The correlation between obesity and various diseases (eg, cardiovascular disease, certain cancers, diabetes, etc) points to a growing public health crisis. Obesity is a leading risk factor for developing type 2 diabetes, thus offering tremendous opportunity for pharmacists to improve patient outcomes.
Patients now have a variety of options to help them lose weight. These include pharmaceuticals, invasive surgeries, minimally invasive implants and devices, and lifestyle modifications such as diet and exercise.1 Similarly, health and wellness services in pharmacy have surged in recent years, with pharmacists offering a variety of specialized services to support their patients’ needs.
OFFER WEIGHT-FOCUSED WELLNESS COUNSELING
Although counseling patients at the time of medication dispensing seems the most obvious time to educate on weight-focused wellness, it is frequently not practical.
Some pharmacists carve out time slots dedicated to addressing individual patients’ needs by scheduling appointments. Planning is key, according to Christina Madison, PharmD, FCCP, AAHIVP, founder and CEO of The Public Health Pharmacist and associate professor of pharmacy practice at Roseman University of Health Sciences in Las Vegas, Nevada.
Consider These Counseling Tips
Educating patients during a consultation is the single most important service pharmacists can offer. What follows are several weight-management counseling points for patients with diabetes:
> Encourage patients to eat a whole foods diet. "If it doesn't walk, swim, run, come from the ground, and it didn't exist 100 years ago, don't eat it," said Harris. In other words, enourage patients to avoid processed foods and any foods that have chemical ingredients that "you would need a PhD to pronounce."
> Educate patients on how to eat for weight loss. Madison recommended that pharmacists drive home to importance of limiting noncomplex carbohydrates and avoiding foods high in sugar. Proper fluid intake is also important.
> Groom the patient for success. "Making lifestyle changes is more easily said than done for people whose lifestyle is not currently aligned with these recommendations," Bisher cautioned. "This is why I always recommend starting off with small changes, so the person can feel successful implementing them." For example, focus on adding foods that are more ideal for their situation rather than suggesting the complete avoidance of certain foods.
> Consider the patient's work schedule, home environment, sleep schedule, social interactions, and stress management. Discuss these factors with the patient and adjust their wellness plan accordingly.
> Encourage patients to get moving. Madison stressed that patients should aim for a minimum of 30 minutes of physical activity 5 days a week. Harris enacted the 20-8-2 method, which has patients sit for 20 minutes, stand for 8 minutes, and then walk for 2 minutes.
Madison describes the ideal scenario as a private space where the pharmacist has allotted 15 to 20 minutes during an off-peak period. She encourages pharmacists to document the encounter and follow up with the patient, which includes recording the patient’s weight before the encounter and at follow-up.
Richard Harris, MD, PharmD, MBA, founder of Great Health and Wellness in Houston, Texas, noted that some pharmacists use these assigned times to conduct wellness checks, review medications, or discuss other issues the patient may be facing.
“There are some pharmacists and pharmacies that offer specific weight- loss programs,” Harris said. “They’ll do functional medicine, which is getting to the root cause of the issues, as well as holistic, lifestyle, or integrative medicine.”
Brian Bisher, PharmD, BCPS, a clinical pharmacist and an Institute for Integrative Nutrition–certified health coach in Cincinnati, Ohio, works at an area hospital that provides some of these services.
“I would label our clinic as a pharmacy-run service that offers weight-loss/nutrition services,” he said. “We set aside 30- to 60-minute appointments specifically for diabetes patient care management in our outpatient wellness clinic.”
Bisher’s clinic sometimes recruits a registered dietician as well. However, unlike some community practice settings, patients cannot receive such services without a referral from their physician.
STOCK UP ON HIGH-QUALITY SUPPLEMENTS
According to Harris, many pharmacies that offer these specialized services also carry high-quality, pharmaceutical-grade supplements—a feature he feels is critical, given the fact that OTC dietary health supplements are not regulated to the same degree of stringency as prescription pharmaceutical products.
“These are high-quality supplements you can trust,” Harris said of the supplements typically carried at pharmacy wellness centers. “There are plenty of these wellness centers out there, and the pharmacies that have these wellness centers are the ones I highly recommend people seek.”
Although they had different opinions about which supplements to stock in the pharmacy, Harris and Bisher did agree on a few products, namely, berberine. “Berberine is a supplement that can be used in place of metformin to start if a patient would prefer to use herbal therapy,” Bisher explained.
Results of a 2012 meta-analysis and systematic review concluded that berberine effectively treated hypoglycemia.2 However, more studies are needed to evaluate the safety of berberine in long-term use.
Berberine is an isoquinoline alkaloid compound isolated from rhizoma coptidis. Its hyperglycemia-mitigating effects were first documented in 1988 when it was used to treat diarrhea in patients with diabetes, and the extract’s antidiabetic potential has since been studied in a variety of clinical trials.2
However, a search in ClinicalTrials.gov using the key words “berberine” and “diabetes mellitus type 2” only resulted in 5 studies on berberine. Two of those studies explored the compound’s effect on diabetes (NCT02084004 and NCT00425009). The first study was withdrawn, and the second study was completed in December 2004.3,4
A different trial helped illustrate berberine’s clinical potential. The pilot study was divided into 2 studies with the goal of evaluating the safety and efficacy of berberine in patients with type 2 diabetes.5
In study A, 36 adults who had received a recent diagnosis of type 2 diabetes were randomly assigned to receive either berberine or 0.5 g of metformin 3 times per day for 3 months. Berberine’s hypoglycemic activity mirrored that of metformin with statistically significant decreases in hemoglobin A1C (HbA1c; from 9.5% ± 0.5% to 7.5% ± 0.4%; P < .01). Patients in the berberine arm also experienced significant decreases in fasting blood glucose (FBG), postprandial blood glucose (PBG), and plasma triglycerides.
Forty-eight patients with poorly controlled type 2 diabetes were enrolled in the second study (study B) and received berberine supplements for 3 months. Similarly, biomarkers for blood sugar improved. FBG and PBG improved within 1 week and HbA1c dropped (from 8.1% ± 0.2% to 7.3% ± 0.5%; P <.0001).5 Although patients in the berberine arm did not lose weight, they experienced a redistribution of body fat. However, some data suggest that, like metformin, berberine may result in weight loss.6
Despite the supplement’s benefits, Bisher does not foresee berberine replacing metformin.
In addition to berberine, Harris and Bisher also recommended stocking the following supplements that may help patients with weight management:
- Magnesium: This mineral is responsible for more than 300 biochemical reactions in the body and an important cofactor for energy generation and metabolism.
- Zinc: “Zinc deficiencies are associated with metabolic derangments,” Harris said.
- Chromium: This mineral helps the body process sugars and facilitate insulin’s activity.
- Vanadium and cinnamon help improve insulin sensitivity.