'Tis the season

The festive season is a time of indulgence, but what impact does this have on people’s health?

Ah, Christmas… A time to snuggle up in front of a roaring fire (or television) with friends and family and culinary delights. But it is all too easy for indulgence to tip over into excess, and that is where problems can begin. In some cases, the issue is painful but transient – a hangover from the office party, for example, or indigestion caused by too much rich food – but in others, the effects can run a little deeper: the flirtation that unexpectedly went much further, for instance.

In many cases, the pharmacy will often be the first port of call for product recommendations and advice. And given how busy pharmacies are at this time of year – the stampede of customers wanting prescriptions dispensed ahead of schedule is the sector’s very own Christmas tradition, after all – staff members need to be prepared for the influx of enquiries that will come their way.

Food issues

For many people, the run up to Christmas and the day itself are the perfect excuse to eat rich, calorific foods. Abi Butler, group brand manager for the gastrointestinal and allergy categories at Bayer Consumer Health, says that this means it is a key time of year for heartburn and indigestion. She explains: “The conditions may strike at any point and while some sufferers may experience mild discomfort that lasts just a few minutes, for others this can lead to severe pain, sometimes accompanied by nausea and vomiting lasting for several hours. Sleepless nights can also affect sufferers as lying flat can increase the pain.”

The wide range of indigestion remedies on offer means the category can be confusing to shop, and research conducted by Nielsen indicates that while tablets outsell liquids by more than two to one, many people are prioritising finding a solution that works for them over brand or format loyalty. With so many classes of treatment on offer, Abi says: “It is important for pharmacy staff to recognise and understand their suitability.” 

Self help measures can make a huge difference to symptoms, Abi adds, suggesting that pharmacy teams pass on the following advice:

  • Work with gravity by not lying down within three hours of eating as this is when acid production is at its peak
  • Sleep well by elevating the head to stop stomach acid rising to the chest and causing reflux
  • Lighten up by keeping weight within healthy parameters to avoid undue pressure being exerted on the stomach, which can force open the lower oesophageal valve and cause reflux
  • Be food smart by avoiding fatty items that can cause the lower oesophageal sphincter muscle to relax when it shouldn’t, and steer clear of caffeinated and carbonated beverages, alcohol and spicy foods, all of which stimulate acid production and can lead to heartburn.

There are certain symptoms that warrant referral to the pharmacist. These include trouble swallowing or breathing; blood in the stools or vomit; persistent or increasingly frequent symptoms; resistance to OTC treatments; pregnant women; children; pain that radiates into the arm or chest or is worse when exercising, and anyone aged over 55 years who has unexplained weight loss in addition to symptoms of indigestion. Individuals who are on medication should also be seen by the pharmacist.

Michelle Dyoss, public health practitioner at Dudley Metropolitan Borough Council, points out that quantity of food as well as quality can be an issue: “On average, we consume 7,000 calories on Christmas day. You’d have to run at a 10 minute pace [per mile] for nine hours to burn off all that! But small changes can make a big difference, for example, making your own stuffing, filling up on more vegetables and avoiding turkey skin.” She also advocates mitigating the calorie overload with exercise, regardless of the inclement weather: “Keep moving – wrap up warm and go for a walk before dinner.”

The demon drink

It isn’t just food that can cause the pounds to pile on: the alcohol that seems to flow freely at this time of year hides calories aplenty. As Michelle points out: “A large glass of wine can contain over 200 calories.”

This message can be tied in with the safe drinking campaigns that frequently run in the build up to Christmas and culminate with the Dry January initiative that has really taken off in recent years, says Michelle. “A display of different alcoholic drinks each marked with their respective calorie content and alcohol units can have a real impact and provide a starting point for conversations on the topic.”

According to Michelle, the messages that pharmacy staff should try to convey when talking to customers about alcohol are: 

  • Think about the size and strength of drinks – cutting down on the alcohol percentage and using measures makes a difference
  • Reduce alcohol intake when socialising by taking out less cash and alternating alcoholic and soft drinks
  • Stay in control by eating a healthy meal before drinking
  • The more alcohol drunk, the greater the risk to health – alcohol is third only to smoking and obesity in terms of lifestyle risk factors for disease and death in the UK
  • Men and women should stick to a maximum of 14 units a week, making sure those units are spread evenly over the week with a number of alcohol-free days.

The last point is particularly topical as the guidelines on safe drinking changed this year – the first update in over 20 years. A document published by the four UK chief medical officers divided the adverse effects of drinking alcohol into two categories: short-term risks such as injuries and accidents (sometimes fatal) linked to binge drinking, and the long-term risks of developing a range of illnesses including certain cancers, stroke, heart disease, liver problems and damage to the brain and nervous system.

Staying safe

Drinking can, on occasion, lead to people doing things that they wouldn’t do when sober, and this is an area in which pharmacy staff can have a significant impact. The provision of emergency hormonal contraception (EHC) through pharmacies is now well established in the public’s consciousness, but more publicity never goes amiss, says the FPA’s Paul Casey.

Paul, who is head of programmes and training at the sexual health charity, says: “Signs advertising the availability of emergency contraception can be quite small and hidden away, but giving them more prominence is a great way of signalling to people – without actually having to say anything – that this is a place where they can talk or think about their sexual health, whether or not that was the original intention of their visit to the pharmacy.”

He continues: “There is a real need to promote different emergency contraception options. Because EHC is often known as the morning-after pill, many people still don’t realise that the window for taking it is much longer – up to five days for EllaOne or having an intrauterine device fitted – and it is important that pharmacies provide signposting for these options as well as promoting the more widely available and better known Levonelle.” Information could be added to the window sign, advising the public where to seek urgent medical help and get prescriptions dispensed when the pharmacy is closed, he suggests.

Paul also encourages pharmacy staff to take any opportunity to raise the topic of sexual health and contraception: “If someone you have noticed looking at condoms comes to the till to buy something completely unrelated, you could ask if they found what they were looking for. Or you might hear someone talking to a friend as they walk in, and you could say ‘I overheard you talking about something you might need – could I help?’ Even simply saying hello when a customer makes a purchase acts as an invitation for a conversation.”

Similarly, dispensing prescriptions provides an opening, he says, suggesting that staff ask if women have enough oral contraceptive to cover the festive period, or have an appointment to renew their long-acting reversible contraceptive method if it is due to run out. Such interactions provide a way of talking about sexually transmitted infections and safe sex, Paul explains.

Make your advice count

At such a busy time of year, it isn’t always possible for staff to spend as much time with each customer as they would like to, so it is vital to find other ways of supplying information. Helen Parton, trainee assistant manager at Boots Newark Northgate branch and winner of two TM Recognition of Excellence Awards, says this is where merchandising and displays come in.

“There are so many categories that are important at this time of year that you need to give careful thought to how they are going to be displayed, otherwise there is a real danger that the shop floor will end up looking cluttered and confusing,” she says. Helen adds that putting prompts on point of sale material can be very effective – for example, by signposting flu vaccinations on the cold and flu fixture.

“The fact that the counter and dispensary are really busy is actually an opportunity to have lots of meaningful consultations,” she continues. “You don’t want to bombard people with too much information, but you do want to make what you say count. That’s the difference that can mean people come to the pharmacy in the future when they could buy the same thing in a petrol station or supermarket, and gives another opportunity to make an intervention that could make a real difference.”

To test your knowledge on this topic, complete the Team Training learning module.

On average, we consume 7,000 calories on Christmas day

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