6 Ways to Help Obese Patients Lose Weight

Approaching patients about their weight can be a delicate topic for pharmacists to broach.

However, the high prevalence of patients who are obese or overweight and the risks they face may give pharmacists confidence to address this issue.

Seena Haines, PharmD, FAPhA, FASHP, BCACP, BC-ADM, CDE, professor and associate dean for faculty at Palm Beach Atlantic University’s Gregory School of Pharmacy, and Michael P. Kane, PharmD, FCCP, BCPS, BCACP, professor in the Department of Pharmacy Practice at Albany College of Pharmacy and Health Sciences, discussed why obesity is considered a chronic disease and how pharmacists can help patients lose weight at the American Pharmacists Association 2016 Annual Meeting & Exposition.

In 2013, the American Medical Association classified obesity as a disease that affects 78 million adults and 12 million children in the United States.

The estimates for the future are even grimmer, as the National Cancer Institute predicts that obesity will lead to 500,000 new cancer cases by 2030. By that same year, it is estimated that 42% of Americans will be obese and 11% will be extremely obese.

Presently, more than two-thirds of adults and around 31% of children are overweight or obese.

Dr. Haines presented a map that showed the percentage of adults in each state who self-reported as obese. No state had a prevalence below 20%, and Dr. Haines pointed out that the percentage categories (20% to 25%, 25% to 30%, 30% to 35%) are just getting higher and higher.

“You’re here to be an advocate for your patients, and you may be here to be an advocate for yourself, because we have to walk the talk,” Dr. Haines said. “We need to be sure that we’re doing everything within our power, and to me, it’s a daily effort. Some things can become more ritualistic and less mind-focused, but I think it does require constant attention. It will never be something you can turn on autopilot.”

Here are 6 ways pharmacists can help patients (and themselves) get healthier by losing weight.

1. Help patients set achievable goals.

The American Heart Association, American College of Cardiology, and Obesity Society Guideline suggest that patients should aim for a weight-loss goal of 5% to 10% in the first 6 months, though even a 3% to 5% difference has shown clinical benefit.

One dietary approach is to limit daily calories to 1200 to 1500 for women or 1500 to 1800 for men. Another approach is to reduce calories by 500 to 750, or 30% of total daily calories. Yet another dietary approach is to try limiting high-fat or trans-fat food, as well as food high in carbohydrates.

Patients may also find success in starting to reduce the number of sugar-sweetened beverages they consume in a week.

She also said that pharmacists need to make sure that patients are "truly committed to making a change."

"I think far too many times we want the change for the patient, but I think unless they are fully open and wanting to make that change" they will fail, Dr. Haines told Pharmacy Times.

2. Monitor weight-loss progress and suggest ways to maintain it.

Health care providers should assess the efficacy and safety of weight-loss methods on a monthly basis for the first 3 months, and then at least every 3 months, according to the Endocrine Society Clinical Practice. Patients will have more success if they have individual or group follow-ups 1 to 2 times per month for up to 2.5 years.

Dr. Haines noted that exercise is especially critical to maintaining weight loss. In addition, small steps like parking your car far away from your destination can be helpful for those who are new to exercise or want to reduce their sedentary time.

Some other tips for weight loss include eating breakfast every day and maintaining a consistent eating pattern through weekends.

3. Tell patients to avoid these 10 mistakes in behavior.

Dr. Haines provided the following 10 actions that will impede patients’ weight-loss progress:

· Trusting solely willpower for long-term weight-loss.

· Going for big leaps instead of small steps.

· Ignoring how environment shapes behaviors.

· Trying to stop old behaviors completely instead of adopting new ones.

· Blaming failures on lack of motivation.

· Underestimating the power of triggers.

· Believing that information leads to action.

· Focusing on abstract goals rather more than concrete behaviors.

· Seeking to change behavior forever, not for a short time.

· Assuming that behavior change is difficult.

Additionally, Dr. Haines told Pharmacy Times that patients often make the significant mistake of not setting “smart goals.”

Patients should think “specific, measurable, attainable, realistic, and time-relevant” when considering their weight-loss milestones, she advised.

4. Refer to the acronym READS.

As pharmacists aid patients on their weight-loss journey, they should remember to take Resistance in stride, demonstrate Empathy, dodge Arguments, show Discrepancy, and support Self-efficacy.

Other motivational interviewing techniques include asking open-ended questions, affirming patients, using reflective listening, and summarizing what patients have said.

5. Have patients hold themselves accountable for the food they eat and the activities they do each day.

“Accountability is so, so important in this process,” Dr. Haines said, adding that it’s important for pharmacists to ask patients not once, but regularly about their weight-loss progress.

One way to help patients be aware of what they eat is to suggest a food log. Some resources include myfooddiary.com, my-calorie-counter.com, myfitnesspal.com, and supertracker.usda.gov.

A food diary can also help record emotions and triggers while dieting, and an exercise log can help patients keep track of the minutes and level of exertion they’ve achieved. Dr. Haines suggested that patients should weigh themselves weekly at the same time of day (preferably the morning) on the same day of the week.

6. Remind patients of the 4 tenets of pharmacologic treatment for obesity.

Dr. Kane suggested health care providers should make patients aware that they need to keep 4 tenets in mind when starting pharmacological treatment for obesity.

First, they should begin new habits with their diet and exercise. Second, they should know that pharmacotherapy can’t replace those lifestyle modifications. Third, pharmacotherapy should increase patients’ likelihood of achieving meaningful weight loss. Lastly, all medications for obesity should target patients with a body mass index (BMI) of ≥30 kg/m², or those with a BMI of ≥27 kg/m² and at least 1 weight-related comorbidity.

If a medication does not seem to be effective, the patient should speak with his or her prescriber about trying alternatives.

“Are we getting somewhere after 12 weeks of maintenance therapy? If we’re not, then it’s time to stop the medication,” Dr. Kane said. “But then, it’s also time to consider perhaps another medication. Maybe we can find a better choice. For some patients, they will have different responses to different medication.”

Of the top 5 medications for weight loss, liraglutide, orlistat, naltrexone/buproprion, phentermine/topiramate, and lorcaserin are the most successful in helping patients lose 5% of their body weight at the 1-year mark, according to the drug package inserts.