Category Archives: IN PHARMACY


S. N. Kreitzman Ph.D. R.Nutr, V. Beeson, S.A Kreitzman Howard Foundation Research Ltd

Obesity is an issue that is now of critical concern to our increasingly overweight society. It is also an area where pharmacists have a real public health contribution to make. Being overweight or obese isn’t a mere cosmetic problem; it greatly raises the risk for other health problems, including High Blood Pressure, Coronary Heart Disease, Type 2 Diabetes. Stroke, Abnormal Blood Fats, Metabolic Syndrome, Cancer, Osteoarthritis, Sleep Apnea, Obesity Hypoventilation Syndrome, Reproductive Problems, Gallstones and more.

At a time when there is increasing competition for over-the-counter sales
and decreasing revenue from prescriptions, weight loss offers an area where pharmacists are able to maximise use of their unique skills and training; offering their customers something that simply cannot be purchased from a supermarket or an online retailer. An effective weight loss service is perhaps the single most important contribution pharmacists can make to their community; certainly it is one of the most rewarding – both professionally and financially.

There are now more than 2000 pharmacies in the UK and Ireland offering the Lipotrim weight management service. The results they are achieving are not only comparable to that which can be achieved with bariatric surgery, they are also able to offer a supported programme for weight maintenance obesity prevention- something that is beyond the remit of surgery.

Of particular value is the contribution these pharmacies are making to the treatment of type 2 diabetes, Any patient taking oral mediations for diabetes must, in conjunction with their GP, stop the medication prior to dieting. The blood sugars often normalise within a few days and, with a stone or more weight loss, the diabetes is likely to remain in remission. Excess weight is a major promoter of type 2 diabetes and weight loss is well known to be an effective treatment.

Less dramatic, but equally important is the impact of weight loss on hypertension. It is estimated that in around 50% of cases with high blood pressure, the hypertension is weight related and responds favourably to weight loss.

With the Lipotrim service it is easy to document a pharmacy’s success. Audits can be completed virtually instantly, on demand, and with considerable flexibility. Secure audits can be completed within a single pharmacy or pharmacy group and even for the patients of a single surgery, providing evidence of the value of the service to local doctors.

The NHS is currently engaged in a losing battle against obesity, hypertension and diabetes in UK society. The runaway cost of treating these conditions is on the verge of bankrupting the health service, and still the numbers are trending inexorably in the wrong direction. Pharmacists are having a real impact on this battle by offering an effective alternative to NHS solutions to the problem (medication and bariatric surgery). Lipotrim is a cost-effective and highly successful weight management programme that is demonstrably providing fundamental health benefits for pharmacy customers, and profits for the pharmacies themselves.







PDF Version: infarm nov 2013

Worth the weight

The market for weight loss products is moving in the direction of a personalised, supportive and structured service offer, says Christine Michael

At New Year millions of people are likely to resolve to lose weight and get fitter, but all too often their good intentions prove short-lived, and obesity remains an intractable public health problem. Data compiled by the World Cancer Research Fund show that in 2010 in England, 62.8 per cent of adults were overweight or obese, and the direct cost of obesity related illness to the NHS was estimated at £5.1bn a year. In Scotland, 65 per cent of adults were overweight or obese, while the figures for Northern Ireland and Wales are 59 per cent and 57 per cent respectively.
For pharmacies, January and February are key times of the year to engage with customers who want to slim, whether on an opportunistic basis, as part of a broader healthy lifestyle offering, or as a commissioned enhanced service.
Keeping track
NPA Board Member and Alliance Healthcare Awards Welsh Pharmacy of the Year shortlisted nominee,
Chris Jenkins, of St Clears Pharmacy in Carmarthenshire, introduced a weight loss service earlier this year, and says it has created a “virtuous cycle” for the pharmacy as a whole. “We enjoy a positive reputation for our successful weight management service, strengthening our position and creating a benchmark in customer care within the local community,” he says. “More than 50 people have enrolled, and some travel up to 30 miles for the service; it even has a local Facebook page.”
One advantage of offering a service based weight loss programme rather than a more ad hoc approach is the opportunity it provides to compile data for potential commissioners. This lies behind the introduction of a ‘Patient Tracker’ audit tool, a new feature of the Lipotrim VLCD programme, which has been running for 25 years and is now available in nearly 2,000 pharmacies. “It is important to have the tools that can satisfy the need for documentation of achievement in this era of evidence-based treatments,” says Gareth Evans, a community pharmacist who offers the Lipotrim programme in East Anglia. His analysis shows that the mean weight loss of 382 people who completed three or more weeks on total food replacement was around 10kg, from 91kg to 81kg on average. “The Patient Tracker software allows me to present evidence not only of individual patients’ experience but also the achievements of cohorts of patients, which has become important for commissioning – for example, to show that successful weight loss is found even in patients with extremely high BMI,” says Mr Evans.


Diet demand
Market analysts Euromonitor International sees growth in `one stop shop’ weight loss services like the Lipotrim programme, as consumers “shift away from weight loss tablets and pills, and towards meal replacement programmes and holistic diet alternatives… due in part to the prevailing economic conditions”.
Its analysis shows some volatility in the retail weight loss category, explained mainly by the dramatic impact of Alli, from GlaxoSmithKline Healthcare (GSK), from its launch as an OTC product in 2009, to a subsequent fall off in sales in 2011.
However, having resolved difficulties with supplies of the product, GSK relaunched Alli in time for the 2012 Christmas and New Year market. Their major campaign of press and online advertising and in-store support, was primarily aimed at females aged 35 and over, with a BMI of 28 or more.
Nevertheless, Euromonitor still forecasts virtually flat sales in the category between 2012 and 2016, with compound annual growth of only 0.4 per cent, rising to an annual total of £128.6m by 2016.
One catalyst for change in the slimming supplement market is the latest batch of claims guidelines from the European 27Food Safety Agency (EFSA), which came into force in December 2012, and which may now lead to some products that make unapproved claims being withdrawn or relaunched with amended packaging.

Products with approved claims are likely to benefit, says Sanjay Mistry of Inovate Health. His company markets Slimsticks, a product containing konjac mannan, a vegetable fibre that the EFSA approves for “weight loss in the context of a hypocaloric diet”. Launching with a short term listing in selected Boots stores, Slimsticks will be rolled out to independent pharmacies through 2013. Other products that have EFSA approved claims are also now likely to want to push their advantage.
Compared with offering slimming products, introducing a personalised service may seem onerous in terms of time and training, but Chris Jenkins believes it is still worthwhile.
“Two members of staff have taken full responsibility for the weight loss service and have great pride in doing this,” he says. “They have the chance to develop new skills, and although it takes time to run such a service it is well invested time – time to care for patients and to make a real difference in their lives.”


PDF Version: Weight-loss-Jan13


Providing routine clinical evidence documenting efficacy in pharmacy under real life conditions

There is probably no current medical discipline more in need of evidence of efficacy than the field of weight loss, especially when the patients are obese and/or with co-morbidities. There is now overwhelming experience with total food replacement programmes (VLCD) , nutrient complete formula diets that are essentially low fat, very low calorie enteral feeds. Over the past four decades, these have gained recognition and acceptance as safe and effective where they are supervised by healthcare professionals, people who are medically experienced so that they can restrict access to the diets or modify treatments when necessary. Real weight loss, beyond simply depleting stored glycogen and water, has physiological implications and the real weight losses due to VLCD programmes, such as Lipotrim, are rapid and substantial. These programmes, run by trained pharmacists and GPs, compete with bariatric surgery in the magnitude of the losses routinely achieved, but without the negatives of substantial costs, higher risks and post weight loss addiction transfer,


While a total food replacement formula diet can obviously not be blind to the dieter and a placebo would be unsafe, an innovative patient tracker system introduced into the Lipotrim pharmacy weight loss programme, allows for on demand, virtually instant, assessment of the secure data kept by the pharmacists offering the service. Statistical evidence can be provided for an individual patient or all the patients from a particular medical practice. Evidence can be provided for a single pharmacy or a pharmacy group or, as required, any selected collection of pharmacies, If necessary evidence can be provided from all the pharmacies in an area, as was recently reported for 150 pharmacies in Northern and Southern Ireland by pharmacist Brendan Feeney.

The flexibility of the tracker is such that statistics can be obtained, for example, within a defined BMI range, such as above BMI 40 or perhaps between BMI 25 and 30, or a defined age range or by gender. It can compare the first dieting period with that of subsequent dieting intervals. It can provide statistics on long term weight maintenance after dieting and the stability of the weight during transition from dieting to maintenance.

Critically, it is possible to quantify the dieting successes of people with concurrent medical issues – diabetes, high blood pressure, hypothyroid, depressive illness or any medical condition where weight loss will have an impact on the condition or treatment protocols. The Ireland assessment, previously referred to, provided statistics of the magnitude of the weight losses, the percent of initial weight lost and BMI changes for a cohort of type 2 diabetes patients – all of whom stopped oral diabetes medications prior to dieting, and remained in remission long after the documented weight loss.

Pharmacist Fin McCaul of Prestwich pharmacy and chairman of the Independent Pharmacy Federation, recently presented data to a National Obesity Forum Conference based on a successful cohort with an initial BMI in excess of 40. At Prestwich 1148 patients with a median BMI of 33.6 kg/m2 used the Lipotrim weight management service. 25% were morbidly obese with a BMI > 40 kg/m2. At the time of audit, during which many patients were still dieting, the median BMI had decreased to < 30 kg/m2. 94% of the dieters lost more than 5% of their pre-diet weight, 47% lost more than 10% and 21% of the patients lost more than 20%. Importantly, all patients with type 2 diabetes had their medication stopped by their GP.

Providing clinical evidence of efficacy under real life conditions, is now routine for pharmacists offering the Lipotrim weight loss service and documenting results with the Patient Tracker software.

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