foods. I have tried, with all my products, to stock those which do have some evidence to show that if used correctly they will give results - for example, lipobind and recently lipotrim. The products recommended are equally as important as the input you as a pharmacist or pharmacy team give to your patient to help them achieve their goals. I have also started a referral scheme with a couple of local gyms. Any patients I send and who join are given a free personal training session and I receive commission. It is important to try and think of new ways to integrate the pharmacy business with other aspects of health to benefit all parties. The patient is happy because you are helping them achieve their health goals and you are happy as you are making a difference and also earning some much-needed extra income.

There has also been a surge in herbal products that claim to aid weight loss, including Adios, Appesat and numerous green tea extract products, such as Thermobol. All of these require lifestyle changes to be effective (i.e. less food more exercise!) but there is evidence to show that some of these products do help to increase the rate of weight loss.

One of the other nutritional products that have seen a boost in sales in my pharmacy are the jointcare products. With an ageing population, it is inevitable that the joints are going to need a little help as we get older. I have found that the glucosamine range of products have really seen a positive growth. I also did research into this whilst at Kings College University and was so convinced by its benefits that I am taking them myself. The theory, in simple terms, is that the glucosamine acts as a building block for cartilage, which reduces in production as we age, therefore if we can give our body the ingredients, it has more of a chance of rebuilding what is lost. Personally, I believe that you get what you pay for. So when patients ask me which brand to go for, I explain it is really up to them but I find the Healthaid range to be fantastic. It is not too cheap and not too expensive, just the right price point and quality of product. There are cheaper brands such as Valupak or more expensive brands such as the Health Perception range, although it comes down to personal preference and/or circumstance.

Even after the bad press homeopathy has received, we are still selling a lot of arnica preparations from Nelsons and Weleda. With any muscle injury, if the patient does not ask for it, we are link selling as we have found it does help the healing process, and patients come back and tell us so and in turn buy another batch to keep in their first aid supplies.

Probiotics, although big business in Europe and looked upon as having genuine clinical benefits, are not really acknowledged in the United Kingdom. We have many European patients who are surprised a probiotic is not given with every anti-biotic course. A company we now use for all our products is DTECTA. They have a fabulous range that caters for people taking antibiotics, people who have diarrhoea, people who are travelling and may develop diarrhoea. Every prescription for anti-biotics is accompanied by the option of the DTECTA probiotic. My team have been told to give the patient the option and advise how it could benefit if they are susceptible to gastro-intestinal side effects whilst on anti-biotics. The support offered by DTECTA is also second to none. They are always on hand to give help and advice about their products and how best to use them, as well as giving suggestions on special offers.

Manuka honey is also another product range that has become increasingly popular. We are now stocking a range of honeys and also manuka honey throat sprays which are very popular in winter to help sore throats. The only thing to be aware of is that diabetic patients, due to the sugar content in these products, need to monitor their sugar levels. The honey itself comes from bees that feed on the nectar of the tea tree plant, which has many positive effects on well-being.

The final supplement I have found that goes well in pharmacy is Echinacea. Like the glucosamine range, there are a number of different brands and prices vary. This is a very good seller during the winter months as it is thought to help boost the immune system. It is of most benefit when given just before a full blown cold or flu takes hold and should not be sold as a treatment, more of a prophylactic.

The nutrition market is huge. It is important to try and make the most of any opportunities that arise as life in community pharmacy is set to get tougher.