Advertisement

Current Obesity Reports

, Volume 3, Issue 3, pp 298–306 | Cite as

What is the Role of the Pharmacist in Obesity Management?

  • Katherine S. O’NealEmail author
  • Kimberly M. Crosby
Health Services and Programs (SFL Kirk, Section Editor)

Abstract

Obesity rates have increased over the last two decades. Based on NHANES data, 68.8 % of US adults are classified as overweight or obese. Obesity increases the risk of diseases and can contribute to increased morbidity and mortality. This review examines studies published in which pharmacists have provided weight management services alone or in a team. The electronic databases OVID Medline, International Pharmaceutical Abstracts and EMBASE (1946-2014) were searched. Nine articles were identified in which pharmacists delivered a weight management service either alone or in a team, and eight studies collected outcomes. Six studies evaluated the participant’s weight loss or satisfaction with the service, and two studies evaluated weight loss associated with a meal-replacement program. The outcomes from these studies are limited and while positive, have failed to provide significant evidence of the impact of pharmacists providing these services. More randomized, controlled trials are needed to document weight management services.

Keywords

Weight management Pharmacists Collaborative practice Community pharmacy Roles Obesity 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Katherine S. O’Neal has received grant support from Merck and Co.

Kimberly M. Crosby declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS data brief, no 82. Hyattsville: National Center for health Statistics; 2012.Google Scholar
  2. 2.•
    Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307:491–7. Authors compare body mass index data retrieved from the National Health and Nutrition Examination Survey from 1999-2008 to 2009-2010. Prevalence of obesity has not changed significantly in the later years.PubMedCrossRefGoogle Scholar
  3. 3.•
    Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;46:563–70. Using data from the 1990-2008 Behavioral Risk Factor Surveillance System, authors conduct nonlinear regression modeling to forecasts the obesity prevalence by 2030 and then simulate what the potential costs savings could be with proactive obesity management.CrossRefGoogle Scholar
  4. 4.•
    Tsai AG, Williamson DF, Glick HA. Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes Rev. 2011;12:50–61. Authors review literature published between 1968 and 2009 to evaluate the direct medical costs associated with obesity. The authors conclude that, overall, the costs is about 5-10% of total US healthcare spending.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.•
    Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011;12:131–41. Authors evaluate literature published between 1990 and 2009 for the direct costs associated with obesity and conclude that obese patients have approximately 30% higher medical costs.PubMedCrossRefGoogle Scholar
  6. 6.
    Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010;3:285–95.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the united states. Qual Life Res. 2008;17:1063–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Heaton PC, Frede SM. Patients’ need for more counseling on diet, exercise, and smoking cessation: results from the national ambulatory medical care survey. J Am Pharm Assoc. 2006;46:364–9.CrossRefGoogle Scholar
  9. 9.
    Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N). http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253& Published November 11, 2011. Accessed March, 2014.
  10. 10.
    Jensen MD, Ryan DH, Apovian CM, Loria CM, Ard JD, Millen BE, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. JACC. 2013. doi: 10.1016/j.jacc.2013.11.004.PubMedCentralGoogle Scholar
  11. 11.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  12. 12.
    Patwardhan A, Duncan I, Murphy P, Pegus C. The value of pharmacists in healthcare. Popul Health Manag. 2012;15:157–62.PubMedCrossRefGoogle Scholar
  13. 13.
    Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ. Pharmaceutical care: past, present and future. Curr Pharm Des. 2004;10:3931–46.PubMedCrossRefGoogle Scholar
  14. 14.•
    Strand MA, Miller DR. Pharmacy and public health: a pathway forward. J Am Pharm Assoc. 2014;54:e220–4. Authors describe the increasing role of pharmacists in supporting public health initiatives and highlight the need for more focused training during in the pharmacy education curriculums.CrossRefGoogle Scholar
  15. 15.
    American Public Health Association. The role of the pharmacist in public health. Washington, DC: American Public Health Association; 2006.Google Scholar
  16. 16.
    Malone M. Enhancing pharmacist involvement in weight management-time to get with the program. Ann Pharmacother. 2004;38:1961–3.PubMedCrossRefGoogle Scholar
  17. 17.
    ASHP Commission on Therapeutics. ASHP therapeutic position statement on the safe use of pharmacotherapy for obesity management in adults. Am J Health Syst Pharm. 2001;58:1645–55.Google Scholar
  18. 18.
    Lloyd KB, Thrower MR, Walters NB, et al. Implementation of a weight management pharmaceutical care service. Ann Pharmacother. 2007;41:185–92.PubMedCrossRefGoogle Scholar
  19. 19.
    Blenkinsopp A, Anderson C, Armstrong M. Community pharmacy’s contribution to improving the public’s health: the case of weight management. Int J Pharm Pract. 2010;16:123–5.CrossRefGoogle Scholar
  20. 20.••
    Gordon J, Watson M, Avenell A. Lightening the load? A systematic review of community pharmacy-based weight management interventions. Obes Rev. 2011;12:897–911. Authors provide a review of literature published between 1999-2009 focusing on effectiveness and cost-effectiveness of community pharmacy weight management services.PubMedCrossRefGoogle Scholar
  21. 21.
    Srnka Q. Weight management and the pharmacist’s role. US Pharmacist. 1999;24:107–18.Google Scholar
  22. 22.
    Lowery M. Pharmacists among must-trusted professionals. Drug topics. Published online, 19 Dec 2013. Available from http://drugtopics.modernmedicine.com/drug-topics/news/pharmacists-among-most-trusted-professionals?page=0,1. Accessed February 28, 2014.
  23. 23.
    Krska J, Lovelady C, Connolly D, Parmar S, Davies MJ. Community pharmacy contribution to weight management: identifying opportunities. Int J Pharm Pract. 2010;18:7–12.PubMedGoogle Scholar
  24. 24.••
    Sarayani A, Rashidian A, Gholami K, et al. Efficacy of continuing education in improving pharmacists’ competencies for providing weight management service: three-arm randomized controlled trial. J Contin Educ Health Prof. 2012;32(3):163–73. Authors demonstrate the effectiveness of training pharmacists on weight management concepts through three different continuing education approaches. Lecture plus small group exercises was found to be the most beneficial for knowledge retention and participant satisfaction.PubMedCrossRefGoogle Scholar
  25. 25.
    O’Donnell DC, Brown CM, Dastani HB. Barriers to counseling patients with obesity: a study of Texas community pharmacists. J Am Pharm Assoc. 2006;46:465–71.CrossRefGoogle Scholar
  26. 26.••
    Newlands RS, Watson MC, Lee AJ. The provision of current and future healthy weight management (HWM) services from community pharmacies: a survey of community pharmacists’ attitudes, practice and future possibilities. Int J Pharm Pract. 2011;19(2):106–14. Authors identify the most common service being provided by pharmacists were dispensing of weight loss medication and counseling associated with it as well as dietary and physical activity advice. Common barriers to providing a HWM service was workload and reimbursement.PubMedCrossRefGoogle Scholar
  27. 27.
    Dastani HB, Brown CM, O’Donnell DC. Combating the obesity epidemic: community pharmacists’ counseling on obesity management. Ann Pharmacother. 2004;38:1800–4.PubMedCrossRefGoogle Scholar
  28. 28.
    O’Neal KS. Obesity: weight management services. In: Sherman J, Ellis A. editors. Clinical pharmacy services in community practice settings: a step-by-step approach. 1st ed. McGraw-Hill Co; May 2013.Google Scholar
  29. 29.
    Commission on Dietetic Registration. Academy of Nutrition and Dietetics. Accessed March 3, 2014. Available from: http://cdrnet.org/weight-management-adult-program.
  30. 30.
    American Council on Exercise. Weight Management Specialty Certification. Accessed March 3, 2014. Available from: www.acefitness.org/fitness-certifications/specialty-certifications/weight-management.aspx.
  31. 31.
    National Exercise & Sports Trainers Associations. Lifestyle & weight management specialist. Accessed March 3, 2014. Available from: www.nestacertified.com/lifestyle-weight-management/.
  32. 32.
    Department of Health and Human Services Centers for Medicare & Medicaid Services. Intensive behavioral therapy (IBT) for obesity. August 2012 ICN 907800. Accessed February 28, 2014. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ICN907800.pdf.
  33. 33.
    Anderson C et al. Feedback from community pharmacy users on the contribution of community pharmacy to improving public health: a systematic review of the peer reviewed and non-peer reviewed literature 1990-2002. Health Expect. 2004;7:191–202.PubMedCrossRefGoogle Scholar
  34. 34.••
    Awad A, Waheedi M. Community pharmacists role in obesity treatment in Kuwait: a cross-sectional study. BMC Public Health. 2012;12:863–71. Authors surveyed community pharmacists and concluded that pharmacists are comfortable with counseling patients on obesity but did it more often when they perceived they could make a positive impact. The barriers identified include lack of patient awareness of the pharmacists providing the service and self-beliefs regarding patient motivation and outcomes.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.•
    O’Neal KS, Crosby KM. Patients’ perceptions of a pharmacist-managed weight management clinic in a community setting. Res Soc Adm Pharm. 2013;9(1):129–36. Authors identified that community pharmacy patients were aware of the health risks associated with obesity but only a small percentage were willing to pay out-of-pocket for weight management services.CrossRefGoogle Scholar
  36. 36.
    Bescoby S, Millar D. Obesity management in a community pharmacy setting – a pilot study. Int J Pharm Pract. 2006;(Suppl 2):B117-118.Google Scholar
  37. 37.
    Ahrens RA, Hower M, Best AM. Effects of weight reduction interventions by community pharmacists. J Am Pharm Assoc. 2003;43:583–9.CrossRefGoogle Scholar
  38. 38.
    Malone M, Alger-Mayer SA. Pharmacist intervention enhances adherence to orlistat therapy. Ann Pharmacother. 2003;37:1598–602.PubMedCrossRefGoogle Scholar
  39. 39.
    Botomino A, Bruppacher R, Krahenbuhl S, Hersberger KE. Change of body weight and lifestyle of persons at risk for diabetes after screening and counselling in pharmacies. Pharm World Sci. 2008;30:222–6.PubMedCrossRefGoogle Scholar
  40. 40.••
    Morrison D, McLoone P, Broshahan N, McCombie L, et al. A community pharmacy weight management programme: an evaluation of effectiveness. BMC Public Health. 2013;13:282–9. Authors successfully demonstrate the use and integration of an existing weight loss program in a community pharmacy. The outcomes were similar to those that are achieved through primary care based weight management programs.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Winter H. Waist management: a pilot scheme using community pharmacists to address the issue of obesity. Pharm Manag. 2007;23:14–8.Google Scholar
  42. 42.
    Malone M, Alger-Mayer SA, Anderson DA. The lifestyle challenge program: a multidisciplinary approach to weight management. Ann Pharmacother. 2005;39:2015–20.PubMedCrossRefGoogle Scholar
  43. 43.•
    Milton-Brown J, Barnes AS, Ndefo UA, Erowele GI. Pharmacist-managed weight-loss program using meal-replacement product. Am J Health Syst Pharm. 2012;69:1456–7. Authors demonstrate the successful collaboration of an inpatient hospital dispensing pharmacy with a weight management clinic. Patients of the clinic receive a meal replacement product and ‘weigh-ins’ at the pharmacy.PubMedCrossRefGoogle Scholar
  44. 44.
    Slezak M. Converting lost pounds into dollars. Am Drug. 1996;213(12):38–40.Google Scholar
  45. 45.
    Bailey R. Putting pharmaceutical care into practice: Mike Gemma develops unique niche-helping patients manage weight loss. Community Pharmacist. 1997; Sep-Oct:24-26.Google Scholar
  46. 46.
    Schwartz SM, Bansal VP, Hale C, Rossi M, Engle JP. Compliance, behavior change, and weight loss with orlistat in an over-the-counter setting. Obesity. 2008;16:623–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Lloyd KB, Krueger KP, Moore RT, et al. Impact of a workplace health and wellness pharmaceutical care service on the weight and obesity classification of employees. J Am Pharm Assoc. 2002;42(1):118–20.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.TulsaUSA
  2. 2.TulsaUSA

Personalised recommendations