Almost 70 per cent of men and 60 per cent of women in England are overweight or obese, according to data from the British Nutrition Foundation (BNF), which can have serious long-term consequences for their health.
Not only does living with obesity or being overweight affect a person’s quality of life and contribute to mental health problems, such as depression, but people living with obesity are at increased risk of developing type 2 diabetes, coronary heart disease and stroke, and cancer.
Maintaining or achieving a healthy weight can be challenging for many people, but pharmacy teams are in the ideal position to expertly – and sensitively – explain the long-term health risks and what to do to avoid them.
In the UK, it is estimated that 3.8 million people aged over 16 years have been diagnosed with diabetes and nearly one million are unaware that they have the condition.
Type 1 and type 2 diabetes occur when sugar in the blood cannot be used properly, and this can cause serious health complications over time involving the eyes, heart, kidneys, feet and nerves.
About 90 per cent of people with diabetes have type 2 diabetes, which is strongly linked with being overweight or obese. Indeed, according to figures from the BNF, around 90 per cent of people diagnosed with type 2 diabetes are overweight or obese.
People can mitigate most risk factors for type 2 diabetes by eating a healthy, varied diet, being physically active and losing weight (if necessary), and some are even able to put their diabetes into remission by losing weight and reducing their blood sugar to below the diabetes range. The condition can also generally be treated in the same way – although sometimes medications such as metformin and/or insulin are also prescribed.
Heart disease and stroke
In the UK, heart disease is one of the major causes of premature death (before 75 years) and a leading cause of ill health.
The condition that causes most heart attacks and strokes is known as atherosclerosis – a build-up of fatty material that narrows arteries and can restrict blood flow to heart. This can cause the symptoms of angina (such as chest pain and shortness of breath), and if the fatty material breaks down a blood clot can form which can completely block the artery and lead to a heart attack or, if the rupture happens in arteries in the brain, a stroke.
There are several risk factors for atherosclerosis and heart disease including high blood pressure (hypertension), high blood cholesterol, a family history of heart disease, as well as diabetes, and being a smoker – but a lack of exercise and being overweight or obese are known to increase blood pressure and cholesterol levels which are risk factors for developing heart disease.
The more risk factors a person has, the greater their chances of suffering from heart disease so, again, pharmacy teams’ expert advice on healthy eating and physical exercise – as well as stopping smoking, cutting down on alcohol, and reducing salt intake to less than six grams a day – can help people reduce their overall risk.
“Helping people address obesity or overweight needs to be done on an individual basis”
While it is well known that smoking is the biggest cause of cancer, may people do not know that obesity is the second biggest preventable cause. According to the BNF, the strongest dietary links are with cancers of the digestive tract – mouth, food pipe (gullet or oesophagus), stomach and bowel (colon), but the good news is that it is estimated that healthier diets and staying at a healthy weight could help prevent one in 10 cancers in the UK.
Indeed, research suggests people should reduce their consumption of red and processed meats, and salt, and eat plenty of fruits, vegetables and foods high in fibre, as this may help reduce the risk of mouth, throat and colorectal cancer.
A team approach
If people are overweight or living with obesity, losing weight has many health benefits but – done safely – it can be a slow process that, for some, can seem like an insurmountable challenge. This is where the expert and accessible support from pharmacy teams can help customers looking to lose weight healthily through diet and exercise.
“Pharmacy staff should approach conversations around weight loss by first emphasising the importance of adopting a holistic approach to weight loss, which includes a balanced diet, regular exercise, stress management, and sufficient sleep,” says Jacquie Lee, Numark medication safety officer and information pharmacist. “They are well placed to offer general dietary advice – based on reputable sources such as the UK Health Security Agency or the NHS’s Eatwell Guide (nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide) – and may be able to signpost customers to websites that offer support for diet and exercise, too.”
Reshma Malde, superintendent pharmacist at John Bell & Croyden, says a great place to start conversations with people wanting to lose weight is by understanding their goal. “Setting weight loss goals is really important,” she says. “Not just how much do they want to lose within what space of time but why are they doing this? If they are clear about their motivations for weight loss, then they’ve got something to remind them why they are doing this in the first place.”
Impacts of alcohol
Alcohol is laden with calories so it’s no surprise that excessive consumption can result in weight gain, not to mention problems with sleeping, risks to organ health, and the chance of addiction. There is also strong evidence that the risk of a range of cancers, especially breast cancer, increases with alcohol consumption.
The UK’s chief medical officers guidelines on the maximum amount of alcohol adults should drink across a week to keep health risks to a low level are:
- Not to drink more than 14 units a week on a regular basis
- If that limit is being reached, to spread drinking evenly over three or more days.
How much is a unit?
- Half a pint of 4% lager = one unit
- A small glass of wine (125ml) = 1.5 units
- Single spirit and mixer = one unit.
Slow and steady
Social media is awash with seemingly miracle quick fixes for both weight loss and exercise ‘hacks’ but these, mostly, are not successful, healthy or even safe ways to lose weight.
“It’s particularly important that pharmacy staff can advise customers against ‘crash diets’,” says Reshma. “Although you will lose weight really quickly, it’s what I call ‘an elastic band effect’ since the moment you go back to your previous eating habits you tend to put on more weight – and that’s definitely not a safe or sustainable approach to weight loss.”
Instead, Reshma says a better place to start supporting customers who want to tackle their weight is to keep a food diary. “This helps them track what they are eating and then make simple diet changes,” she adds. “Swapping white bread for wholegrain, and white rice and pasta for brown rice and wholemeal pasta are small switches that can make a big difference and adding more healthy protein – such as from beans and lentils – is another good way.”
Encouraging hydration is also important, according to Jacquie. “Explain the importance of staying hydrated and suggest drinking water throughout the day, especially before meals, to help control appetite,” she says. “Customers often think they are hungry when in actual fact they are dehydrated, and a drink will suffice.”
Work it out
When it comes to physical activity, Government guidance is to aim for at least 150 minutes of moderate-level activity per week as well as doing weight bearing activities twice a week, but Bridget Benelam – nutrition scientist at the BNF, says: “Even if customers are a long way from meeting this recommendation, staff can highlight that even a little activity is better than none and that people can build up to doing more over time.”
Examples of moderate intensity activities include brisk walking, riding a bike, dancing, pushing a lawn mower and hiking. Vigorous activities include running, swimming, walking up stairs, skipping, aerobics, sports like football, rugby, netball and hockey, and martial arts.
Physiotherapist and advisor to the Deep Heat and Deep Freeze expert hub Sammy Margo, says just a few of the proven health benefits of regular exercise are:
- Type 2 diabetes risk cut by up to 50 per cent
- Coronary heart disease and stroke risk cut by up to 35 per cent
- A 46 per cent reduction in all-cause cancer risk
- Colon cancer risk cut by as much as half
- Up to a 20 per cent lower risk of breast cancer
- Depression risk cut by up to 30 per cent
- Odds of developing dementia cut by as much as a 30 per cent.
“We know that even a very moderate increase in activity means you’re burning more calories and, as with diet changes, there are plenty of small switches people can make to their daily exercise levels,” says Reshma. “For example, if you commute to work, get off public transport a couple of stops earlier to add a 15-minute walk at both ends of your day and that adds up to the recommended 150 minutes a week on its own.”
“It’s particularly important that pharmacy staff can advise customers against ‘crash diets’”
What else can help?
Since staff in community pharmacies have a great opportunity to ‘make every contact count’ to support customers who want to move towards a healthier weight, Bridget says another important step is to “ensure that staff are aware of local weight management services and how customers can be referred, which may include services run by their pharmacy. There is also the free NHS weight loss app (nhs.uk/better-health/lose-weight) and a number of NHS supported apps to get active including Couch to 5K and Active10, which could be recommended for customers who prefer digital approaches”.
For customers living with obesity who also have diabetes and/or high blood pressure, the pharmacist – or their GP – can refer them onto the NHS Digital Weight Management Programme (england.nhs.uk/digital-weight-management/how-to-access-the-programme) which is another free 12-week digital programme.
But perhaps the most important thing for pharmacy teams to bear in mind is that helping people address obesity or overweight needs to be done on an individual basis, as there is no single approach that works for everyone.
“It’s about seeing each person as an individual and helping them build all this into their life without them feeling they’ve made changes that they can’t commit to,” says Reshma. “Life doesn’t have to be different; life can still remain the same – just make clever switches that are easier to stick to.”
Deficiencies and their impact
The latest data from the UK National Diet and Nutrition Survey Rolling Programme (NDNS) and the Department for Environment, Food and Rural Affairs (DEFRA) Family Food Survey reveal the nation’s vitamin and mineral status has got worse.
In particular, declines are seen in intakes of:
- Riboflavin (vitamin B2) – needed for energy metabolism; nervous system function; red blood cells; skin; vision; iron metabolism
- Folate (vitamin B9) – for maternal tissue growth during pregnancy; blood formation; psychological function; immune function; cell division; reducing tiredness and fatigue
- Vitamin A – for iron metabolism; maintenance of mucous membranes and skin; vision; immune function
- Iron – for cognitive function; energy metabolism; red blood cell and haemoglobin formation; oxygen transport in the body; immune function; reducing tiredness and fatigue
- Calcium – for normal blood clotting; energy metabolism; muscle function; neurotransmission; digestive enzyme function; maintenance of bones and teeth
- Magnesium – for reducing tiredness and fatigue; electrolyte balance; energy metabolism; nervous system function; muscle function; protein synthesis; psychological function; maintenance of bones and teeth
- Vitamin D – for absorption of calcium and phosphorous; regulating blood calcium levels; bone and teeth maintenance; muscle function; immune function; cell division.
Source: ‘Back to Basics: The Nutrients you need Served on a Plate’ by The Health and Food Supplements Information Services (HSIS), 2021.
For most people, eating a healthy, balanced diet is the best way of protecting their vitamin and mineral intake, but in some cases supplementation is necessary. For example, vitamin D is essential for maintaining bone and muscle health, as well as supporting normal immunity. The Government recommends adults and children over four years old consider taking a daily supplement containing 10 micrograms of vitamin D from October to March, and people at risk of vitamin D deficiency and infants and children up to four years old are advised to take a vitamin D supplement all year round.