Pharmacists have role in prevention and management of obesity

Q&A: Seena Haines, PharmD, FAPhA, FASHP, and Carrie Koenigsfeld, PharmD, FAPhA

Haines
Koenigsfeld

Seena Haines, PharmD, FAPhA, FASHP, Professor and Associate Dean for Faculty at Gregory School of Pharmacy at Palm Beach Atlantic University, and Carrie Koenigsfeld, PharmD, FAPhA, Professor at Drake College of Pharmacy and Health Sciences, prepared a talk on how pharmacists can help improve the health and wellness of individuals who are overweight or obese for the 2015 APhA Annual Meeting & Exposition in San Diego. Following is a Q&A with Koenigsfeld and Haines.

Pharmacy Today: Why are pharmacists in an ideal position to empower and coach obese patients?

Haines: Pharmacists are uniquely positioned based on our education and training. Pharmacists can assist with weight loss steps by evaluating potential obesity-related diseases; obtaining a weight history; identifying patient triggers and screening for medications that may influence weight gain; measuring and tracking weight and height and calculating body mass index (BMI), body fat analysis, and waist circumference; determining a patient’s health risk and obesity classification for the purposes of recommending treatment; collaborating with other health professionals to initiate treatment; reassessing goals and expectations periodically throughout the treatment process; and arranging for follow-up monitoring and social support.

Today: When is it appropriate to intervene with drug therapy?

First, a pharmacist needs to assess a patient’s risk factors and BMI. A BMI of 25 to 29 places the patient in an overweight category, which may mean only lifestyle changes are needed. Patients with a BMI of 27 to 29 with two or more risk factors would also qualify for drug therapy. Patients with BMI of 30 or higher are classified as obese. These patients, with or without risk factors, will also be indicated for drug therapy.

Also, drug therapy for treatment of obesity should be short-term. I look at it as helping to give patients the motivation to get over the hump, begin to see weight loss, and then identify ways to establish ongoing lifestyle changes.

Haines: Drug therapy can also be considered adjunctive to lifestyle modification after 6 months of lifestyle alone. Patients can be initiated on a trial of drug therapy for 12 weeks and evaluated for signs of clinical improvement (5% weight loss of initial body weight). If no clinical improvement is seen, the provider can titrate the dose if applicable or consider alternative weight management drug therapy.

Today: Which guidelines should pharmacists be paying attention to?

Haines: There are several guidelines for screening patients: the United States Preventive Services Task Force; National Heart, Lung, and Blood Institute (NHLBI); American Heart Association (AHA)/American College of Cardiology (ACC); and American Society of Bariatric Physicians (ASBP) obesity algorithm.

Each of these guidelines discuss when to screen, how to determine patient risk, and when to consider lifestyle alone or pharmacotherapy and surgical intervention. The more recent AHA/ACC introduces the use of pharmacotherapy earlier than the original NHLBI guidelines. Candidates for pharmacotherapy include patients with at least one risk factor for obesity- related complications. Also, dietary approaches are kept broader.

The ASBP obesity algorithm is a comprehensive educational tool that gives providers an algorithm overview of principles necessary when evaluating patients and initiating treatment plans. Algorithms are provided for nutrition strategies, exercise, behavior modification, guidance for pharmacotherapy, and surgical interventions.

Today: What does a comprehensive approach to weight loss mean and why is it effective?

Koenigsfeld: Pharmacists have to look at the whole picture: What aspects of a patient’s life have caused them to gain weight? Is it the result of a medication [or] medical condition, or is it behavioral?

We also have to listen to what the patient wants through motivational interviewing. If the patient is not engaged, you’re not going to get very far. Always remember the patient is at the center of everything we do in health care. Once the patient is engaged and we have developed that understanding, it’s helping them to develop a plan that helps them lose weight and maintain that weight loss over time. This is not a 6-month change. These are changes that are needed for a lifetime.