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2017 HCHB_digital

Weight Loss Obesity has

Weight Loss Obesity has reached epidemic proportions globally. Historically more prevalent in high-income countries, obesity is now common in low-to-middle income countries with nearly one-third of the world's population now obese or overweight. According to the World Health Organization (WHO), 44% of diabetes, 23% of heart disease, and 7%–41% of certain cancers are attributable to excessive weight. Obesity is typically the result of an increased consumption of high-calorie foods without a corresponding increase in physical activity. Environments that promote healthy eating and exercise typically contain fewer individuals who are overweight. The risk of heart disease, indigestion or heartburn, gallstones, sleep apnoea (see Sleep Problems), type 2 diabetes and certain cancers increases in people who are overweight. Reducing weight to within the healthy range reduces most of these risks and may also benefit customers with osteoarthritis or those having issues with reproductive health. Maintaining a healthy weight makes exercise and movement easier and increases life expectancy. More information is available through the NZ Ministry of Health’s HealthEd website (www.healthed.govt.nz). mass index (BMI) as medically obese (BMI more than 30). Weight loss is also recommended for people with a BMI of more than 25. »» BMI is calculated as body weight divided by height squared, ie, kg/m 2 . Calculate this by obtaining a person’s weight (in kilos), dividing by their height (in metres), and then dividing by their height again. A BMI of 18.5–25 is a healthy body weight. People should aim for a BMI of 25 or less. »» For people of Asian or Indian descent, a lower BMI may be desirable. • Waist circumference should also be measured as this gives an indication of truncal or abdominal obesity. »» Weight carried mainly around the middle part of the body is associated with a higher risk of metabolic complications (ie, high blood pressure, dyslipidemia, insulin resistance) which can lead to heart disease, diabetes, stroke, and gall-bladder disease. • People with a high muscle mass (eg, body builders) may have a higher BMI but may not be overweight. Waist circumference may be a more accurate measure of body fat in very muscular adults, in ethnic groups with a smaller body size (eg, South Asian populations) and in older people. When is weight loss important? • Weight loss is extremely important when a person is defined by their body TREATMENT OPTIONS Category Examples Comments Weight loss programmes eg, System: Slim Personal, trained consultants are available on site at specific pharmacies. Consultants provide weight management advice and eating plans to develop good eating habits using normal grocery items. Dietary supplements are also available but meal replacement formulas are not used. Weekly visits to consultants are encouraged (www.systemslim.co.nz). Meal replacements eg, Optifast VLCD (Very Low Calorie Diet) VLCDs are intended for people with a BMI greater than or equal to 30 or greater than 27 with obesity-related medical complications. People should see a health professional twice a month while on the programme, and people with type 2 diabetes and hypertension need careful monitoring. See www.optifast.com.au Oral medication for weight loss Other products Natural / herbal products / supplements eg, Kate Morgan Weight Management Programme [PHARMACIST ONLY MEDICINE] eg, Orlistat (Xenical) eg, IsoWhey Weight Management, Radiance WellTrim, XL-S Medical Direct Oral Powder Whey protein powder Hoodia (eg, Go Healthy Slim Hoodia) Caralluma fimbriata, garconia cambogia, green coffee bean eg, Synetrim Slim* 5-way weight management programme. Replace two meals per day with Kate Morgan meal replacement, which also contains essential vitamins and minerals. Guidance on low GI foods, low fat meals and physical activity provided (www.katemorgan.co.nz). Xenical can be sold only to people with an initial BMI of greater than or equal to 30 or greater than 27 with additional risk factors (eg, high BP, raised cholesterol, diabetes). It blocks approximately 30% of dietary fat from being absorbed. The recommended dose is one capsule taken three times daily with each main meal (breakfast, lunch and dinner), or up to one hour after a meal. Use with well-balanced, low-fat meals and regular physical activity. May contain ingredients that bind fat or create a feeling of fullness. Whey protein may help reduce body weight and increase insulin sensitivity. Hoodia is used by Kalahari bushmen to prevent hunger during long journeys. Growing and extracting the active ingredient out of the plant is difficult and evidence of a benefit for weight loss is limited. Evidence for a benefit for caralluma fimbriata or garconia cambogia is also limited. Small studies have been favourable towards green coffee bean extract. Synetrim Slim is a multi-action formula containing Cissus quadrangularis, green tea, green coffee bean seed and chromium for weight management. Products with an asterisk have a detailed listing in the Weight Loss section of OTC Products, starting on page 267. Significant learning opportunity: Wound care Your new Group 3 CPD project Page 168 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Waist Circumference Measurement and Health Risk Risk Men Women Average 88cm Heart Foundation. Measurements apply to Caucasian men and women and Asian women, and are yet to be determined for other ethnic groups • While children should eat healthy food, they are not small adults. A growing child’s diet requires a different proportion of fats, carbohydrates and fibre, compared with an adult diet. Initial assessment Losing weight is hard and specific training in selling weight-loss regimens is recommended since correct consultation techniques, coupled with an empathic approach, will help you to engage the customer. Know what products your pharmacy stocks for weight loss and any extra support they may offer. All regimens need to be combined with a reduced-calorie diet and exercise programme. Encourage customers to maintain a healthy weight and to increase their consumption of vegetables and fruit; choose unsaturated fats instead of saturated or trans fats; and to limit their intake of salt and sugar. Even a small weight loss (ie, 5%–10% of current weight) will lower the risk of obesity-related diseases. Treatment A wide range of products for weight loss (many marketed with online, phone, or face-to-face support programmes) are available through pharmacies. Options range from meal replacement regimens to pharmacist-only products (eg, orlistat) that reduce the amount of fat absorbed. Prescription medicines are also available and bariatric surgery may be considered for some people after specialist referral. Advice for customers • Have a realistic weight loss target. A weekly weight loss of 0.5–1kg is healthy and achievable. • Research has shown that people who weigh themselves daily are more successful at keeping weight off as they use it as an early warning system for preventing weight regain. • Waist measurement is important for measuring fat loss. • Targeting weight loss from just one spot, eg, the hips, generally does not work, but overall weight loss will eventually result in reduction of the size of the problem spot. • Beware of products which advertise “no effort or exercise required”, “burn fat”, and other fad diets. They rarely work. Starvation diets (ie, 5:2) may cause excessive muscle loss in addition to fat loss and should be used with caution. • A change in lifestyle is usually necessary to maintain weight loss – this involves increased activity and different eating habits. Refer to DOCTOR Refer the following people to a doctor: • people with signs of obesity who also have other medical conditions (such as heart disease). The doctor can assess the person’s ability to cope with any increase in physical activity • anyone who appears to be losing weight quickly or appears to be losing too much weight • anyone regularly buying laxatives, which may be an indication of unhealthy weight loss methods • anyone with persistent complaints of faintness or dizziness • people showing signs of bulimia (self-induced vomiting after food), bingeing until sick, or anorexia nervosa • children with weight problems. • Choose healthier foods and make use of wristband activity monitors. Download the FoodSwitch App to identify what's in packaged foods which allows you to make simple switches to healthier options. • Eat a bit less of most things (except vegetables and fruit). See Vitamins and Dietary Supplements: Eating and Activity Guidelines. • Take every opportunity to move and be active, eg, get rid of the TV remote, park on the far side of the supermarket car park, walk up and down stairs, get off the bus one stop early, and do housework energetically. • Smoking should not be used to lose weight. Smoking increases the risk of heart and lung disease. It also reduces circulation and ages skin, increasing wrinkles. • Some medicines, eg, for blood pressure and diabetes, may need adjusting as weight loss continues. Visit ELearning to start your project www.pharmacytoday.co.nz Facilitated by Dr Alesha Smith Page 169

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