16 OTC december 2012

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Module 0186Weight lossIn this article you will learn about:

weight loss advice for adults and children

medication that can aid weight loss

diet and exercise tips for your customers.

December is a new year special 10 facts to know about smoking p11 How to prevent exercise pains p21

Heavyweight champions Three case studies on beating the bulge

Weight management is one of the most important health interventions you can make. The number of people who are overweight or obese has increased

dramatically in the past decade, leading

to fears of a large number of customers

developing serious health problems in later

life. Liver disease, high blood pressure,

diabetes, heart disease... all are linked to

obesity, making it important that you are

there to support weight loss.

And support is important, as theres a

lot of bad information out there, including

celebrity fad diets that promise much

but can be harmful if attempted. Each

year the British Dietetic Association (BDA)

Maintaining a healthy weight reduces the risks of diabetes and heart disease. Heres how you can help, says Helen Boreham

lists the worst fad diets, and the 2012

list includes diets focused on avoiding

food to binge-drink alcohol, and having

food delivered by a naso-gastric tube!

Obviously neither are advisable, as the

BDAs spokesperson Sian Porter

explains: There is no magic solution to

losing weight and keeping it off long

term. There is no wonder diet you can

follow without some associated nutritional

or health risk.

There are no shortcuts in dieting; smaller

portions of healthier food with increased

exercise and, if necessary, support from

products available in your pharmacy, are

the best ways to lose weight.

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Case 1 Adult weight loss

A man approaches you at the counter. Id really like to lose some weight but I dont know where to start. Can you help?First you should check the customer actually needs to

lose weight. Body mass index (BMI) is a good measure of

whether a person is a healthy weight for their height and

can be quickly calculated (see Assessing BMI, below.)

Based on the customers BMI, you can then discuss

achievable weight loss targets. If his BMI falls in the

overweight range, he should aim to lose enough weight to

reach the healthy range; if his BMI is in the obese range,

he should try to lose between five and 10 per cent of his

starting weight.

Successful weight loss involves a combination of eating

less and getting more active. You should recommend

that the customer cuts back on how many calories he

currently consumes in food 2,500 calories per day

is the amount needed by an average man (2,000

calories per day for women.)

As well as controlling intake, it is also

important to burn more calories off. For

sustainable weight loss, the customer should

aim for a calorie deficit ie more calories used

than consumed of 600 calories per day.

To stay healthy, NHS guidelines recommend

all adults aged between 19 and 64 years take

150 minutes (two and half hours) of moderate-

intensity aerobic physical activity such as

cycling or fast walking every week. Moderate-

intensity activity works you hard enough to raise

your heartbeat and break into a sweat.

People who are overweight or obese may need

to do even more activity than this to lose weight.

You should suggest the customer starts slowly and

gradually builds up to the recommended 150 minutes.

Any customer with an underlying health problem or on

any medication should be advised to discuss exercise

plans with their GP first.

Evidence shows that the best way to lose weight and

keep it off is to make lifestyle changes that result in a

1Assessing BMI

BMI=Patientsweight(inkg)

Patientsheight2(inmetres)

Orusingimperialmeasurements

BMI=Patientsweight(inlb)x703

Patientsheight2(ininches)

Below18.5 underweight

18.5to24.9 normal

25to29.9 overweight

30andabove obese

gradual but steady shedding of excess pounds. Explain that

it is better to aim for a loss of around 1 to 2lb (0.5 to 1kg)

each week and that quick fix solutions such as faddy

diets or drastic exercise regimens that give rapid weight

loss are unlikely to be sustainable

in the long term.

The customer should be

advised

to focus on making lifelong

changes to unhealthy habits,

swapping their usual meals,

drinks and snacks for lower

calorie, healthier alternatives

and incorporating physical

activity such as walking

into everyday life.

december 2012 OTC 19

2Do you have any weight loss tips?Sharethemonlineatotcmag.comorviaTwitter:@CandDChris

Case 2 Weight loss in children

A mother would like some advice. My 10-year-old daughter has just been weighed at school and her BMI is too high. But surely its just a bit of puppy fat?For parents, it can be difficult to recognise and accept

that their child has a weight problem. Consequently all

children are now weighed and measured at school

(in both reception and year six) as part of the National

Child Measurement Programme.

Overweight and obese children have an increased risk

of serious health problems, such as type 2 diabetes and heart

disease, in later life. Because of these future health risks, you

should explain to the woman that it is important to address

her daughters weight now and take simple steps towards

a healthier lifestyle.

It is particularly important that children get plenty of

exercise (see p21). You should also point out that those

who are overweight may need to do even more than the

recommended amount to achieve a healthy BMI.

Time spent on sedentary hobbies such as watching

television and playing computer games should also be

cut back and replaced with active pursuits such as team

sports and walking.

As well as increased physical activity, you can suggest

changes to the childs diet. This could include simple steps

such as swapping unhealthy snacks (eg biscuits and chocolate)

for fruit, cutting down on fizzy drinks and replacing them with

water, taking a healthy packed lunch to school and eating

home-cooked dinners rather than takeaways or ready meals.

These changes are often most successful if the whole family

takes part in a drive towards a healthier lifestyle.

Because children are still growing it is not always necessary

for an overweight child to lose weight sometimes it is better

to simply keep their weight stable until their height catches

up. Whether active weight loss is needed depends on how

high the childs BMI is and other factors such as underlying

medical conditions that may be exacerbated by obesity.

If the child is very overweight or has other health problems

you should advise the woman to consult her GP. Other key

sources of support and advice include the practice nurse and

local weight management programmes for children, which are

usually free and run through the local PCT.

Top tips to recommend for diets

Limitportionstryeatingfromasmallerplate.Eatsoups,whichmakeyoufeelfullerandareusuallyahealthyoption.Identifydietdangerzones(egfinishingoffthekidsleftoversorthatFridaynightcurryafterwork)andplanaheadtoavoidthem.Allowyourselfalittleindulgence:ratherthancuttingouttakeawayfoodscompletely,swapthemforlower-calorie,home-madeversionsorchoosethehealthiestoptionfromthetakeawaymenu.JoinChange4Lifeforideas,recipesandgamestohelpgetthewholefamilyhappierandhealthier.nhs.uk/Change4LifeDownloadtheNHSBMIcalculatorandtrackerappfortheiPhoneoriPod,whichcantrackweightandBMIovertimeforthewholefamily,setweightlossgoalsandprovidekeytipsandadvice.nhs.uk/Tools/Pages/BMI-iPhone-app.aspx

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Your next stepsReadaboutmoretipsforweightlossontheNHSLiveWellwebsiteatnhs.uk/livewellMakesureyouarefamiliarwiththeNHSappsforweightloss(theyareontheLiveWellwebsiteasabove)andfindoutaboutlocaldietandexercisegroupssoyouhavesuggestionsforcustomersArethereothermedicationsforweightlossavailable?Howeffectivearethey?Whatotherweightlossproductsdoesyourpharmacyoffer?

PraCtiCal

Bach gets celebrity backing

Bach Emotional Eating Kit has

launched a new campaign fronted by

ITV weathergirl Clare Nasir to raise

awareness of the flower essences

product. The kit, which allows you to

create your own combinations, claims

to help reduce food cravings and

emotional eating.

Nelsonsbachremedies.co.uk0800 289515

Alli back for new year rushAlli is

returning to

pharmacy

shelves in

December to

help support

weight loss

ahead of the

new years rush. The product, which

contains orlistat, helps dieters lose an

extra pound for every two lost, and will

be supported with shelf talkers and

dummy packs. A 28-day supply of Alli

retails at 52.13.

Ceuta Healthcare 0844 2436661 mypharmassist.co.uk

3Case 3 Weight loss with orlistat

A new customer to the pharmacy wants more information on weight loss medication. My wife lost a lot of weight taking Alli, is that something I could try?Alli or orlistat is a drug that aids weight loss in people who are

overweight or obese. It works by blocking the enzymes in the gut that

help the body digest fat. When orlistat is taken with a meal, around

a third of the fat consumed in the food simply passes out of the body

in the faeces and is not absorbed.

You need to explain that orlistat is not suitable for everyone who

wants to lose weight. It is only recommended for adults aged 18 to 75

years with a BMI of 28 or above. Customers need to have their BMI

rechecked each time they buy more orlistat and the medication should

be stopped if, after three months, they fail to lose at least 5 per cent of

their starting body weight. However, patients successfully losing weight

on orlistat can carry on taking the drug for several years if needed.

It is important to check for any underlying health problems or other

medication being taken, and refer the patient to the pharmacist if the

answer is yes (or the pharmacist prefers to take the lead on orlistat

consultations). Orlistat is not suitable for people with malabsorption

syndrome (where the body has difficulty absorbing nutrients from food)

or cholestasis (a condition where bile does not flow properly from the

liver to the upper intestine). It can also interfere with the activity of

other drugs including ciclosporin, acarbose, amiodarone, warfarin and

the contraceptive pill.

You should make it clear to the customer

that orlistat or any other weight

loss drug is not a short cut to easy

weight loss. To achieve the best

results, any weight-loss medication,

including orlistat, must always be

used alongside a calorie-controlled

diet and exercise.

Eating large amounts of fatty foods

while taking orlistat not only cancels

out the weight-loss benefits

of the drug but also

increases the likelihood

of side effects. You

should explain that

most of the side

effects associated

with orlistat are

caused by dietary

fat passing out in

the stools. These

include fatty,

smelly stools, an

urgent need to

go to the toilet,

oily spotting on

the underwear

and excess wind.

To minimise the risk of side

effects, the customer should

be advised to stick to a low fat

diet. Most orlistat side effects

settle with time and serious

adverse events associated

with any licensed weight loss

medication are rare.