Many will remember Marjorie Dawes of sketch show Little Britain’s ‘Fat Fighters’ — unfortunately, her silly approach to obesity prevention and weight loss is not dissimilar to those I’ve seen in real life.
Obesity is a chronic problem, implicated in dozens of diseases, and is debatable as being a disease-state itself. There are vast amounts of data confirming the health benefits of weight loss, from a reduction in hypertension and cancer risk to improved mobility and blood glucose and lipid profiles, to name just a few.
We must take obesity seriously. The NHS spends an eye-watering £10bn each year on treating type 2 diabetes mellitus (T2DM), and yet, around 80% of cases are said to be entirely preventable.
With a degree of reticence, I agree with the National Institute for Health and Care Excellence (NICE) guideline tiered system of weight management. NICE guides the treatment of adults according to escalating interventions, from tier 1; passive lifestyle information dissemination, to tier 4; bariatric surgery. Tier 2 reflects more structured interventions such as slimming clubs, and tier 3 incorporates interventions such as pharmacotherapy and very low calorie diets (VLCDs). Tier 3 is where pharmacy can make the biggest difference.
Pharmacists have the expertise to be able to offer a complete package of evidence-based options, from simple diet and nutritional advice — for example regarding portion and calorie control using the NHS Eatwell Plate principles — to offering weight loss aids and partial to total food replacements. All in all, pharmacists can provide individuals with full and joined-up support.
With all of these health-related principles in mind, as well as a desire to increase footfall and income for our small village pharmacy, I formed Waistaway Ltd, a long-term, private community pharmacy-led weight management service.
I was fully trained and supported by Howard Foundation Research (a charitable foundation that provides funding for research of obesity and nutrition) without cost, and I completed a pack on weight management from the Centre for Pharmacy Postgraduate Education, which revealed that my initial knowledge spanned little more than was available in the Sunday newspaper supplement!
The service is available to anyone who requires help losing excess weight and/or maintaining a healthy weight. They are recruited by opportunistic health and lifestyle-related interventions, signposted from other healthcare professionals.
Participants generally attend every week for a weight check and monitoring appointment and can use the various weight management options under my professional guidance. Two options are available to each participant: a flexible plan for those wanting to lose less than 6.35kg of weight, and a sure plan for those wanting to lose more.
Achieving >5% weight loss of initial weight, the recognised threshold for medical benefit, is critical to success and must be tracked to prove medical outcome. A published long-term evaluation of the Waistaway service between 2002 and 2019 showed that more than 1,000 patients had a combined weight loss of 14,330kg and more than 65% of diet sequences achieved over the 5% weight loss threshold. The average weight loss per diet sequence was 7.6kg and 35% of patients completed more than one diet sequence.
Our records are kept on a secure and fully auditable system, which tracks patient progress and optimises support. We have achieved >10% weight loss on average from more than 1,000 individuals, confirming the value of the total food replacement programme, which accounts for a vast majority of our dieters. Up to 1,099 days’ maintenance data at an average 1.4kg gain gives an insight into the long-term benefits.
The evaluation shows that a community pharmacist providing a private weight management service using a VLCD programme can effectively support ongoing, clinically significant weight losses in large numbers of individuals over many years.
From my experience of offering this service I have found a lack of awareness among healthcare professionals around weight management and a hesitance to signpost and refer. This is apparent by the low numbers of patients with hypertension and T2DM on the Waistaway programme. However, it is important to note that individual audits of these cohorts produced similar results to those achieved across the whole study.
Therefore, with targeted education for healthcare professionals and an increased understanding of the potential for pharmacy in this field, these limitations could be easily surmounted.
If pharmacies across the UK committed to helping their communities manage their weight in a similar way, it could make a significant impact in tackling not only the £1.5m per hour the NHS spends on T2DM, but also ease the financial burden of many other obesity-related co-morbidities.
Pharmacy has the accessibility, availability and expertise to tackle obesity head-on and at no expense to the NHS.
Gareth Evans, community pharmacist and director of the Waistaway weight loss and weight management programme