A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

Effect of pharmacist interventions on the management of overweight and obesity: A systematic review

BACKGROUND

Pharmacists are underused healthcare professionals who are well positioned to provide weight management interventions; however, a systematic review of the literature supporting the role of pharmacists in weight management is lacking.

OBJECTIVES

To conduct a systematic review to assess the body of evidence supporting the role of pharmacists in the management of obesity.

METHODS

A literature search of OVID MEDLINE, Embase, Web of Science, and CINAHL was conducted from inception through February 23, 2023, to identify studies involving pharmacist interventions for weight management. Included studies were retrospective or prospective studies reporting a change in body weight, body mass index (BMI), or waist circumference as a primary endpoint; and a weight management intervention involving a pharmacist. Studies were excluded if they did not report the desired outcomes, involved pediatric populations, or lacked a pharmacist in the intervention.

RESULTS

Twenty-nine studies met the eligibility criteria. A total of 6,423 study participants were enrolled with a mean BMI of 27 to 46 kg/m2. The included studies were conducted across 8 different countries with 15 from the United States. The primary approach was a prepost/quasi-experimental study design, typically conducted in community pharmacies. The pharmacists' role varied widely but mainly involved educational counseling as the pharmacist made medication recommendations in only 5 studies. Multidisciplinary collaboration was infrequent. All but 3 studies reported a significant improvement in the weight loss outcome of interest, although most study durations were less than 6 months. A critical appraisal of the 29 studies found the overall quality of the available studies to be relatively poor.

CONCLUSION

Pharmacist interventions for weight management were mostly effective in reducing body weight; however, more robust clinical trials with a comparator group and for longer duration are warranted. The pharmacist's role in managing weight loss medications also requires further study.

Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

Background

Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies.

Methods

A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components.

Results

The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles).

Conclusions

In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula.

Evaluation of pharmacy-led weight management service to minimise the risk of cardiovascular disease

AIMS

The primary aim of the programme was a minimum of a 5% weight reduction of the initial weight, while the secondary outcomes were a reduction in participants' body mass index (BMI), waist circumference (WC), blood pressure (BP), AUDIT-C score and an increase in the Mediterranean diet (MD) score and an improvement in physical activity levels.

METHODS

This 'before and after' study was a 10-week weight management (WM) programme and it was developed and delivered in community pharmacies in Patras chosen for convenience, thus consisting the first service of its type in Greece. The sample size was calculated (n = 96) based on the mean BMI for a Greek male and female individual, and the standard deviation (SD) of weight at baseline of 14 kg.

RESULTS

Nearly every participant enrolled in the 20 participating pharmacies, 97.4% (n = 114/117), achieved the programme's aim, losing at least 5% of their initial weight. The mean percentage of total weight loss of the 117 participants at the 10th week was 8.97% (SD 2.65), and the t-test showed statistically significant results (P-value < 0.001; 95% CI [8.48, 9.45]). A significant reduction in the waist-to-height ratio (WHtR) was observed in both male (P-value = 0.004) and female (P-value < 0.001) participants. The participants' BP and AUDIT-C score and physical activity levels significantly improved (P-value < 0.001), as well as their MD score.

CONCLUSION

This study provides the first evidence that Greek pharmacists have the potential to play an important role within primary healthcare and that after training they are able to provide public health services for both the public's benefit and their clinical role enhancement.

Effectiveness of a Patient-Centered Weight Management Model in a Community Pharmacy: An Interventional Study

PURPOSE

The aim of this study was to evaluate the provision of a professional pharmaceutical patient-centered model in a weight management program and optimization of the medication in a Spanish community pharmacy.

PATIENTS AND METHODS

This was a single-group intervention study with a mean follow-up period of 8.2 months (sd 2.3). Patients ≥18 years old seeking to lose weight or improve eating habits were recruited. On the first visit, the pharmacist collected patients' sociodemographic and anthropometric variables, dietary history and lifestyle habits, biochemical measurements and other clinical and therapeutic data. The intervention was based on the Spanish Society of Community Pharmacy recommendations for diet and exercise and for pharmacotherapy management. The follow-up included a two-month visit and a final visit.

RESULTS

A total of 330 patients were included (80% women; mean age 51.3 years old (sd 15.3)). A statistically significant reduction in anthropometric measurements (weight, BMI, and waist circumference) and a statistically significant increase in the number of patients with normal cholesterol and LDL-cholesterol (p<0.001) were observed at two-month visit compared with first visit (p<0.001). The number of patients with normal triglyceride levels at final visit compared with first visit also increased significantly (p=0.04). A total of 186 (56.4%) patients had drug-related problems at first visit and 31 (9.4%) patients at two-month visit.

CONCLUSION

The implementation of a patient-centered weight management model had a positive impact on the improvement of anthropometric, clinical and therapeutic parameters.

Building a Patient-Centered Weight Management Program: A Mixed Methods Project to Obtain Patients' Information Needs and Ideas for Program Structure

Achieving and maintaining weight loss for large segments of the population remains elusive, despite evidence demonstrating the value of many weight management programs. This study aimed to gather patients’ perceptions on weight management education needs, and ideas for the structure of a weight management program to be delivered in community pharmacies. This was an exploratory mixed methods study combining qualitative focus group interviews with a cross-sectional survey. Three focus group interviews were conducted, along with a brief survey based on focus groups findings and sent to all eligible participants. The survey allowed for individual responses on the program components and narrowing down of focus group findings. Nearly half of the respondents (45.9%) wanted further education on limiting carbohydrate and sugar intake. Participants were most interested in identifying different exercises appropriate for those with physical limitations (48.6%). Most participants preferred 1 h meetings (70.3%) that contain a mix of one-on-one and group meeting formats (67.6%). The results of the study suggest a three-month weight management program, with a combination of group and individual in-person meetings occurring twice per month, would be of most interest to patients.

Pharmacists’ Perceptions of Feasibility and Development of a Weight Management Program for Implementation in Community Pharmacies

Background:

Community pharmacists-directed weight management programs have demonstrated positive impacts.

Objective:

To explore the feasibility of developing a community pharmacy-based weight management program by examining pharmacists’ perceptions of the implementation of such a program in their practice setting.

Methods:

This study employed a cross-sectional online survey design. The respondents were registered community pharmacists in the southeastern United States. The survey contained 5 sections including demographics and questions gauging pharmacists interest in the proposed program. Survey findingswere examined using descriptive statistics, and analysis of variance (ANOVA).

Results:

A total of 426 surveys were completed and returned. Over half (53.3%) of the respondents obtained a BSc in Pharmacy. Several respondents were already providing prescription (44.1%) or over-the-counter (OTC) product (30.4%) recommendations to patients interested in weight management. Approximately 35% of respondents were at least somewhat interested in starting a weight management program. Pharmacists self-identifying as practicing in chain pharmacy or rural settings or as being staff pharmacists were less in favor of implementing a program than the other groups.

Conclusions:

Community pharmacists’ respondents appeared interested in implementing a weight management program. The information gathered herein will be used to design a weight management program specifically for community pharmacies.

Results of a Pharmacist Intervention on Weight Parameters and A1c Compared to Standard Patient Care

Obesity is linked to many accompanying comorbidities and has a substantial effect on the cost of health care. Pharmacist are able to provide management and intervention for the treatment of these disease states. This study examined outcomes 12 months prior to pharmacist intervention and 6 months postintervention. The primary outcome was to determine if pharmacist service intervention resulted in improved markers of weight and diabetes. This study revealed significant improvement in the HgbA1c and body mass index (BMI) from baseline (A1c 7.9%, BMI 35.3 kg/m2) to postintervention (A1c 7%, BMI 34.1 kg/m2). These results were statistically significant (P < .001, Bonferroni correction applied for multiple comparisons), indicating the clinical importance of adding pharmacists to the health care team in obesity and diabetes management.

A review and critique of published real-world weight management program studies

BACKGROUND

Beyond the essential but somewhat artificial conditions that typify formal clinical studies, real-world evidence (RWE) of weight loss program effectiveness is paramount for an accurate assessment of such programs and refinement of best practices.

OBJECTIVES

To evaluate the current state of RWE studies and publications on weight loss, identify the range of weight loss components being used in RWE programs, and to provide a general overview of the consistency or lack of consistency with regard to measuring and reporting outcomes.

METHODS

A structured search of PubMed was performed to identify relevant English-language publications from 2006 to December 2017 that reported real-world studies of weight loss among adults. Duplicates, non-relevant publications, articles on weight loss surgery, pediatric studies, randomized controlled trials, studies with self-reported weight loss, no objective weight measures, or that failed to include weight loss results were excluded.

RESULTS

This review included 62 RWE publications. Forty-nine studies included dietary intervention, 37 included exercise, 29 included motivational counseling, and 5 contained some patients who had pharmacologic treatment as part of their weight loss regimen. The numbers of participants per study ranged from 10 to more than 3 million. The interventions reported in the publications included diet, exercise, counseling to promote diet and/or exercise, motivational counseling, and pharmacotherapy, and various combinations of these.

CONCLUSIONS

Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies.

Weight management counselling among community pharmacists: a scoping review

OBJECTIVES

To complete a scoping review of studies of community pharmacy-delivered weight and obesity management services from January 2010 to March 2017.

METHODS

A scoping review was conducted to obtain an overview of research related to the study objective. The PubMed, EBSCO and CINAHL databases were searched from January 2010 to March 2017 for articles examining obesity/weight management in community pharmacies. Included studies had to contain an obesity/weight management programme delivered primarily by community pharmacies. All non-interventional studies were excluded.

KEY FINDINGS

Nine articles were eligible for data extraction. Across the nine included studies, 2141 patients were enrolled. The overwhelming majority of patients enrolled in the studies were female, approximately 50 years of age, had a mean weight of 92.8 kg and mean BMI of 33.8 kg/m² at baseline. Patients in these various programmes lost a mean of 3.8 kg, however, two studies demonstrated that long-term (>6 months) weight loss maintenance was not achieved. The average dropout rate for each study ranged from 8.3% to 79%.

CONCLUSIONS

Obesity has a significant impact on the health and wellness of adults globally. Recent research has shown that community pharmacies have the potential to positively impact patient weight loss. However, additional research is needed into the specific interventions that bring the most value to patients and can be sustained and spread across community pharmacy practice.