Pharmacy U Vancouver presenter Rick Siemens: Obesity and weight management
Pharmacists are ideally positioned to not only support patients on their current weight loss journey but take a more proactive role. Pharmacists have long been considered the medication experts but increasingly they are being recognized for their commitment to chronic disease management.
Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and reduces lifespan. It is estimated that since 1985 the incidence of obesity has increased at least threefold.
This is not simply a cosmetic issue and excess and ectopic body fat are important sources of adipocytokines and inflammatory mediators that can alter glucose and fat metabolism. Those metabolic changes make patients with obesity have increased risks of developing familiar metabolic disorders like Type 2 diabetes, fatty liver disease, etc. But often overlooked is that approximately 20% of cancers can be attributed to this insidious disease. This has been a disease that has been woefully undertreated and ignored for too long. We cannot simply provide advice to “eat less and exercise more” but realize that this is in fact a chronic disease that is unrelenting, complex, progressive, and relapsing.
The recent release of the Canadian Obesity Guidelines has been certainly welcomed for both patients and healthcare professionals alike. This robust document provides access to evidence-informed interventions including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.
Pharmacists are ideally positioned to not only support patients on their current weight loss journey but take a more proactive role. Pharmacists have long been considered the medication experts but increasingly they are being recognized for their commitment to chronic disease management. Pharmacists must ensure that patients are provided with evidence-based recommendations for the three pillars of obesity management: psychological support, pharmacotherapy, and/or bariatric surgery.
Pharmacists need to educate themselves on how the control of appetite is complex and involves the integration of the central neural circuits including the hypothalamus (homeostatic control), the mesolimbic system (hedonic control) and the frontal lobe (executive control). Providing this education to patients can be one of the most important steps in letting patients know that some aspects of their increased weight are not within their control. This can form an important bridge to patients struggling with obesity and position the pharmacist to become an important healthcare professional in any weight loss journey.
We will review the mechanistic aspects of current approved weight loss pharmacotherapy and compare and contrast their efficacy. Pharmacists are ideally suited to further assist patients to navigate side effects, coverage concerns, while ensuring realistic expectations. We will review common myths/misconceptions and help distinguish between evidence and conjecture. We will also focus on emerging therapies and provide some insight to some new and exciting options that might soon be available.
Pharmacists continue to be among the most trusted and accessible healthcare providers and with the ongoing shortage of physicians in many areas of Canada, it is time to act on behalf of our patients. We continue to shine in chronic disease management and our realization that obesity IS a disease and CAN be treated SHOULD provide all pharmacists with some real “food for thought.”