Recognising and managing addiction transfer

Jan 2013

Food addiction, according to Dr Nora Volkow, head of the National Institute for Drug Abuse, shares the same brain dopamine reward pathways as addictions to drugs and alcohol. It explains much of the compulsive overeating that results in obesity. The two treatments most likely to combat the excess weight of obesity are bariatric surgery and Lipotrim.

Bariatric surgery has been linked to many reports of addiction transfer – where after treatment the addiction to food transfers to
other substances or habits, such as alcohol, drugs and cigarettes. A recent study in the Archives of Surgery found a 50 percent rise in the frequency of substance abuse two years after the procedure.
Alcohol misuse, smoking cessation and weight management are high on the public health agenda and are areas that pharmacy is long familiar with. In fact, the addiction transfer from cigarettes to food is familiar and one that pharmacists counsel on when running a quit smoking service. Food addiction is therefore a subject that pharmacists should be advising on when offering a weight management service.
Drugs and food addictions activate the common dopamine reward pathway in the brain. The best treatment for addictions is complete abstinence from the addictive substance. With food this is not usually possible which is what makes dieting hard. Total Food Replacement diets, such as Lipotrim overcome this because people whose weight gain is due to food ‘abuse’ can safely avoid food until the habit is broken and normal eating habits can be re-introduced, for example in conjunction with the Lipotrim maintenance formulas.


Positioning pharmacy as an effective option to bariatric surgery

Nov 2012

Recent NHS figures show that the number of people undergoing bariatric surgery has quadrupled in the last 5 years – from 1,573
people in 2006-07 to 6,723 in 2011-12.
Although bariatric surgery is very effective at producing rapid weight loss that causes type 2 diabetes to go into remission, it comes with a multitude of problems including high morbidity and mortality risk, prohibitive initial and followup costs and limited availability. However, there is a readily available alternative to bariatric surgery that is evidence-based, safer, much
more cost-effective and one where pharmacies are playing an active part: Very Low Calorie Diets (VLCDs) properly monitored by healthcare professionals.
The rise in bariatric surgery has led to prominent pharmacy figures Mike Holden, chief executive of NPA, and Ajit Malhi, AAH
Pharmaceuticals’ head of marketing services, arguing the case for pharmacy which is playing an increasingly prominent role in tackling obesity in the community, as part of the public health and Healthy Living Pharmacy drive.
With over 2000 pharmacies offering the Lipotrim VLCD programme, overweight people have ready access to a pharmacist who can not only help them reduce weight, but also assist them adopt healthier lifestyles, change eating and exercise habits and pre-empt or control existing diabetes.
Pharmacists therefore deserve considerable recognition for providing a service capable of promoting remission of type 2 diabetes and relief of co-morbidities, where present, without depleting the assets of the NHS. And, crucially, praise for the effective reatment of excess weight in hundreds of thousands of patients, where documentation of weight loss represents evidence for the value of pharmacy.


Keeping trim

With “losing weight” being one of the most popular New Year resolutions, Victoria Goldman investigates how pharmacies can help customers to achieve this goal – and stick to it

According to the latest NHS statistics on obesity, 26 per cent of men and women were classified as obese in 2010, with a further 42 per cent of men and 32 per cent of women classified as overweight.

Losing weight isn’t easy, however, and surgery is often seen as a simple solution. NHS statistics show that there were more than 8,000 hospital procedures for weight-loss stomach surgery in 2010-11, a 12 per cent increase from the previous year and a 30-fold rise in the last decade. According to a review by the National Confidential Enquiry into Patient Outcome and Death in October 2012, many people are opting for obesity surgery without proper consideration of the risks, with almost a fifth of patients having to be readmitted to hospital because of complications. “The major issues at the moment appear to be that of gastric surgery and the messages that surround it,” says Ajit Mahli, head of pharmacy affairs for Celesio Group (UK). “It is a subject that we all need to be aware of since patients are bound to ask further questions. The key is to advise the patient as to what options best suit them and mutually agree some goals that both parties can work towards.”

Customers should avoid so-called fad diets and diets that are particularly restrictive, as these approaches are likely to cause binge eating and eventual weight gain. You need to find slimming regimes that suit your customers in the long-term rather than provide a quick fix. So what can you offer customers this New Year in terms of weight loss support?

Weight management services

a3Many pharmacies offer weight loss advice as part of a medicines use review or as a standalone weight management service. Ajit Mahli says that since weight management is a sensitive area for many people, it should be approached with care. “My advice would be to start by talking in terms of general health improvements,” he says. “Offer blood pressure screening and cholesterol checks and engage the patient with advice on living a healthy lifestyle in the first instance. It is certainly not a subject that can be handled with offers of miracle cures and overnight success.” Pharmacy-led weight management services can be particularly beneficial for customers who have a lot of weight to lose and need ongoing support. According to Helen Bond, British Dietetics Association spokesperson, customers need to learn to decrease their portion sizes of healthy foods and increase their exercise levels. “With today’s fast paced society, many people want to see extreme weight loss results within the shortest amount
of time,” she says. “But it’s probably taken years to accumulate the extra weight – so taking a year or so to lose the weight is
completely reasonable. Research shows that it’s far healthier and safer to lose weight slowly and steadily – around 1 to 2lbs (0.5 to 1kg) each week.”
There is no set way to lose weight and each customer will respond to different approaches.
“We are all very different and the way that we behave in relation to external and internal stimuli varies considerably, so what works for some people may not be right for others,” says Bridget Benelam, senior nutriti on scientist at the British Nutrition Foundation. “There are lots of different options to choose from in terms of making changes in our behaviour that could have a positive impact on our health.”

Meal replacement programmes

Meal replacement programmes are a popular choice for dieters. Some programmes offer total meal replacements, while others involve a combination approach, mixing meal replacement products with healthy meals. Research in the American Journal of Clinical Nutrition in September, 2012, found that commercial weight-loss programmes, especially the very low calorie diets (meal replacements providing 500 calories a day for six to 10 weeks), can be effective at helping people to slim down. “There is plenty of clinical research backing the role of meal replacements, which usually work by reducing calorie intake,” says Helen Bond. “These can be used as a tool to kickstart healthy eating plans.”
Meal replacements are convenient as they avoid the need for portion control and calorie counting. However, pharmacists need to educate customers about how to change their eating habits as well, so that they don’t put the weight back on again afterwards. The Slim-Fast plan is backed up by online support teaching the principles of healthy eating and how to manage everyday food and drink.

Lipotrim, which started out in 1987 as a GP programme but was extended to pharmacies in 2000, involves using Lipotrim Total Food Replacement formulas in place of all regular meals alongside weekly visits to the pharmacy.

“Lipotrim is aimed at the severely overweight or obese,” says Dr Stephen Kreitzman, the nutritionist who established the brand and is co-director of the company. “Pharmacists have to be trained and are backed up by our helpline. Maintaining the weight loss afterwards is very difficult and this is when most people need advice.”

Weight loss products

There are many weight loss products available and customers should buy products backed by clinical research, such as alli, XLS-Medical and Adios. “It is important that pharmacists look at the evidence behind each product and make sure that they won’t interact with anything else the customer is taking,” says Helen Bond.

Alli 60mg hard capsules, from GSK, are back on shelf after an absence and are being supported by an intensive marketing campaign to raise awareness and drive sales through pharmacy. Aimed at women aged 35-plus with a BMI of 28 or more, the brand’s key message is “for every 2lb lost through healthy eating, alli can help you lose 1lb more”. “We are delighted that alli is back in time to help people achieve their weight loss goals at a time when health and fitness will be top of their minds,” says alli brand manager Laura Street. “We will once again be hosting consumer information online to help people take responsibility for long-term changes and encourage a healthier lifestyle and sensible eating to achieve gradual weight loss.”

According to a double-blind, placebocontrolled clinical study, published in the journal Obesity, the recently launched XLSMedical Fat Binder helps dieters lose 3lbs for every 1lb they lose on their own. This patented natural fibre complex supplement comes with a free 12-week online weight loss programme ( designed to help dieters manage their weight loss successfully without cutting out important food groups.
According to marketing manager for the brand Nicole Ehlen, pharmacists and pharmacy assistants play a very important role when it comes to weight management. “A lot of consumers are looking for professional advice about how to lose weight and which products could help them,” she says. “Pharmacists should ensure customers understand that weight loss requires a long-term commitment and results won’t be achieved overnight. Encourage people to set themselves realistic weight loss goals.”
To achieve the maximum benefit from XLSMedical Fat Binder, the product should be taken regularly: two tablets, three times a day after each meal with plenty of water.
Additional support is also available on the brand’s website (, where customers can find healthy eating and exercise tips from the company’s experts as well as a free online support programme to help dieters achieve their goals.

Case study

The Buchanhaven Pharmacy in Peterhead, Scotland, set up its weight management programme around four years ago. According
to pharmacist Samantha Melrose (pictured second from the right, with her team), the programme was introduced in response to customer demand. “We had always offered weight, a4height and BMI measurement, but just added more services to the bundle as they became available,” she says. “We then heard about Lipotrim and investigated its potential in the pharmacy. Celebrity Slim was then launched by Numark and, along with the launch of alli, this gave us a pretty comprehensive package. We also offer the Numark plan, which is similar to the Weight Watchers idea, where we offer lots of advice and a weekly weigh in.”
With its wide range of products and services, the programme has something to offer every customer. “Some products come with their own restrictions for use, but I believe that we offer something to suit everyone wishing to lose some weight,” says Samantha. “Some customers attend weekly, while some use the services on a more ad hoc basis, such as in preparation for a special event. We have had lots of really positive feedback. One of our Lipotrim customers brings the staff doughnuts every time she attends!”
All of the staff are fully trained in the services. “Many of our staff have used the products themselves and that helps the quality of the service we offer,” says Samantha. “We have a great team here and they are all extremely encouraging and delighted to help. Some services involve our pharmacist more than others, but we offer a very joined up approach involving the best person in the team for that customer.”
The programme is promoted regularly to attract new people to the pharmacy and remind regular customers that the weight management programme and other services are available. “We use our Facebook page every day to promote health and pharmacy news and messages,” says Samantha. “We also have a new website and we use our windows to their best advantage.
Of course, word of mouth is very important too. One happy customer will tell many more!”

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Support GPs in tackling obesity

Feb 2013

The Royal College of Physicians (RCP) suggested in a report last month (Action on obesity: comprehensive care for all) that GPs
should direct obese patients to community services, including pharmacies, rather than offering in-house clinics. The report pushes for multi-disciplinary teams with pharmacists working alongside GPs, dieticians, counsellors and physiotherapists, and called for a national model for the commissioning of community services for obese patients.

This is further testament that pharmacists must be doing something right here.
Pharmacies have been running dedicated weight management services for over a decade. In the last couple of years the Royal
Society for Public Health has become more involved in pharmacy, and the NHS has given the nod to the Healthy Living Pharmacy initiative.
The big sticking point for pharmacy has been demonstrating value. But this has all started to change over the last couple of years with the introduction of the Lipotrim Patient Tracker, an online IT programme that keeps patient records for their weight management service and provides for comprehensive audits to be produced.
The evidence produced so far from Lipotrim pharmacies clearly shows that pharmacy offers a very successful and costeffective
service that will make a big impact in reducing the obesity epidemic and the costs to the NHS.
With only two months until clinical commissioning groups (CCG) take over from PCTs, it’s crucial that pharmacists embrace
and push for the RCP model to work and shout out about the evidence.


Offering pharmacy support behind VLCDs

Oct 2012

Not all Very Low Calorie Diets (VLCDs) are the same, and not all VLCD programmes are the same. Customers need to be made aware that some online VLCDs come without the proper formulations or essential support of a healthcare professional.
VLCDs should use nutritionally complete food formulas designed to replace all regular meals with no additions. The professional weight management programmes are especially valuable for the obese where the excess weight has led to co-morbidities such as type 2 diabetes, hypertension and mobility problems. They are not for the casual dieter who wants to shed a few pounds before going on holiday, but can help prevent overweight from progressing to obesity.
but weight loss can have an impact on existing medical conditions. Real weight loss should be managed in a healthcare setting where knowledgeable screening and weekly monitoring are routine.
Lipotrim is a professional VLCD programme that is only available from pharmacies and GP surgeries. The initial consultation involves screening for suitability and taking a careful medical and drug history. In some cases GP involvement is required, e.g. for stopping drugs in patients with type 2 diabetes. Patients are required to return to the pharmacy weekly for monitoring, counselling if necessary and to collect the next week’s supplies. People nearing their target weight are given lifestyle advice on
maintaining their weight and offered the followon maintenance programme.
Online VLCDs cannot replace the comprehensive care, support and expertise provided by a pharmacy‘s professional weight
management service. And importantly, online purchases cannot guarantee the compositional integrity of products that have at times been known to violate international standards for total food replacement products and programmes. Caveat emptor!


Capitalising on the post-Olympics healthy living drive

Sep 2012

The Government has been very keen on using the Olympics and Paralympics as a driver for getting more people doing sport and exercise and it seems that, with the post-games euphoria, people are taking up the opportunity of becoming more active.
But there is another driver to this health agenda – the cost to the NHS of the consequences of an unhealthy lifestyle, in particular diabetes. According to the latest figures from the Health and Social Care Information Centre (HSCIC), diabetes prescription numbers topped 40 million for the first time last year, a rise of nearly 50% in six years. That now puts the drugs bill for diabetes
at a staggering £760.3 million.
Health Minister Simon Burns responded to the report saying: “The number of people with diabetes has been rising for years, mainly because of an increase in the number of people who are obese due to a lack of exercise and unhealthy diets… it is so important that we take urgent action to tackle the problems caused by obesity.’’
Tackling obesity is something that pharmacy is proving to be well placed to do. It reaches further out into the community to get
the message across about healthy living, for example linking with local diabetic nurses or capitalising on current sports initiatives. And Lipotrim, with the unique Patient Tracker, now has documentation that, in parallel with bariatric surgery, the rapid weight loss induced with Lipotrim can often put type 2 diabetes into remission.
Lipotrim allows pharmacists to offer and document a very effective weight management programme that provides the eassurance of a healthcare professional selecting and monitoring patients, some of whom may have diabetes. And with the current Government push, now is a time for pharmacy to make a real difference.


Promoting adherence to your weight management service

Jun 2012

Adherence is an area that pharmacy is claiming for its own. The New Medicines Service (NMS) and Medicines Use Reviews (MURs) are both based on promoting adherence to prescribed medication.
But what about adherence to weight loss? The principles of adherence are the same and the semi structured questionnaire used in these services could be adapted for your weight management, for example by asking the customer how they are getting on, if they are having any problems, if they think it’s working, if there have been any lapses and if there is any further information or support they need.
However, weight loss, like smoking cessation, are complicated by an addiction element (one to food, the other to nicotine) so
any counselling will also take into account motivation and willpower.
The Lipotrim Pharmacy Programme has been designed to help patients adhere to the diet and maintain their weight afterwards. Total Food Replacement with Lipotrim uniquely allows the dieter to totally stop the substance of abuse, which is an essential component of addiction management. The initial consultation and subsequent weekly visits help you to educate and encourage dieters and address any concerns. This gives dieters confidence in your service and also means you can help them maintain their target weight, such as with Lipotrim maintenance products.
The programme also comes with resources and tools which include factsheets, patient progress cards and a new engaging patient DVD that uses the latest animation to explain weight loss and the Lipotrim programme. The Lipotrim Pharmacy Patient Tracker has a patient interface, complete with graphs and charts, which means patients can login securely into their records and monitor their own progress to keep motivated.


Capitalise on HLP to drive your weight management service

May 2012

The Healthy Living Pharmacy initiative has far exceeded expectations, now having nearly 200 accredited HLPs in 20 pathfinder sites across 30 PCTs, with many more vying to get involved. In the meantime, the government’s Pharmacy and Public Health Forum chair Professor Richard Parish has told community pharmacy that ‘its time has come’ and urged it to capitalise on the opportunities out there.
Pharmacy has not had a bigger opportunity than this to make its mark in public health. HLP aims to improve the health and wellbeing of the local community through high quality pharmacy-delivered public health services, including weight management. The pathfinder sites’ remit will also be to build the evidence-base for pharmacy’s contribution to public health
before roll-out.
Lipotrim has been behind pharmacy’s public health role all along, developing its weight management service package to enhance pharmacy’s developing professional roles. And since introducing the service from the GP arena to pharmacy over 10 years
ago, Lipotrim now has more than 2000 pharmacies offering the service, this represents a strong body of evidence to support pharmacy’s role in weight loss.
Foreseeing the value of evidence, the company has also developed the Lipotrim Pharmacy Patient Tracker to make it easy for each pharmacy to audit its own service and demonstrate value. For anyone looking to get involved in HLPs and use it to drive
their weight management service, this will be an invaluable tool.


Conducting your own audit of evidence

Apr 2012

Getting evidence from services is no longer a luxury for pharmacy. With the new NHS bill, every healthcare professional and service will have to demonstrate value if they want a future.
However, collating evidence has been a particular challenge for pharmacy – pharmacists are not in the habit of documenting the value of their services and they often don’t have the means to do this efficiently, relying too much on paper.
Conducting an audit and gathering evidence for your service is easier if you have an online recording system and the PSNC are going that way with Pharmabase.
When it comes to your weight management service, the evidence from your audit can be compelling. Using the Lipotrim Patient Tracker, you can pull off data to demonstrate benefits using a range of criteria, for example by gender, BMI, age and co-morbidities such as hypertension and diabetes, all at the click of a button. It allows you to continuously audit your pharmacy service for evidence based commissioning while at the same time monitor and support your patients and cut down on paperwork and filing.
Getting started is easy. Draw up objectives and then decide on what evidence you want to present, to whom and for when. Set aside time to become familiar with the Lipotrim Patient Tracker or simply book a quick 20-minute online demo to see it in action and get your first patient record in place.


Promoting weight management alongside your stop smoking service

Mar 2012

All the publicity surrounding No Smoking Day (March 14th) gives you a great opportunity to advise on healthy eating and promote your weight management service.
Smokers considering quitting are often deterred by the potential of weight gain.
Not all quitters gain weight and the exact mechanism is poorly understood, but has been linked to the fact that nicotine may suppress appetite and increase metabolism by a small amount. Food can also be used as a comfort by quitters and as a replacement to the habit and addiction of smoking. For people that are concerned, the advice should be about the overwhelming benefits of quitting, the need to eat healthily and how they can manage their weight if this becomes a problem.
The pharmacy is in a unique position in being able to offer support on these two inter-linked pharmacy services. The pharmacy
team should be on the lookout for customers who decide not to stick with the stop smoking programme because of worry about weight gain. Normal weight people will be assured of remaining weight stable after quitting using the Lipotrim maintenance formulas and healthy eating. Likewise people who are trying to lose weight and give up smoking at the same time may need more in-depth counseling and the strict weight loss service.

The Lipotrim Pharmacy Programme offers a range of diet products and maintenance products to support these customers. The
Patient Tracker can also be used to show weight loss or stability over time and encourage them to remain quitters.