As some of the most accessible health care professionals, pharmacists are uniquely positioned to help patients manage their weight
It’s no secret that the United States is facing an obesity epidemic: Over 40% of the adult population is living with obesity, which can increase the risk for a multitude of health conditions including heart disease, stroke, and type 2 diabetes.1 Besides its impact on quality of life, obesity can be a burden on both individual finances and the health care system. Can pharmacists—positioned as trusted health care professionals in the communities they serve—play a role in bringing weight loss programs to the public?
Meagen M. Rosenthal, PhD, associate professor, Department of Pharmacy Administration, University of Mississippi School of Pharmacy, has taken part in research investigating the role of pharmacists in weight loss programs, including a scoping review of literature on the topic and research into pharmacists’ and patients’ attitudes toward pharmacy-based weight loss programs. “We have community pharmacists who are interested in doing this kind of work, and we have patients who are willing to see community pharmacists to make this work happen, which to me is the perfect storm of opportunity to do more of this work,” she said. In small rural communities dealing with recent hospital closures, Rosenthal noted, community pharmacists can play an important role in improving health outcomes.
In a review of 9 studies of pharmacist-run weight loss programs published between 2010 and 2017, Rosenthal and her colleagues found that patients in these programs lost a mean 3.8 kg over the course of the programs2 which, she said, “translates to important clinical reductions in...glucose levels for people who have diabetes and blood pressure levels for folks who have hypertension.”
Kathy M. Campbell, PharmD, owner of Medicap Pharmacy in Owasso, Oklahoma, who has had over 300 patients complete her pharmacy-based weight loss program over the past 6 years, reported dramatic results over the course of the 12-week program in some patients, including reductions in glycated hemoglobin A1c from 13.5 to 6.5 and a 107-point reduction in low-density lipoprotein cholesterol.
In focus group interviews with potential participants, many highlighted their desire for programs that are tailored to their individual needs, with a mix of one-on-one and group counseling sessions.3 Instead of a program with a specific defined curriculum, Rosenthal noted, they wanted opportunities to say things like “I can exercise fine on my own, but what I really need to know more about is how to cook for myself.”
Campbell’s 12-week pharmacy-based weight loss program typically includes 6 half-hour individual counseling sessions, but also offers group activities such as cooking demonstrations. Some pharmacy-based weight loss programs feature pharmacists working in conjunction with other providers to manage patients who are taking weight loss drugs. Campbell takes a more biochemical view of weight loss, and incorporates a Mediterranean diet–based meal plan, pharmaceutical-grade supplementation with multivitamins, omega-3 fatty acids, and vitamin D, as needed, and counseling on movement (“It doesn’t have to be formal exercise,” she emphasized), stress management, and sleep. “The biggest secret is that it’s not a weight loss program. It’s a health program; it’s a lifestyle program,” Campbell said. “The by-product of a healthy body is a healthy weight.”
In sessions with patients, Campbell assesses whether they have drug- or disease-induced nutrient deficiencies that may cause weight gain and can be corrected by diet and supplementation. In some cases, she may recommend that a patient switch to a different drug.
Desiree Gaines, PharmD, health and wellness director at Avant Pharmacy and Wellness Center in Charlotte, North Carolina, does lab work before and after her 12-week weight loss program, examining patients’ lipid panels as well as vitamin D, magnesium, vitamin B12, and folate levels to identify potential chronic conditions that require further evaluation by a medical provider. Gaines also uses these data to give patients recommendations on supplements and nutrition education outside counseling sessions, and she offers an app that allows patients to contact the pharmacist with questions at any time.
Pharmacists have a unique perspective on weight loss, as they recognize not only the effects of prescription drugs on weight, but also the effects of weight on prescription drugs. Most of the patients Campbell works with are taking between 3 and 5 medications.She coaches patients on communicating with their providers so they can, for example, adjust the dose of their antihypertensive medications.
“Many supplements actually enhance the effects of our traditional medications. Eventually, these patients are able to either lower their doses, or…come off some of their medications,” Gaines said.
As in so many areas of pharmacy practice, lack of insurance reimbursement for services is a major impediment. Campbell’s motto is “no margin, no mission,” and she has moved beyond the dispensing fee model to charge patients for counseling services. After a great deal of market research, she introduced her weight loss program with a price tag of $1000—which patients were willing to pay. She also offers related products for sale in her pharmacy, such as cast-iron cookware and microgreens, and has even started her own line of supplements.
Gaines offers weight-loss counseling packages tailored to patients’ needs for cash prices that can range from $199 to $1500. “We are working on trying to find grants that will cover the cost of this program for our community so that we can make this accessible to everyone,” she said.
There is room for pharmacy advocacy in this area, Rosenthal added, to convince payers that reimbursement for health and weight management education will yield tremendous savings in health care costs.
Gaines advises pharmacists who want to start a weight loss program to focus on their goals and training. Education on topics related to health and weight loss is important. One such source is a course that Campbell teaches through the National Community Pharmacists Association, but there are other avenues of education as well.
One major challenge is figuring out how to fit weight loss counseling into pharmacy workflow. Gaines began by offering these classes in the evenings and on weekends and, once she had built up enough business, designated 1 day a week when she does only counseling while another pharmacist handles dispensing.
Promotion can be done through a combination of word-of-mouth, point-of-sale, print, and online advertising. Gaines’ pharmacy uses social media and hosts free events where it gives out products and showcases its offerings to specific demographic groups.
“I think that the biggest thing with marketing is telling people what you can do for them and then doing it,” Campbell said.
“Reach out to other pharmacists who may be doing similar programs,” Gaines advised. As an individual who struggled with her own weight challenges before establishing a program to help others, she added, “Start your program with yourself, family members, and close patients that you feel comfortable with. This is a great way for you to tweak your program the way you feel is best for you and your patients.”