Your advice in this module is understandable and nothing different to that seen many times, because the whole field of weight management is full of perpetuation rather than real analysis of science and the corresponding data. We are often duty bound as healthcare professionals to disseminate such information without our own assessment of the facts. This is something I have only learnt relatively recently.

I feel this module is missing an important opportunity to elevate the professional recognition of the pharmacist above that of the lay-person hosting slimming clubs. The recent media blitz, promoting their 12 week weight management programme also ignores the evidence, especially that provided by pharmacies who have documented their evidence over recent decades. 

I hope I have written my comments to each section positively and in addition to the information you have kindly provided.

Please feel free to make contact to discuss anything I have added.

Total Diet & meal Replacements Europe - https://tdmr-europe.com/

Howard Foundation Research, Downing Park, Station Road, Swaffham Bulbeck, CB25 0NW. lipotrim@lipotrim.co.uk

Gareth Evans, BPharm (Hons) MRPharmS, Waistaway Ltd, info@waistawayuk.co.uk

Evidence-based, safe and accurate advice is indeed necessary as I have noted throughout my comments.

You may wish to read my peer reviewed, published pharmacy work here for inspiration: https://www.mdpi.com/2226-4787/8/1/22/htm

NICE are the main drivers of best practice, and at the same time please be aware of conflicting advice. For instance: think how NICE incorporates VLCDs, whereas the NHS advises not to use VLCD, yet at the same time is piloting LCDs for type 2 diabetes based upon VLCD data (DIRECT study). Confusing isn’t it?

Please be aware that someone with obesity is likely to be hesitant to permit the contact needed for a waist measurement, and to be aware of the maximum weighing capability of your pharmacy scales.

Pharmacy can, and in in my opinion should be offering weight management services. What other healthcare professional is in any defined way across the UK?

Not being a dietician absolutely does not limit the advice a pharmacist may offer, especially when there are health or other medication issues to consider.

Pharmacists are more than capable offering lifestyle advice, discussing the use of the Eatwell plate, supplying, monitoring and supporting Low Calorie and Very Low Calorie Diets, using PGDs for POM pharmacotherapy and discussing the role of bariatric surgery.

Please note that the Eatwell plate states:  Most of us still are not eating enough fruit and vegetables. They should make up over a third of the food we eat each day.

Eating more food when suffering from excess weight is not the best advice so we must be careful how this is approached. Be especially careful with fruit, it is sugar after all!  It is important to note that Fructose has been linked to many of the health problems associated with carbohydrate intakes.

The maths and target rate losses that we are often citing, ie 1 to 2 lbs a week weight loss, often doesn’t unfortunately offer the dieter a realistic outcome. In general lifestyle interventions such as the Eatwell Plate allow (at best) only for a 1lb a week weight loss, with data showing only around 3% average weight losses. This is far below the 5% weight loss of initial weight required for medical benefit.

The research data for long-term weight maintenance post weight loss is opposite to that stated:

Anderson et al (24) performed a meta-analysis of 29 long-term observational studies using VLCDs or hypoenergetic balanced diets and found that the VLCD group maintained significantly more net weight loss than the hypoenergetic balanced diet participants after 5 y (29% compared with 18%). Indeed, an increasing number of studies now indicate that a substantial initial weight loss predicts a larger long-term net weight loss (2, 34–36).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862452/

Food diaries are notorious for lacking clarity and truth. I advise against weighing daily as it is all too easy to react to natural daily fluctuations in weight, rather than an overall progress seen by fewer checks, generally once a week.

It is important for pharmacists, and anyone else offering weight management advice, to also consider the mind-altering effect of alcohol. Yes, there are calories, but anyone who has had the “munchies” after consuming a small amount of alcohol will know the calories in the food consumed (chips, kebab, chocolate, etc) is likely to be far more of an issue than the calories consumed as alcohol.

A great way to engage customers on the difficult subject of weight is to be broad in your initial engagement. Discussing lifestyle and encompassing weight management allows for an open and non-judgemental discussion.

Posters and point-of-sale only go so far, and there is nothing comparable to actively engaging opportunistic discussion.

Other areas where weight may be related include:

Hypertension and type 2 diabetic prescription transactions

Requests for help with snoring and sleep apnoea

Vitamin and supplement purchases

Flu-jabs

Stop smoking services

Pretty much everything we do because excess weight will ultimately be playing a part.

I am sure those other mediations such as the GLP-1 receptor agonists (recently gaining much attention) and the other medications offered successfully under PGD in pharmacy should have been included here. Again, pharmacy can offer a range of effective weight management options, with licensing not an absolute barrier to beneficial outcomes.

Yes, yes!! Pharmacists are ideally placed to do this. As the most available and accessible healthcare professional we are the front line of lifestyle advice.

No, no!! The reference to total diet replacements as not being part of a long term solution for weight loss is an outdated viewpoint. Decades of research demonstrates otherwise, including the latest research for example the COUNTERWEIGHT, DIRECT and DROPLET studies.

Orlistat is indeed the only licensed medication in the UK for weight loss and is not well tolerated. 

In any diet it is imperative to obtain all essential nutrition, however it is critical to point out that the human body will not be able to differentiate between the amino acid or fatty acid obtained from cheese to that obtained from a meal replacement.

The essential nutrition is the critical factor, not the source.

The source, however, may determine the nutritional quality.