Cutting out entire food groups can be unsafe

By Alex White

We know that a significant proportion of UK adults are overweight or obese, which increases the risk of type 2 diabetes, coronary heart disease and some cancers. Therefore, there is a large-scale public health effort to try to reduce this number and help people to control their weight.

However, losing weight and especially keeping it off can be extremely challenging and understanding the best approach to weight loss can be confusing, especially considering the sometimes conflicting advice in both the media and on social media.

It is important that people can access reliable, evidence-based advice from health care professionals, but what recommendations should pharmacists be making when it comes to losing weight? Below are a few things to consider in your pharmacy.

Healthy lifestyle vs fad diet

Whilst many may think that the terms ‘healthy lifestyle’ and ‘diet’ can go hand in hand, some specific fad diets can be extremely restrictive. The idea of a quick fix to losing weight with a very restrictive diet or an unusual combination of foods can be attractive, however, in practice, it’s extremely difficult to maintain in the longer term and so it is likely that any weight loss will be regained, which can be really demoralising.

It is also important to recommend that people avoid extreme dieting, such as going without food for long periods or cutting out entire food groups, as this can be unsafe or mean that the diet is unbalanced and lacking in key nutrients. Guidelines are generally to try to lose weight gradually, around 0.5-1kg a week, and to make healthy diet and lifestyle changes to help keep off the weight lost.

Making every contact count

As pharmacists have so many daily interactions with the public, they are in a great position to offer help and advice. Making every contact count (MECC) is an NHS initiative that focuses on this and has been set up to encourage and enable staff across health, local authority and voluntary sectors to help initiate healthy behaviour change in individuals.

The MECC approach covers many aspects of health, one of which is keeping to a healthy weight. It involves short conversations with service users, delivered whenever the opportunity arises in routine appointments and contacts.

Research has shown that brief, opportunistic interventions delivered in primary care can lead to a five-fold increase in the proportion of service users engaging in weight management services.

Conversation about weight

Weight can be a sensitive subject but many service users will be open to you discussing their weight with them. Being able to incorporate these types of conversations, even if they are only short, as part of routine consultations can be an important part of helping service users begin the process of losing weight.

In these conversations, it is important to address the issue appropriately by finding the right language and being considerate to the service user. As part of the MECC approach, pharmacists can find a step-by-step guide for health and care professionals to brief interventions discussing weight with adults.

Appropriate signposting

We know that weight loss programmes that contain some form of support are easier to stick to and therefore helping service users to find a weight-loss group, weight management service or online community to help can be really beneficial.

Therefore, it is important that pharmacists are aware of what support is available in their area, so that they can signpost people directly, or via their GP, to weight loss programmes or support. For community pharmacists, this would involve being familiar with the local obesity care pathway, referral criteria and process.

This helps to enable an understanding of the weight management services available in the specifi c area, which is important as referral criteria may vary in different areas. The Public Health team at the local authority and clinical commissioning group should be the first contact.

Weight loss programmes

One option to help support service users with weight loss would be to run weight control programmes within a pharmacy, which tend to last from between 10 weeks to 6 months. It’s important to consider the resources available to set these up, including staff time and expertise.

However, running pharmacy-led weight management services could be considered as one of a number of ways of tackling obesity in communities.

Tackling obesity is certainly not an easy task as there are many factors that can influence obesity risk. However, with well over a million health-related visits every day, pharmacists are in a great position to support with people’s weight loss and can play an important part in promoting health and wellbeing.

This may be through offering trusted evidence-based and practical advice, aiding individual behaviour change and signposting to other healthcare professionals and services where appropriate.

Alex White is nutrition scientist at British Nutrition Foundation.

This article also appears in the December/January issue of Pharmacy Business.

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