Effects of Weight Reduction Interventions by Community Pharmacists

doi:10.1331/154434503322452210

Journal of the American Pharmacists Association

Volume 43, Issue 5, September–October 2003, Pages 583-589

https://doi.org/10.1331/154434503322452210 Get rights and content

Objective: To compare a meal replacement (MR) program with a conventional reduced-calorie diet (RCD) for weight management using the pharmacy as the setting and the pharmacist as the point of contact for dietary advice. Design: Randomized, controlled, open- label trial. Setting: Travis Pharmacy in Shenandoah, Iowa. Patients: Ninety-five patients from southwestern Iowa and southeastern Nebraska were enrolled, of whom 88 were considered eligible for comparison (by continuing through week 2 of the study). Intervention: Patients were randomized to an MR plan or a traditional RCD plan. Patients were followed for a 3-month period of active weight loss and a 10-week period of weight maintenance. Patients returned every 3 weeks for follow-up with the pharmacist, for a total of 13 visits. Main Outcome Measure: Weight changes. Results: During the active weight loss phase, the MR (n = 45) and RCD (n = 43) groups lost a significant amount of weight, although no significant difference was found between the groups (mean ± standard error = 4.90 ± 0.30 kg MR versus 4.30 ± 0.30 kg RCD; P = .16). In the weight maintenance phase, the MR group lost 0.70 ± 0.40 kg and the RCD group lost 0.90 ± 0.40 kg (P = .60). Significant improvements were observed in waist circumference, systolic and diastolic blood pressure, and triglyceride levels. No significant changes were seen in high-density lipoprotein cholesterol or low-density lipoprotein cholesterol levels in either group. Conclusion: Successful weight management can be achieved in a pharmacy setting. Both MR and RCD programs were effective.

Section snippets

Objectives

The primary objective of this study was to compare an MR program with a conventional reduced-calorie diet (RCD) for weight management using the pharmacy as the setting and the pharmacist as the point of contact for dietary advice. The effect of these programs on overall health and modification of health risk factors was also assessed.

Setting

This randomized, controlled, open-label study was performed at Travis Pharmacy in Shenandoah, Iowa, in affiliation with the University of Nebraska Medical Center. The study protocol was approved by the medical center’s Institutional Review Board for the Protection of Human Subjects.

Patients were block randomized to either the conventional RCD group or the MR group. Study participants were followed for 12 weeks during the active weight loss phase (period 1) and for an additional 10 weeks of weight

Demographics

Ninety-five patients, 83 women and 12 men, were screened and randomized to one of two treatment groups. Of those randomized, 88 patients continued through the end of week 2 and were considered eligible for comparison (see Table 1 for demographic information). Sixty-eight patients (72%) completed the active weight loss phase, and 55 (58%) completed the weight maintenance phase. No exclusions were made for nonadherence, but patients were able to voluntarily withdraw from the study. Patients

Discussion

People have difficulty losing weight and maintaining weight loss. Results from a survey published in 1999,²⁶ conducted in the Behavioral Risk Factor Surveillance System (BRFSS), reveal that in 1996, 28.8% and 35.1% of men in the United States attempted to lose weight and maintain weight loss, respectively; 43.6% and 3.4% of women made these attempts. Health care providers, pharmacists included, have not been very active in helping patients with these efforts. In the 1996 BRFSS survey of

Conclusion

In 2001 the U.S. Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity described obesity as an epidemic that, if left unaddressed, may soon “cause as much preventable disease and death as cigarette smoking.”³⁸ With the prevalence of obesity in the United States today, and the numerous health risks associated with excess weight, easy-to-implement, effective weight management programs are needed. Both an MR strategy and an RCD were effective methods for weight loss and

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Effect of pharmacist interventions on the management of overweight and obesity: A systematic review
2024, Journal of the American Pharmacists Association
Pharmacists are underused healthcare professionals who are well positioned to provide weight management interventions; however, a systematic review of the literature supporting the role of pharmacists in weight management is lacking.
To conduct a systematic review to assess the body of evidence supporting the role of pharmacists in the management of obesity.
A literature search of OVID MEDLINE, Embase, Web of Science, and CINAHL was conducted from inception through February 23, 2023, to identify studies involving pharmacist interventions for weight management. Included studies were retrospective or prospective studies reporting a change in body weight, body mass index (BMI), or waist circumference as a primary endpoint; and a weight management intervention involving a pharmacist. Studies were excluded if they did not report the desired outcomes, involved pediatric populations, or lacked a pharmacist in the intervention.
Twenty-nine studies met the eligibility criteria. A total of 6,423 study participants were enrolled with a mean BMI of 27 to 46 kg/m². The included studies were conducted across 8 different countries with 15 from the United States. The primary approach was a prepost/quasi-experimental study design, typically conducted in community pharmacies. The pharmacists’ role varied widely but mainly involved educational counseling as the pharmacist made medication recommendations in only 5 studies. Multidisciplinary collaboration was infrequent. All but 3 studies reported a significant improvement in the weight loss outcome of interest, although most study durations were less than 6 months. A critical appraisal of the 29 studies found the overall quality of the available studies to be relatively poor.
Pharmacist interventions for weight management were mostly effective in reducing body weight; however, more robust clinical trials with a comparator group and for longer duration are warranted. The pharmacist’s role in managing weight loss medications also requires further study.
The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
2021, Journal of the Academy of Nutrition and Dietetics
Citation Excerpt :
The initial search identified 493 potential studies for inclusion. Ultimately, 2227-30,33-50 met the inclusion criteria and were included in this systematic review and meta-analysis (Figure 2), which included 24 interventions and a total of 1,982 patients. Twenty-one studies,27-30,33-49 including 22 interventions, compared MR-based LED with food-based LED; 1 of the studies,50 which included 2 interventions, compared MR-based VLED with food-based VLED.
Portion control is a useful component of weight reduction interventions and meal replacement (MR) plans represent a promising strategy for portion control. Research performed with pooled data on the effect of MR plans according to various characteristics of MR interventions remains scarce.
Our aim was to assess the effects of MR-based diets compared with food-based diets on weight loss, according to calorie-restriction types and energy intake proportions from MR.
Electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Embase, and Research Information Sharing Service) were searched for randomized controlled trials on weight loss results of MR-based calorie-restricted diets compared with food-based calorie-restricted diets from January 2000 to May 2020. Standardized mean differences (Hedges' g) from all study outcomes were calculated using a random-effects model. Heterogeneity was quantified by Q test and I². Publication bias was assessed using a funnel plot and a trim and fill method. Both interventions (MR and control) were separated into very-low-energy diets and low-energy diets (LEDs). A meta-analysis of variance was conducted by dividing patient-related factors and treatment-related factors into subgroups. In multivariable meta-regressions, background variables were selected first, after which main independent variables were included.
Twenty-two studies involving 24 interventions and 1,982 patients who were overweight or obese were included. The effect size in which MR-based LED was compared with food-based LED for weight loss was small, favoring MR (Hedges’ g = 0.261; 95% CI 0.156 to 0.365; I² = 21.9; 95% CI 0.0 to 53.6). Diets including ≥60% of total daily energy intake from MR had a medium effect size favoring MR with regard to weight loss among the groups (Hedges’ g = 0.545; 95% CI 0.260 to 0.830; I² = 42.7; 95% CI 0.0 to 80.8).
The effect of MR-based LED on weight loss was superior to the effect of food-based LED, and receiving ≥60% of total daily energy intake from MR had the greatest effect on weight loss.
“Each one has their own role”: Exploratory study on consumers’ perceptions about nutritionists services provided in community pharmacies
2021, Research in Social and Administrative Pharmacy
Obesity and overweight have grown to epidemic proportions in the past decades. To tackle this rising threat to health systems, lifestyle changes and nutritional education have been promoted through specialized programs and nutritional primary health care services. Community pharmacies adjustment to a new paradigm of pharmacy services means that they are not just a place for buying and selling medicines, but increasingly a space for diverse health care services. One such service addresses the weight problems of community pharmacy users through the provision of nutrition consultation services. In Portugal, these consultations are provided by nutritionists, many times under formal agreements with nutritional supplements commercial brands. Methods: The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. Results: Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. Conclusion: the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies’ accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.
Patients' perceptions of a pharmacist-managed weight management clinic in a community setting
2013, Research in Social and Administrative Pharmacy
There have been many studies demonstrating patients' willingness to pay for medication therapy management services provided by pharmacists. There are few studies, however, evaluating the possible provision of a weight management service in the community pharmacy setting.
The objectives were to (1) determine patients' knowledge of obesity and its resultant health risks, (2) determine patients' beliefs about obesity, (3) determine interest in pharmacist-delivered weight management services, and (4) identify factors associated with knowledge, beliefs, and interest in obesity and/or weight management services.
One thousand patients were selected from 5 community pharmacies under a single chain located within a large metropolitan area to receive a mail survey. Survey items assessed patients' knowledge of obesity and the health risks associated with it by using the Obesity Risks Knowledge Scale and the Obesity Beliefs Scale. Additional survey questions were added to measure patients' willingness to pay for a pharmacist-managed weight management clinic. Descriptive statistics and linear regression models were used in analysis of the data.
Nearly two-thirds (62%) of respondents were classified as overweight or obese based on self-reported height and weight. Most of the respondents demonstrated an average level knowledge regarding the health risks associated with obesity. Attitudes toward obesity were commensurate with prevailing knowledge. Only a small proportion (13%) of respondents were willing to pay out of pocket for a pharmacist-delivered weight management service. Very little variance in knowledge, beliefs, or interest in pharmacist-delivered weight management services were identified.
Despite the fact that patients are aware of the health risks associated with obesity and believe it is healthier to maintain ideal body weight, most are not doing so. Additionally, most patients are not willing to pay for pharmacist-delivered weight management services. The findings can begin to assist pharmacists in developing strategies for implementation of weight management services.
Perceptions about a pharmacy-delivered weight management service in community pharmacy settings in Jordan
2024, Journal of Applied Pharmaceutical Science
Comparative effectiveness of a low-calorie diet combined with acupuncture, cognitive behavioral therapy, meal replacements, or exercise for obesity over different intervention periods: A systematic review and network meta-analysis
2022, Frontiers in Endocrinology

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The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

This study was funded by a grant from the Slim-Fast Nutrition Institute, West Palm Beach, Fla. The grant was used to cover overhead, supplies, and analysis costs for the study. No additional royalties were given to the authors.

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RESEARCHEffects of Weight Reduction Interventions by Community Pharmacists

Section snippets

Objectives

Setting

Demographics

Discussion

Conclusion

Am J Clin Nutr.

Am J Clin Nutr.

J Am Diet Assoc.

Am J Clin Nutr.

Am J Clin Nutr.

J Am Diet Assoc

Prevalence and trends in obesity among US adults, 1999-2000

JAMA.

Obesity and chronic disease—impact of weight reduction

Current estimates of the economic cost of obesity in the United States

Obes Res

Obesity: genes, glands or gluttony

Reprod Fertil Dev.

Short-term medical benefits and adverse effects of weight loss

Ann Intern Med.

Effect of degree of weight loss on health benefits

Obes Res.

Metabolic and weight loss effects of long-term dietary intervention in obese patients four-year results

Obes Res.

Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II

Ann Intern Med.

Weight control in the physician's office

Arch Intern Med.

Weight management using a meal replacement strategy: meta and pooling analysis from six studies

Int J Obes.

RESEARCH
Effects of Weight Reduction Interventions by Community Pharmacists