PROFESSIONAL DEVELOPMENT AND PRACTICE SUPPORT FOR THE SELF CARE PROGRAM
Weight
management
V ol .16
NUMBER 1
PRINT POST APPROVED
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FEBRUARY 2015
John Bell says
Contents
FEBRUARY 2015
V ol .16
NUMBER 1
Production coordinator Laura Wilson
Contributor Jill Malek
Peer review Carolyn Allen
Layout Caroline Mackay
Lifestyle interventions are the first approach in weight
management. The aim is to reduce energy intake, increase
physical activity and encourage behavioural change.
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See page 4, Facts Behind the Fact Card: Weight management
PHARMACIST CPD
4
Facts Behind the Fact Card: Weight management
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inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Health column
Weight management
By Jill Malek
As a nation we are getting larger.
Weight management has become a public
health imperative. Australia, like many
other countries, is struggling with a rise in
overweight and obesity rates. More than
60% of Australian adults, and nearly 25% of
children and adolescents are overweight
or obese.
The causes of overweight and obesity
are not easy to define. Although diet and
physical activity are central to maintaining
a healthy weight, social, environmental,
behavioural, genetic and physiological
factors all play their part in contributing
to weight gain. For many, weight gain is
hard to avoid and very difficult to reverse.
People often have unrealistic expectations
of how much weight loss is possible. Weight
loss goals should be realistic (e.g. 1–2 kg
per month), and even small amounts of
weight loss improve health and wellbeing.
Weight management must focus on health
improvement and behavioural change
rather than only on weight loss.
Weight management is a long-term
strategy. It must be initiated by the
individual and then maintained with the
help of healthcare professionals, family,
friends and carers. It involves setting
realistic goals, self-monitoring behaviour
and progress, understanding stimulus
control (recognising and avoiding triggers
that prompt unplanned eating), modifying
thinking and problem solving.
Lifestyle interventions are the first
approach in weight management,
with an aim to reduce energy intake,
increase physical activity and encourage
behavioural change. Interventions that
manage all three of these areas have been
shown to be more effective than those that
address only one or two. More intensive
interventions of very low-energy diets,
weight loss medicines and bariatric surgery
may be required if no weight loss or
reduction in waist circumference is seen
after three months.
This issue of inPHARMation outlines the
role of the pharmacist and pharmacy
staff in identifying high-risk customers
based on body mass index (BMI) and
waist circumference (WC) measurements.
Weight loss medicines and meal
replacement products are reviewed.
Also included is guidance on the
development of individually-focussed
weight management programs, including
key weight management messages
and pharmacist actions using the 5As
framework. Counter connection highlights
the need for a healthy diet, regular physical
activity and lifestyle change to achieve and
maintain a healthy weight.
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inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
3
John Bell
saysBehind the Fact Card
Facts
Weight management
Pharmacist CPD
Module number 256
By Jill Malek
Weight management has
become a global public health
imperative.1 Australia, like many
other countries, is struggling
with a rise in overweight and
obesity rates. More than 60% of
Australian adults, and around
25% of children and adolescents
are overweight or obese.2 It has
been predicted that by 2025,
based on current figures, nearly
80% of Australians will be
overweight and obese.3 A recent
report, Overcoming obesity:
An initial economic analysis has
suggested that to reverse the
growing problem of worldwide
obesity ‘a holistic, broad, and
multipronged approach’ must be
employed.4
Learning objectives
After reading this article, pharmacists
should be able to:
• Discuss the public health issues
associated with overweight and
obesity
• Explain the principles of weight
management including diet and
exercise
• Advise on different weight loss
products and medicines
• Counsel patients on weight
management including use of 5As
approach.
Competencies addressed: 1.3, 6.1,
6.2, 6.3.
4
UP TO
Weight management
2
CPD CREDITS
GROUP 2
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
Support and ongoing monitoring are essential for weight management.
Peter is 47 years old. He comes to the
pharmacy wanting to lose weight. He says
he has tried eating less and walking to
and from work, but his weight is still the
same. He feels sleepy all the time and finds
it hard to concentrate. A friend has lost
weight by taking Xenical (orlistat) and
he would like to try it. He says he has no
medical conditions and is not taking any
medicines. On questioning about his diet,
he admits to drinking a couple of beers
each night.
Public health
Overweight and obesity is defined by the
World Health Organization (WHO) as an
abnormal or excessive fat accumulation
that may impair health.1 It has been
recognised as the greatest contributing
factor (apart from ageing) to the Australian
community’s chronic disease burden.3
In Australia, there is an increasing number
of people who are overweight or obese.
Between 1995 to 2007–08, the number of
Australians aged 18 years and over who
were overweight or obese increased from
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
56.3% to 61.2%. By 2011–12, this figure had
increased to 62.8%.2
Overweight and obesity is present across
all population groups. It has been shown
that obesity is particularly prevalent in
certain groups such as disadvantaged
socio‑economic groups, Aboriginal and
Torres Strait Islander people and many
people born overseas. Obesity is more
prevalent in rural and remote areas than
other areas of Australia.5,6
Overweight and obesity lead to premature
death and disability. They have been
identified as major risk factors for type 2
diabetes, cardiovascular disease and some
cancers, and are associated with mental
health and eating disorders.5,7,8
The health problems associated with
overweight and obesity create a large
economic burden, which not only affects
individuals, but also their families and
carers and the wider community.5 In 2005,
the AusDiab study found the direct cost of
overweight and obesity was $21 billion, and
estimated the indirect costs at $35.6 billion.5
With the increasing rates of overweight and
obesity, these costs will increase.
Weight management
Weight management in
adults
Weight management of overweight and
obesity is the responsibility of the individual.5
Healthcare professionals can provide a range
of strategies and support, including assessing
the reasons for weight gain and managing a
range of lifestyle and behavioural changes.
Weight management is structured using the
5As framework – ask and assess, advise, assist,
arrange (see Table 3).3,5
Weight management must be individualised
based on the age, body mass index (BMI),
waist circumference (WC), medication
history, cultural background, lifestyle,
comorbidities, and work and social
environment of each individual.3,5
See Practice points 1 and 2.
Weight management should focus on
health improvement and behavioural
change as well as weight loss.3 Weight loss
goals should be realistic (e.g. 1–2 kg per
month), as even small amounts of weight
loss improve health and wellbeing.5,9
A weight loss of 5% of initial body weight
has been found to reduce health risks.
For example, it lowers blood pressure and
reduces the risk, or delays progression,
of type 2 diabetes. It also reduces kidney
disease, sleep apnoea and musculoskeletal
problems. The benefits increase with further
weight loss, particularly in people with
obesity.5
Lifestyle interventions are the first approach
in weight management. The aim is to
reduce energy intake, increase physical
activity and encourage behavioural change.
Interventions that manage all three of these
areas have been shown to be more effective
than those that address only one or two.5
Strategies for behavioural change need
to include goal setting, self-monitoring of
behaviour and progress, stimulus control
(recognition and avoidance of triggers
that prompt unplanned eating), cognitive
restructuring (modifying thinking patterns)
and problem solving.1,9 Psychological
therapies such as cognitive behavioural
therapy can increase weight loss when
combined with lifestyle changes.3,9
Support and ongoing monitoring are
essential for weight management. Weight
management plans should be reviewed
fortnightly for the first three months to
ensure sustainability, address any problems
Pharmacist CPD
Module number 256
the individual may be encountering and
for possible referral. Three months after
initiating diet and lifestyle interventions,
BMI and WC should be remeasured.
Ongoing support and encouragement
are vital, particularly if the patient has
experienced weight plateauing or regain.
Individuals who show no weight loss
or reduction in WC after three months
may need referral for more intensive
interventions.5
Weight management for adults who are
obese and overweight includes5:
• lifestyle interventions:
-- a reduced energy diet that produces
a 2,500 kilojoule (598 Calorie) per day
energy deficit using current Australian
Dietary Guidelines
-- increased physical activity based
on current Australian Physical
Activity Guidelines – approximately
300 minutes of moderate-intensity
activity or 150 minutes of vigorous
activity, or an equivalent combination
of moderate-intensity and vigorous
activities each week
Facts Behind the Fact Card
Practice point 1
Weight assessment in adults
When assessing weight gain in adults
consider3,5,11:
• body mass index (BMI)
• waist circumference (WC)
• dietary behaviour such as eating an
unbalanced diet, consumption of
high-energy foods, irregular eating
patterns (e.g. binge eating)
• physical inactivity and disability
• readiness to change current
behaviour, such as patient interest and
confidence to change
• comorbidities such as sleep apnoea,
osteoarthritis, gastro-oesophageal
reflux disease, polycystic ovary
syndrome, pulmonary hypertension,
right-heart failure, some psychological
disorders (e.g. depression)
• use of medicines that cause weight
gain (see Practice point 2)
• support for behavioural change through
education and psychological therapies
• smoking cessation as a cause of
weight gain
• intensive interventions (added to lifestyle
interventions and based on the needs of
each individual):
-- very low-energy diets (<3,350 kJ/day)
for patients with a BMI >30 kg/m2 or
BMI >27 kg/m2 with obesity-related
comorbidities
• weight history such as many weight
loss attempts, family history of obesity,
early age of onset
-- weight loss medicines for patients with
a BMI >30 kg/m2 or BMI >27 kg/m2
with obesity-related comorbidities
• social influences such as cultural
background, access to healthy foods,
capacity to understand health advice,
support of family and friends
• lifestyle factors such as smoking and
excessive alcohol consumption.
-- bariatric surgery for adults with BMI
>40 kg/m2 or with BMI >35 kg/m2
and comorbidities; currently the most
effective intervention for severe obesity.
Body mass index (BMI)
Body mass index (BMI), calculated by
dividing a person’s weight by their height
squared, is used to classify underweight,
overweight or obesity in adults, and to
identify those who may benefit from weight
advice and management.5 It provides a
basic indication of total body fat but does
not indicate the location of fat on the
body. When BMI rises above 30 kg/m2,
a noticeable increase in the mortality and
incidence of disease related to increased
fat mass is seen at the population level.5
See Table 1 and Practice point 3.
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
5
John Bell
saysBehind the Fact Card
Facts
Practice point 2
Medicines and weight gain
Medicines that can cause weight gain:
• Atypical antipsychotics, particularly
clozapine and olanzapine
• Anabolic steroids
• Beta-adrenergic blockers, particularly
propranolol
• Insulin
• Lithium
• Pizotifen
• Sodium valproate
• Sulphonylureas
• Thiazolidinediones
• Tricyclic antidepressants including
amitriptyline.
Adapted from NHMRC5 and AMH 2015
Weight management
Pharmacist CPD
Table 1. Body mass index (BMI), waist circumference (WC) and associated risks for
type 2 diabetes, hypertension, and cardiovascular disease
WHO classification
BMI (kg/m2)
Men WC 94–102 cm
Women WC 80–88 cm
Men WC >102 cm
Women WC >88 cm
Healthy weight range
18.5– <25
–
–
Overweight
25– <30
Increased
High
Obese class I
30– <35
High
Very high
Obese class II
35– <40
Very high
Very high
Obese class III
≥ 40
Extremely high
Extremely high
Adapted from the Management of Obesity
11
BMI is a useful tool for predicting
the amount of body fat in Caucasian
populations. It is not a conclusive predictor
of body fat in other population groups such
as Aboriginal and Torres Strait Islander,
South Asian, Japanese, Chinese and Pacific
Islander people. Different BMI thresholds
may need to be used for groups with
high or low muscle mass as BMI does not
distinguish between muscle mass and
fat mass.1
Waist circumference (WC)
The location of body fat is important and
can be a better indicator of disease risk than
the total amount of body fat. Abdominal
adiposity (fat around the waist and chest) is
associated with a greater risk of developing
long-term health problems than fat around
the hips and thighs.5,10 See Practice point 4.
WC measurement is a good predictor of
both total body fat and visceral fat.5,11
It has been shown that WC is a better
predictor of cardiovascular risk, type 2
diabetes (in women not in men) and
metabolic syndrome than BMI.5 Therefore,
both WC and BMI should be measured for
a more complete indicator of the risk of
obesity‑related comorbidities.5,12 See Table 1.
Related Fact Cards
Alcohol
Back pain
Bladder and urine control
Diabetes type 2
Exercise and the heart
Fat and cholesterol
Fibre and bowel health
High blood pressure
Gender differences and ethnicity
(e.g. Aboriginal and Torres Strait Islander,
South Asian, Chinese and Japanese adults,
Pacific Islanders) should be considered
when using WC to assess disease risk
associated with overweight and obesity.
These differences can affect the threshold
at which WC indicates increased or high
disease risk.5,11 WC will not be an accurate
measure of body fat in some situations such
as pregnancy and medical conditions that
cause stomach distension.5
Osteoarthritis
Weight and health
6
Module number 256
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Weight loss products and
medicines
Orlistat
Orlistat is currently the only medicine
registered for use in treating overweight
(with comorbidities) and obesity that has
been evaluated for long-term safety. It is
recommended for adults with BMI ≥30 kg/
m2 or adults with BMI ≥27 kg/m2 and
comorbidities, based on the individual
situation.5
Orlistat acts by preventing the absorption
of approximately 30% of dietary fat.
Weight loss is modest. Orlistat plus lifestyle
changes can produce a mean loss of 2–4 kg
(or 2–3 kg in patients with diabetes) more
than lifestyle changes alone after one
year.5,9,12 Blood glucose, blood pressure,
blood lipids and waist circumference (WC)
may also improve. Orlistat has been shown
to reduce the incidence of type 2 diabetes
when combined with lifestyle modifications.
It should be used with a modified
lifestyle.9,12,13 See Table 2.
Refer to the PSA Guidance for the
provision of a Pharmacist Only medicine:
Orlistat www.psa.org.au/supportingpractice/professional-practice-standards/
pharmacistonly-medicines-s3-protocols
Phentermine
Phentermine is a central nervous system
(CNS) stimulant and indirect-acting
sympathomimetic agent.12 It suppresses
appetite, thereby reducing food intake.
It should be used with lifestyle changes for
adults with a BMI >30 kg/m2 or >25 kg/m2
with comorbidities.3,12 The mean weight loss
compared to placebo is 3.6 kg following
2–24 weeks treatment.3
It is registered for short-term (e.g. 3-month)
use with dietary management of obesity.5
Weight management
With continued use, tolerance develops,
the drug becomes ineffective, and the
risk of dependence and abuse increases.
It is preferable to use phentermine for
a maximum of 12 weeks followed by
4–12 weeks drug free.5,9,12 See Table 2.
Other medicines
Some medicines used for treatment of
other conditions have caused weight loss
such as fluoxetine, topiramate, metformin
and glucagon-like peptide agonists
(e.g. exenatide, liraglutide). These medicines
may be beneficial for weight management
when treating the relevant comorbidities.3,5
Meal replacements
Meal replacement products can be used
to replace one or two meals each day
and are used as part of a very low-energy
(e.g. 1,675–3,350 kilojoules/400–800 Calories)
diet program.5 These products are largely
protein based, and contain essential
fatty acids, vitamins and minerals, but
very little carbohydrate. Side effects such
as bad breath, dizziness, tiredness and
extreme hunger are associated with these
products.3,5
Due to controlled portion size, the
individual’s energy intake is reduced and
rapid weight loss is often achieved with
these products.5 This rapid weight loss may
act as a motivation for continued weight
Pharmacist CPD
Module number 256
management.5,15 Evidence suggests that
a reduction in energy intake achieved by
using meal replacements provides greater
weight loss in overweight and obese adults
than general dietary advice for periods of
time varying from 1–12 months.16
It is important that these products are
not used as a complete diet replacement.
If healthy eating and regular exercise habits
are not followed, once the use of meal
replacement product is stopped, weight is
likely to be regained.15 Replacing healthy
meals with a meal replacement product
does not help educate the individual about
portion control, which is important in
being able to maintain a healthy weight
over the long term. Before starting a meal
replacement diet, the Dietitians Association
of Australia recommends a medical
assessment from a healthcare professional.14
Meal replacement products include
Celebrity Slim, Slimfast, Ultra Slim, ProSlim,
Optislim, OptiFast, Swisse Slimshakes and
Tony Ferguson Shakes. They are available in
various forms such as powders (i.e. shakes),
drinks, soups, bars and biscuits.
Pharmacist’s role
As part of the public health strategies
to combat overweight and obesity
in the community, pharmacists can
offer weight management programs.
These programs can include identifying
Table 2. Medicines used in intensive intervention in overweight and obesity5,9,11,12,14
Medicine
Dose
Precautions/adverse effects*
Counselling
Orlistat
(Xenical)
120 mg three
times a day
• Absorption of fat-soluble vitamins
(A,D,E,K) may decrease
• Take during or up to 1 hour after
three main meals
• Faecal incontinence
• Do not take if meal is missed
• Steatorrhoea (oily, loose stools with
excessive flatus due to unabsorbed
fats reaching the large intestine)
• Avoid high fat foods
• Interacts with warfarin, fat-soluble
immunosuppressants
• Contraindicated in pregnancy,
cholestasis, pancreatic enzyme
deficiency, malabsorption syndrome
• Eat a low-kilojoule, low-fat diet
Facts Behind the Fact Card
Practice point 3
Measuring weight and height
A person’s weight and height can be
used to calculate their BMI by dividing
weight by the square of height.
Electronic tools for calculating BMI are
also available.5
Weight
1. Use a regularly calibrated scale on a
hard, level surface.
2. Ask the person to remove shoes and
heavy outer garments (coat, jacket).
3. Ask the person to stand centred on
the scale with weight evenly on both
feet.
4. Record the weight.
5. If the person weighs more than the
scale can measure, note this and the
upper limit of the scale.
Height
1. Use a height rule taped vertically to
a hard, flat wall with the base at floor
level.
2. Ask the person to remove their shoes,
heavy outer garments, and any hair
ornaments.
3. Ask the person to stand with their
back to the height rule. The back
of the head, back, buttocks, calves
and heels should be touching the
wall, and the person’s feet should
be together. Ask the person to look
straight ahead.
4. Press hair flat and record height.
5. If the person is taller than the
measurer, the measurer should use a
platform to avoid parallax error.
• May cause fatty stools especially
with a high-fat diet
• May need fat-soluble vitamin
supplement after 1 year use; take
vitamins at least 2 hours apart from
orlistat
• Continue for as long as there are
clinical benefits (e.g. significant
weight regain prevented)
Phentermine
(Duromine,
Metermine)
15 mg up to a
max of 40 mg
once daily
with breakfast
• Only use for a maximum of 12 weeks
• May cause hypertension,
tachycardia, insomnia
• Risk of tolerance and dependence
• May affect ability to drive and
operate machinery
• May increase effects of alcohol
• If experience shortness of breath,
notify your doctor
• Avoid evening dose
*list is not exhaustive
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
7
John Bell
saysBehind the Fact Card
Facts
Weight management
Pharmacist CPD
Module number 256
Practice point 4
Measuring waist circumference
Waist circumference (WC) is used to assess
the risk of obesity-related comorbidities
in adults.5
1. Ask the person to remove heavy outer
garments, loosen any belt and empty
pockets.
2. Ask the person to stand with feet fairly
close together (about 12–15 cm) with
their weight evenly distributed, and to
breathe normally.
3. Measure midway between the last rib
and the crest of the ileum (hip bone) in
a horizontal plane.
4. The tape should be loose enough to
allow the measurer to place one finger
between the tape and the person’s
body.
5. Record the measurement taken on an
exhalation.
6. Measure to the nearest 0.1 cm.
high-risk consumers and providing advice
on evidence-based weight management
medicines and weight loss products as well
as diet and exercise.17 Many pharmacies
already offer other related health services
(e.g. smoking cessation, blood pressure
testing) that would complement weight
management programs. A recent study
in Scotland found that a pharmacy-based
weight management program achieved
clinically significant, objectively-measured
weight losses over a 12-month period in
10% of patients who enrolled.18 Refer to
Practice point 5 for a pharmacist weight
management program checklist.
• Very low-energy diets and weight loss
medicines can further reduce weight,
and may act as motivators for continuing
lifestyle change to achieve longer term
weight loss goals.
Case study
• A weight loss of 5% of initial body weight
reduces health risks, including lowering
blood pressure and reducing the risk of, or
delaying progression of, type 2 diabetes.
Peter has asked for orlistat (Xenical).
To ensure this is appropriate therapy
for Peter, you follow the systematic
procedure in the PSA Orlistat guidance
document. Peter consents to have his BMI
and WC measured (31 kg/m2 and 102 cm
respectively). These measurements place
him in the obese range with an increased
risk of developing type 2 diabetes,
hypertension, and cardiovascular disease.
You also measure his blood pressure
(125/72 mmHg). He is currently not taking
any medicines and is planning to give up
smoking. Xenical would be an appropriate
intensive intervention for Peter (BMI
≥30 kg/m2 or adults with BMI ≥27 kg/m2
and comorbidities).
• Lifestyle intervention, including a
healthy eating plan, increased physical
You recommend Peter take one Xenical
120 mg capsule with each main meal
Table 3 is an outline of the 5As framework
highlighting the key messages for weight
management and possible pharmacist
action.3,5
Key messages
• Weight management should focus on
behavioural change and improved health
as well as weight loss.
8
activity and support for behavioural
change, is the first approach to weight
management.
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Weight management
Pharmacist CPD
Module number 256
Table 3. 5As framework: Ask, Assess, Advise, Assist, Arrange for weight management
for adults
Ask and
assess
Key messages
Pharmacist action
Routine assessment of BMI and WC identifies overweight
and obesity.
Routinely measure BMI and WC.
Assessing for overweight or obesity identifies
people who may benefit from advice about weight
management and/or intervention.
• health risks associated with elevated BMI
Assessing for risk or presence of comorbidities that
may be influenced by overweight and obesity allows
for overall risk to be estimated and for conditions to be
managed together.
Asking about contributors to weight gain and weight
history should be part of weight assessment.
Discussing a person’s readiness for behavioural change
involves talking about their interest and confidence in
making changes, and the benefits and difficulties of
weight management.
• benefits of lifestyle changes (e.g.
smoking cessation, increased physical
exercise, balanced diet) even with no
weight loss.
• Assess for other cardiovascular (CV) risk
factors (e.g. smoking, raised BP, lipids,
blood glucose), and assess absolute
cardiovascular risk.
Complete a MedsCheck or HMR to identify
contributors to weight gain (e.g. medicines,
smoking cessation) and weight history.
Identify lifestyle changes the person
would like to start with. Encourage small
changes initially to increase confidence
and chance of successful lifestyle change
(e.g. for those not regularly active suggest
they start with 5–10 minutes a day and
work up to more time each week).
2. Agree on goals
Reducing weight by even small amounts can bring
health benefits including reduced CV risk and
prevention, delayed progression or improved control of
type 2 diabetes.
Host a weight management health
promotion focusing on healthy lifestyle.
Provide written information about nutrition
and physical activity.
3. Encourage self-management
Reduced energy intake and increased physical activity has
health benefits that are independent of weight loss.
Explain benefits of weight management.
Discuss the role of effective
self‑management in weight loss,
along with continuing contact with
healthcare professionals.
Provide assistance in developing a weight
management program (see Practice point 5).
4. Provide information
Interventions in all three lifestyle areas related to
overweight and obesity – nutrition, physical activity and
attitude to behavioural change – are more effective than
single component interventions.
Reducing energy intake, increasing energy expenditure,
or both create an energy deficit.
Achieving a weight loss of 5% will result in health benefits.
Adding very low-energy diets, a weight loss medicine or
bariatric surgery to lifestyle approaches is required if a person
is obese and/or has risk factors or comorbidities, or has been
unsuccessful reducing weight using lifestyle approaches.
Individuals need to be informed and supported in
changing health behaviours, and assisted by one or
more healthcare providers.
Interventions need to be individualised, and supported
by self-management principles and regular review by a
healthcare professional.
Use current Australian Dietary Guidelines.
Use current Australian Physical Activity
Guidelines.
Link patients with local community support
groups.
Provide support for long-term weight
management including strategies to
cope with increased hunger and weight
plateauing or regain.
Provide information and education on safe
use of very low-energy diet products or
weight loss medicines as appropriate.
Consider the social, physical and psychological factors
when planning interventions with individuals.
Arrange
1. Discuss lifestyle change
Explain modest amounts of weight loss
improve health, and goals should include
health improvements and behavioural
change as well as weight loss.
Overweight and obesity are associated with a wide
range of other conditions (e.g. CV disease, type 2
diabetes, some cancers), and the risk of comorbidity
appears to rise with increasing BMI.
Assist
Practice point 5
Weight management program
checklist
Discuss health issues:
Discuss readiness for behavioural change,
and benefits and difficulties of weight
management.
Advise
Facts Behind the Fact Card
Fortnightly review of a weight loss program in the first
3 months allows assessment of suitability and support of
program goals.
During long-term weight management, the individual
needs to overcome potent physiological responses that can
increase hunger and encourage weight regain. They also
need to resist a return to weight-promoting lifestyle habits.
Lifestyle interventions underpin long-term weight
management, to help prevent or reverse weight regain.
Providing ongoing monitoring and support for weight
management is important as:
Review and monitor; arrange regular followup, either face-to-face or electronically.
Give information about weight loss
that is appropriate and accessible to
the individual based on language and
literacy.
5. Arrange referral if required
Consider referral to other services based
on the individual circumstances.
6. Arrange review
Arrange fortnightly review for the
first 3 months and plan for continuing
monitoring for at least 12 months, with
additional intervention as required.
Adapted from NHMRC5
Provide long-term support of weight
management.
Refer to a specialist health provider
(e.g. specialist weight management clinic,
dietitian, behavioural therapist) if needed.
Involve family or carers in decision-making
and interventions (e.g. peer support
groups).
• health benefits of weight loss continue even if some
weight is regained
• supporting weight management, including frequent
contact with healthcare professionals, achieves better
results
• once people have maintained a weight loss for 2–5 years,
the chances of longer term success greatly increase.
Adapted from NHMRC5
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
9
John Bell
says
Facts
Behind the Fact Card
Practice point 6
Australian weight management
resources
• Clinical practice guidelines for the
management of overweight and obesity
in adults, adolescents and children in
Australia. 2013.
At: www.nhmrc.gov.au
• Australian pharmaceutical formulary and
handbook. 22nd edn. (APF22) – Weight
management (p.218–21).
• PSA Guidance for provision of a
Pharmacist Only medicine: Orlistat.
At: www.psa.org.au/supportingpractice/professional-practicestandards/pharmacist-only-mediciness3-protocols
• Australian Dietary Guidelines. 2013.
At: www.eatforhealth.gov.au
• Australian Physical Activity and
Sedentary Behaviour Guidelines.
At: www.health.gov.au
• A Healthy and Active Australia.
At: www.healthyactive.gov.au
• Dietitians Association of Australia.
At: www.daa.asn.au
• Healthdirect Australia.
At: www.healthdirect.gov.au/
• Effects of obesity, Weight loss and
weight control, Healthy eating on
myDr website. At: www.mydr.com.au
Weight management
Pharmacist CPD
three times a day (or up to one hour after
the meal). You advise that if he misses a
meal, or it contains no fat, he should not
take the dose. You emphasise that he
must eat a low-fat diet, and explain that
Xenical is not a substitute for lifestyle
change. You also recommend a vitamin
supplement containing vitamins A, D, E
and K, and explain it must be taken at
least 2 hours apart from Xenical.
After assessing Peter’s readiness to
change, you recommend that Peter
focus on reducing his energy intake by
drinking alcohol on a maximum two
nights of the week, eating a low-fat and
low-carbohydrate diet and increasing his
physical activity to 300 minutes weekly.
You also recommend that Peter cease
smoking (even though there may be
some weight gain, this is outweighed by
the overall health benefits) and suggest
he participate in the smoking cessation
service offered at the pharmacy.
You explain to Peter that the most common
side effects of Xenical include flatulence,
faecal urgency, and fatty or oily stools,
which can occur if his diet is too high in
fat. If any of these effects start to bother
him, he should return to the pharmacy.
If he experiences blood in stools, severe
epigastric pain, fever, or persistent
diarrhoea, he should return to the
pharmacy immediately or see his doctor.
The effect of the treatment needs to be
regularly monitored and you suggest he
returns for a follow-up to measure his
BMI and WC as well as discuss his diet and
exercise plan, and sleepiness. Daytime
drowsiness and concentration problems
could be signs that Peter has sleep apnoea.
Obesity is one of the most common causes
of sleep apnoea, and a 5% weight loss has
been shown to improve the symptoms.
If necessary he may need a referral
to another healthcare professional
(e.g. doctor or dietitian). You also discuss
the likelihood of weight being regained
when Xenical is stopped. You arrange for
Peter to come back in two weeks.
10
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Module number 256
You provide him with PSA Self Care Fact
Cards on Weight and health, Exercise
and the heart, Smoking and Nicotine
replacement therapy.
References
1. World Health Organization. Obesity and overweight fact
sheet. 2014. At: www.who.int/mediacentre/factsheets/
fs311/en/
2. Australian Bureau of Statistics. Overweight and
obesity. 2013. At: www.abs.gov.au/ausstats/[email protected]/
Lookup/by%20Subject/4338.0~2011-13~Main%20
Features~Overweight%20and%20obesity~10007
3. Grima M, Dixon J. Obesity – Recommendations for
management in general practice and beyond. Aust Fam
Physician 2013;42(8):532–41. At: www.racgp.org.au/afp/2013/
august/obesity/
4. McKinsey Global Institute. Overcoming obesity: An initial
economic analysis. Discussion paper. 2014. McKinsey and
Company. At: www.mckinsey.com/mgi
5. National Health and Medical Research Council. Clinical
practice guidelines for the management of overweight
and obesity in adults, adolescents and children in
Australia. Melbourne: NHMRC; 2013. At: www.nhmrc.gov.
au/_files_nhmrc/publications/attachments/n57_obesity_
guidelines_130531.pdf
6. Preventative Health Taskforce. Australia: The healthiest country
by 2020. Canberra: Department of Health and Ageing; 2009. At:
www.health.gov.au/internet/preventativehealth/publishing.
nsf/Content/E233F8695823F16CCA2574DD00818E64/$File/
obesity-jul09.pdf
7. Australian Institute of Health and Welfare. Burden of
overweight and obesity. 2003. At: www.aihw.gov.au/
overweight-and-obesity/burden-of-disease/
8. Tanamas SK, Magliano DJ, Lynch B, et al. AusDiab 2012.The
Australian Diabetes, Obesity and Lifestyle Study. Melbourne:
Baker IDI Heart and Diabetes Institute; 2013. At: www.
bakeridi.edu.au/Assets/Files/Baker%20IDI%20Ausdiab%20
Report_interactive_FINAL.pdf
9. Management of overweight and obesity. In: eTG complete.
Melbourne: Therapeutic Guidelines; 2014. At: http://online.
tg.org.au/complete/tgc.htm#
10.Snijder MB, Dekker JM, Visser M, et al. Associations of hip and
thigh circumferences independent of waist circumference
with the incidence of type 2 diabetes: the Hoorn Study1,2,3.
Am J Clin Nutr 2003;77(5):1192-7. At: http://ajcn.nutrition.
org/content/77/5/1192.long
11.Scottish Intercollegiate Guidelines Network. Management
of obesity. Edinburgh: NHS Quality Improvement Scotland;
2010. At: www.sign.ac.uk/pdf/sign115.pdf
12.Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2015. At: www.amh.net.au/
online/view.php?page=index.html
13.Rucker D, Padwal R, Li SK, et al. Long term pharmacotherapy
for obesity and overweight: updated meta-analysis. BMJ
2007;335:1194. At: www.bmj.com/content/335/7631/1194
14.Pharmaceutical Society of Australia. Guidance for provision of
a Pharmacist Only medicine: Orlistat. Canberra: PSA; 2011. At:
www.psa.org.au/supporting-practice/professional-practicestandards/pharmacist-only-medicines-s3-protocols
15.HealthDirect Australia. Diet reviews. 2013. At: www.
healthdirect.gov.au/diet-reviews
16.Dietitians Association of Australia. Best practice guidelines for
the treatment of overweight and obesity in adults.2012. At:
http://daa.asn.au/wp-content/uploads/2011/03/FINAL-DAAobesity-guidelines-report-25th-January-2011-2.pdf
17.Fakih S, Marroitt J, Hussainy S. Exploring weight management
recommendations across Australian community pharmacies
using case vignettes. Health Ed Research 2014;29(6):953–65.
18.Morrison D, McLoone P, Brosnahan N,et al. A community
pharmacy weight management programme: an evaluation
of effectiveness. BMC Public Health 2013;13:282. At: www.
biomedcentral.com/1471-2458/13/282
Weight management
Pharmacist CPD
Module number 256
Facts Behind the Fact Card
Assessment questions for the pharmacist
Weight management
Personal ID number:
— — — — — —
Full name:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pharmacy:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suburb:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Circle one correct answer from each
of the following questions.
Please submit your assessment by
31 March 2015
Before undertaking this assessment, you need
to have read the Facts Behind the Fact Card
article and the associated Fact Cards.
This activity has been accredited by PSA as a
Group 2 activity. Two CPD credits (Group 2)
will be awarded to pharmacists with four out
of five questions correct. PSA is accredited by
the Australian Pharmacy Council to accredit
providers of CPD activities for pharmacists
that may be used as supporting evidence of
continuing competence.
Submit answers
1. Mrs Black regularly visits the pharmacy.
Over the last eight years her weight has
increased by 20 kg. She now weights
72 kg (BMI = 32 kg/m2). What is the
most appropriate information you can
give her?
2. You decide that Xenical (orlistat) is an
appropriate treatment for Mrs Black.
What is the most appropriate advice
to give her?
a) She should lose weight as her
weight is putting her at risk of
developing type 2 diabetes.
b) Her weight gain over the last eight
years is not a concern, as weight
gain in middle age is common.
c) She needs to lose at least 14 kg
to significantly reduce her risk of
cardiovascular disease.
d) She can easily lose weight just by
replacing saturated fats in her diet
with unsaturated fats.
Submit online at www.psa.org.au/selfcare
Fax:
02 6285 2869
Mail: Self Care Answers
Pharmaceutical Society of Australia
PO Box 42
DEAKIN WEST ACT 2600
a) She should also start a low-fat diet.
b) She should also start a low-fat diet
and an exercise program.
c) She should also start a low-fat,
reduced-energy diet and an
exercise program.
d) She should also start a reduced
energy diet and an exercise
program.
3. Weight gain is an adverse effect of
which medicine?
a)Olanzapine.
b)Topiramate.
c)Metformin.
d) St. John’s wort.
Accreditation number: CS150001
This activity has been accredited for 1 hour Group 2 CPD
(or 2 CPD credits) suitable for inclusion in an individual
pharmacist’s CPD plan.
Please retain a copy for your own purposes.
Photocopy if you require extra copies.
4. Choose the correct statement about
weight loss medicines.
a) Phentermine has a role in the longterm management of obesity.
b) Orlistat aids weight loss by
reducing carbohydrate absorption
in the small intestine.
c) Phentermine aids weight loss by
suppressing appetite.
d) The mean weight loss of orlistat
compared to placebo is 2.9 kg after
three months.
5. Choose the correct statement about
meal replacement products.
a) They reduce daily energy intake by
480–960 kcal per day.
b) They are used as a means of
teaching portion control.
c) They are indicated for long-term
treatment of people with severe
obesity.
d) They can act as a motivator for
continued weight management.
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
11
John Bell says
Counter Connection
Weight management
Pharmacy assistant’s education
Module 256
Weight management
By Jill Malek
This education module is independently researched and compiled by PSA-commissioned authors and peer reviewed.
More than 60% of Australian
adults are overweight or obese.
It has been predicted that by
2025, based on current figures,
nearly 80% of Australians will
be overweight or obese. Weight
management is now an important
part of pharmacy practice.
Sue is 37 years old. She comes into
the pharmacy and says she really
wants to lose some weight, as her
doctor has told her she is at risk
of developing type 2 diabetes.
She has put on about 10 kg over
the last 2 years since the birth
of her son. Sue admits to doing
very little exercise and often eats
ready-prepared meals as she has
no time to cook. Having seen meal
replacement shakes advertised in
magazines, she’d like to try one.
Even a modest weight gain can increase the risk of developing a chronic health condition.
Overweight and obesity
The World Health Organisation (WHO)
defines overweight and obesity as abnormal
or excessive fat accumulation (build-up) that
may impair health.
Fat builds up on our bodies when our energy
intake (what we eat) is greater than our
energy output (what we use). Overweight
and obesity usually develops over a long
period of time.
Table 1. Classifying body mass index (BMI)
BMI (kg/m2)
Classification
<18.5
Underweight and possibly
malnourished
18.5–24.9
Healthy weight range
25.0–29.9
Overweight
≥30
Obese
12
Energy is measured in kilojoules (kJ) and
different foods provide different amounts of
energy. For example, two scoops of ice‑cream
or half a small chocolate bar provides about
150 kJ, the same as a small banana. It is
recommended that the average daily intake for
an Australian adult is 8,700 kJ (2,078 Calories).
Calories (Cals) are the old measure for food
energy. One Cal is about 4 kJ.
Measuring tools
Measuring body mass index (BMI) and waist
circumference (WC) is a way of identifying if a
person is overweight or obese and may benefit
from advice about weight management.
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Body mass index (BMI)
Body mass index (BMI) is a tool to estimate
total body fat and to classify weight
(see Table 1). To calculate a person’s BMI,
divide their weight in kilograms by their
height (in metres) squared (kg/m2). For
example, a person who is 165 cm (1.65 m)
tall and weighs 64 kg would have a BMI of
24 kg/m2. If this person’s weight increases to
90 kg, their BMI will increase to 33 kg/m2. See
Practice point 3 in the Facts Behind the Fact
Card article – Measuring weight and height.
Although BMI is a useful estimate of total
body fat, it does not differentiate between
body fat and muscle mass. Therefore,
BMI calculations will overestimate the
amount of body fat for people who have
a lot of muscle (e.g. body builders and
some high‑performance athletes). It will
underestimate the amount of body fat for
people who have reduced muscle (e.g. some
elderly people, and those with a physical
disability who have muscle wasting because
they are unable to walk). BMI is also not an
accurate indicator for people with eating
disorders like anorexia nervosa, people with
extreme obesity or pregnant women.
Weight management
Pharmacy assistant’s education
Waist circumference
Waist circumference (WC) is a simple measure
of total body fat as well as abdominal (waist)
fat. It is also a useful predictor of chronic
disease. It is used for adults.
The location of fat on the body can be used
as an indicator of health risks.
• Least risk – slim (evenly distributed body
fat).
• Moderate risk – overweight but without
weight on the stomach.
• Moderate-to-high risk – slim but with
weight on the stomach.
• High risk – overweight with excess
stomach fat.
Fat around the waist is linked to increased
risk of developing chronic diseases such as
type 2 diabetes, high blood pressure, high
cholesterol and cardiovascular disease.
Some people, who have a BMI in the healthy
weight range, can have an increased WC.
Therefore, when assessing a person’s health,
measure both BMI and WC. See Table 2.
Table 2. Waist circumference (WC) measurements and risk of developing disease in
certain adult population groups
Increased risk of disease
Substantially increased risk
of disease
Men (Caucasian)
94–102 cm
>102 cm
Women (Caucasian and Asian)
>80 cm
>88 cm
3. Place the tape measure midway between
the hip bone and the bottom of the ribs.
The tape should be loose enough to
allow the measurer to place one finger
between the tape and the person’s body.
4. Record the measurement after the
person has breathed out.
Health issues associated with
overweight and obesity
Use a measuring tape that is not stretched.
Overweight and obesity increases the risk of
many diseases. Even a modest weight gain
can increase the risk of developing a chronic
health condition. For example, a person in
their 50’s who weighs 10 kg more than they
did in their early 20s has an increased risk
of high blood pressure, stroke, diabetes and
coronary heart disease. Overweight and
obesity can also cause pain, arthritis, some
cancers, inability to work, and isolation.
1. Ask the person to remove bulky outer
clothes, loosen any belt and empty
pockets.
2. Ask the person to stand with their feet
fairly close together (about 12–15 cm)
with their weight equally distributed,
and to breathe normally.
Obesity is often seen in certain population
groups such as people who are socially and
economically disadvantaged, Aboriginal
and Torres Strait Islander people and many
people born overseas. Obesity is also
more common in rural and remote areas
compared to urban areas.
How to measure waist circumference (WC)
Counter Connection
Module 256
Weight management
Weight management should focus on
maintaining weight at a healthy level. To
achieve and maintain a healthy weight, a
person who is overweight or obese must:
• eat a balanced, nutritious diet
• increase physical activity
• change lifestyle behaviours that cause
weight gain.
Many people focus on dieting to manage
their weight rather than on changing
their lifestyle behaviours. Diets are often
associated with hunger and avoiding foods
and are seen as a ‘quick fix’. Although this
may cause rapid weight loss, it is very
difficult to maintain. When dieting stops,
any weight that has been lost, often returns.
Weight loss should be gradual (e.g. about
1 kg in a month) so it can maintained over
a long period of time. It is very important to
tell consumers that even small amounts of
weight loss improve health.
Balanced diet
Advise consumers on healthy diet practices
using the Australian Dietary Guidelines.
Table 3. Weight loss medicines and products
Medicine/product
Information
Consumer advice
Orlistat (Xenical)
• Pharmacist Only medicine
• Combine with lifestyle approaches
• Reduces fat absorbed from the gut
• Can cause flatulence (wind), fatty or oily stools, stomach cramps if diet is too high in fat
• For adults with BMI ≥30 kg/m2 or BMI ≥27 kg/m2 and other
chronic diseases
• Avoid fatty foods
• Prescription Only medicine
• Use only short term (up to 3 months)
• Reduces appetite so reduces the amount of food eaten
• Combine with lifestyle approaches
• Called an appetite suppressant
• May affect ability to drive or operate machinery
• Weight loss product
• Low in energy and can cause fast weight loss
• Not a sustainable long-term weight loss strategy, but can help with fast weight
loss when starting weight management
• Low-fat, low-calorie powders, drinks, soups, bars and biscuits
• Should not be used long term due to severe energy restriction
• Designed to replace a regular meal and to give the feeling
of ‘fullness’
• Should not be used to replace all daily meals
• Expensive
• May not be nutritionally complete
• Ensure you get adequate training before recommending
these products
• May cause side effects such as bad breath and tiredness
Phentermine
(Duromine, Metermine)
Meal replacement
products for weight
loss (e.g. Celebrity
Slim, Slimfast, Ultra
Slim, ProSlim, Optislim,
OptiFast, Swisse
Slimshakes, Tony
Ferguson)
• Does not teach people about good eating habits and
changing their behaviour
Herbal and
complementary
weight loss products
• Eat a low-fat, low-kilojoule diet
• Portion-controlled and designed to be filling
• When using these products, it is essential to maintain a healthy diet and physical
activity
• Return to the pharmacy 2 weeks after starting to review progress
• Used commonly
• Lack of medical evidence for these products
• Little evidence to support use in assisting weight loss
• Recommend a healthy diet and physical activity
• Expensive
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
13
John Bell says
Counter Connection
Weight management
Pharmacy assistant’s education
Table 4. 5As framework of weight management for overweight and obese adults
5As
Key messages
Pharmacy assistant action
Ask and
assess
• Measurement of BMI and WC can identify
people who may benefit from advice about
weight management.
• Discuss BMI and WC measurements.
• Discuss readiness to change lifestyle behaviours.
• WC is a good indicator of total body fat and a
useful indicator of abdominal fat.
Advise
• Measure BMI and WC (if trained) after gaining
consumer consent, or refer to the pharmacist.
• Discuss that even small amounts of weight loss
improve health and wellbeing.
• Small amounts of weight loss bring health
benefits, including lowering the risk of
chronic disease (e.g. type 2 diabetes and
cardiovascular disease).
• Advise about the health benefits of lifestyle
change and weight management.
• Changing lifestyle behaviours (less energy
intake, more physical exercise) is likely to have
some health benefits even if no weight is lost.
Assist
Arrange
• Changing multiple approaches to lifestyle
(e.g. nutrition, physical activity and attitude
towards behavioural change) are more
effective than a single approach.
• Provide consumers with information on all three
lifestyle areas – nutrition, physical activity and
behavioural change.
• Successful long-term weight management
is achieved by overcoming strong urges that
encourage weight regain and a return to
weight-promoting lifestyle habits.
• Provide support and encouragement to
consumers for self-management of long-term
weight management.
• Refer consumers to the pharmacist to assist in
weight management planning.
• Provide ongoing monitoring of BMI and WC with
consumer consent.
• Suggest consumer involvement in community
support groups (e.g. walking groups).
Encourage healthy eating by displaying
a healthy eating poster in the pharmacy.
This is available at: www.eatforhealth.gov.au/
guidelines/australian-guide-healthy-eating
Physical activity
Physical activity is an essential part of
weight management regardless of cultural
background, gender or ability. Using the
2014 Australia’s Physical Activity & Sedentary
Behaviour Guidelines for Adults (18–64 years)
provide consumers with the following advice:
• Any physical activity is better than none.
• If they currently do no physical activity,
start by doing some, and gradually build
up to the recommended amount.
• Be active on most, preferably all days,
every week.
• Accumulate 150–300 minutes (2.5–5 hours)
of moderate-intensity physical activity
or 75– 150 minutes (1.25–2.5 hours) of
vigorous-intensity physical activity, or an
equivalent combination of both moderate
and vigorous activities, each week.
• Do muscle strengthening activities
(e.g. bike riding, skipping, using hand
weights) on at least 2 days each week.
Provide consumers with health information
including the PSA Self Care Fact Card
on Weight and health and the Make your
move – Sit less – Be active for life! brochure.
Advise consumers to use online resources
such as Shape Up Australia resources at
www.shapeup.gov.au.
14
Lifestyle change
To effectively manage weight, a readiness
to change lifestyle behaviours is essential.
Consumers must be prepared to embrace
changes that may involve ceasing smoking,
reducing alcohol consumption, improving
eating habits and increasing physical exercise.
Discuss with the consumer their readiness
to change, including their interest and
confidence in changing and what they see
as the barriers to change. Suggest a network
of family, friends and community and
professional groups to provide support for
changing health behaviours.
Weight loss medicines and
products
Some consumers will achieve a healthy
weight by changing their lifestyle behaviours,
but some may need more intensive
approaches. These intensive approaches must
be supervised by healthcare professionals
and include very low-energy diets, weight
loss medicines or surgery.
Weight loss medicines and products should
be used with a healthy diet and increased
physical activity for consumers who are
overweight and obese. See Table 3.
5As of weight management
The 5As framework – ask and assess, advise,
assist, arrange – is a structure that can be
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
Module 256
used for weight management. This framework
can show if referral to other healthcare
providers, community-based programs
(e.g. peer support groups) and specialist
services (e.g. specialist weight management
clinic) is needed, based on the individual’s
situation and needs.
See Table 4 for an outline of the 5As
framework highlighting the key messages
for weight management and pharmacy
assistant action.
Case study
Sue seems very motivated to lose weight.
Although Sue is not taking any medicines and
has no medical conditions, she hasn’t used
weight loss products before, and you suggest
she speaks to the pharmacist to ensure these
products are appropriate for her.
Sue agrees and speaks to the pharmacist who
measures her BMI and WC. The pharmacist
tells you a meal replacement product such as a
shake is suitable for Sue. They have developed
a weight management plan.
You emphasise that meal replacement
shakes should not be taken for a long
period of time and to start by replacing only
breakfast or lunch. You also advise her that
she may experience bad breath and tiredness
when she starts using the shakes.
A balanced healthy diet is still essential
when using meal replacement products.
You encourage Sue to eat a healthy portioncontrolled meal for dinner and suggest she
visit the Heart Foundation ‘Recipe finder’
(www.heartfoundation.org.au/recipes/
Pages/default.aspx) for some ideas for easy
to prepare, nutritious meals.
Increasing physical activity is also part of
a balanced weight loss program and you
encourage Sue to try to exercise regularly.
You invite her to join the pharmacy’s
walking group. You give Sue the PSA Self
Care Fact Cards on Weight and health,
Exercise and the heart, and Fat and
cholesterol.
Follow up is an essential part of weight
management and you invite Sue to return
to the pharmacy in two weeks to discuss her
weight management plan.
Weight management
Pharmacy assistant’s education
Counter Connection
Module 256
Assessment questions for the pharmacy assistant
Weight management
Personal ID number:
— — — — — —
Full name:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pharmacy:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Suburb:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Circle one correct answer from each
of the following questions.
Please submit your assessment by
31 March 2015
Submit answers
Before undertaking this assessment, you
need to have read the Counter Connection
article and the associated Fact Cards.
Please retain a copy for your own purposes.
Photocopy if you require extra copies.
Fax:
The pass mark for each module is five
correct answers. Participants receive one
credit for each successfully completed
module. On completion of 10 correct
modules participants receive an
Achievement Certificate.
1. What is the main cause of overweight
and obesity?
3. What health problem is NOT
associated with being overweight?
a) Having fatty foods and drinks.
a) High blood pressure.
b) Eating and drinking more
kilojoules than the body uses.
b) Back pain.
c) Inherited genes.
d) Type 1 diabetes.
d) Not getting any exercise.
2. Choose the CORRECT statement
about body fat.
a) Fat around the thighs is more of a
risk to health than fat around the
abdomen.
b) A person’s weight is the most useful
measurement of their body fat.
c) Waist circumference (WC) is a
simple measure of abdominal fat.
d) As a person’s body fat increases,
their body mass index (BMI)
decreases.
Submit online at www.psa.org.au/selfcare
02 6285 2869
Mail: Self Care Answers
Pharmaceutical Society of Australia
PO Box 42
DEAKIN WEST ACT 2600
b) Orlistat is only indicated for
customers with a BMI >30 kg/m2.
c) Orlistat can cause flatulence
(wind), fatty or oily stools, stomach
cramps if diet is too high in
carbohydrates.
c) Some cancers.
4. Weight management should focus
on:
a) Losing weight over a short period
of time.
b) Eating a healthy diet, increasing
exercise and lifestyle change.
c) Reducing the amount of kilojoules
eaten.
d) Eating a healthy diet and reducing
physical exercise.
5. Choose the CORRECT statement
about orlistat.
d) All of the above statements are
correct.
6. You have given Mrs Lee the PSA Self
Care Fact Card Weight and health.
Which of the following statements
are CORRECT about weight loss?
a) Healthy eating habits are not
needed to lose weight.
b) Reducing energy intake is the only
way to lose weight.
c) Physical activity does not use up
energy.
d) Weight loss should be gradual
(e.g. 1 kg per month).
a) The pharmacist must be involved
whenever a customer requests
orlistat.
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
15
John Bell says Noticeboard
Self Care achievers
Self Care presents certificates to staff who successfully complete a year
of Counter Connection modules. We would like to congratulate the
following people:
Year 13
Year 6
Lia Cody
Carol West
Mitchell Webb
Year 11
Alison Bray
Anne McNally
Janice England
Mary Martella
Michelle Cotterill
Scott Donatti
Louise Runnalls
Year 5
Annabel Peach
Year 10
Karen Whelan
Kari-Lee Guy
Lynelle Tighe
Maxine Miller
Tracy Hill
Dao Doan
Year 4
Julie Kubank
Amy Williams
Belinda Salter
Eleanor Barillas
Elly Hamilton
Gail Smith
Jan Davidson
Jennifer Gowen
Jenny Jones
Katrina Kunz
Katherine Ygosse
Year 12
Jenny Gooley
Stella Kessey
Elizabeth Lorensene
Shilaja Thekkute
Wendy Honeybone
Year 8
Izabela Westwalewicz
Melanie Reynolds
Year 7
Laura Donaldson
Lyn MacDonald
Nicole Vogel
Norma Hansen
Wayne Hastie
Nicole Rowlings
Paula Hales
Sheree Portelli
Year 3
Ann Song
Debbie Bowerman
Diane Haydon
Dorothy Alexander
Helen Sharp
Kathryn Clark
Kelly Mudford
Lauren Oakley
Leah Parr
Leone Finnis
Lisa Scullthorpe
Margherita De Luca
Sheryl Ding
Suzanne Bain
Tamara McQuade
Tara Potter
Year 2
Alexandra Brown
Amelia West
Amy Bowen
Annette Astles
Brittany Tiberi
Claudia Digrazia
Danielle Ives
Ellen Jackson
Erynn Johnson
Heather Cornish
Indiana NicholRedman
Jacquie Smith
Jasmine Davis
Jenelle Stone
Jo-Anne Gavin
Juanita Allen
Jyothika Pratap
Kate Barron
Lauren Chick
Lauren Santalucia
Leanne Mann
Morgan Preston
Rachel Jethon
Rhonda Davidge
Conferences
Conferences
National health calendar dates
Annual Therapeutic Update
February
Advancing clinical knowledge and medication
management
6–8 March 2015
Crown Plaza, Terrigal, NSW
www.psa.org.au/conferences
Australian Pharmacy Professional
Conference and Trade Exhibition
12–15 March 2015
Gold Coast Convention Centre, Queensland
www.appconference.com
The Third BioCeuticals Research
Symposium
Interconnected Drivers of Health and Disease
17–19 April 2015
Hilton Hotel, Sydney, NSW
Website: www.bioceuticals.com.au/education
40th PSA Offshore Refresher Conference
30 April–10 May 2015
Berlin and Paris
www.psa.org.au/refresher
13th National Rural Health Conference
24–27 May 2015
Darwin Convention Centre, NT
16
All month
Heart Research Month
www.heartresearch.com.au
16–22
Healthy Weight Week
www.healthyweightweek.com.au
March
2–8
Sleep Awareness Week
www.sleepfoundation.org
12
World Kidney Day
www.worldkidneyday.org
16–22
Brain Awareness Week
www.dana.org/BAW
April
7
World Health Day
www.who.int/campaigns
24–30
inPHARMation February 2015 I © Pharmaceutical Society of Australia Ltd.
World Immunisation Week
www.who.int/campaigns
Year 1
Amanda Tabone
Amelia West
Amelia Wood
Amy Fullarton
Bethany Wallington
Candis Enever
Carly Stoll
Carmen Cousins
Catherine Clifford
Charlie Sims
Chloe Bacak
Dana Andersen
Dayna Carnell
Dayna Gelsi
Deborah Tiver
Donna Chapman
Elizabeth Donnelly
Elyse Burdak
Gail Klein
Hayley Nugent
Helena Dunlop
Holly Avery
Jane Emma
Janelle Over
Josie Sammut
Kamran Zia
Kathryn Small
Kim Veale
Kimberley Dileva
Kylie Walton
Lauren Kempe
Leanne Daly
Leiza Croft
Leonie Anzin
Lisa Keys
Mallorie Gan
Marija Masalkovski
Mary Makarov
Michelle Crouch
Samantha Constable
Sara Saunders
Shannon Clover
Silvana Tupanceski
Stacey Petchell
Stefani Symes
Stephanie Leong
Suzanne Wright
Sylvia Klatka
Tahnee Vining
Tina Mercieca
Tori Briggs
Vanessa Silvarich
Vian Kunda
What’s coming up
in inPHARMation?
Next month’s inPHARMation will focus on
OTC codeine-containing analgesics.
The misuse of codeine by customers is
an issue many pharmacists encounter
regularly. Despite the 2010 up
scheduling of CACC many people still
misuse these products, and experience
harm as a result.
Pharmacists and pharmacy assistants
should assist customers to manage pain,
and provide advice on appropriate use
of OTC analgesics. The March issue of
inPHARMation discusses the misuse
of CACC from both the customer’s
and pharmacist’s perspective. Facts
behind the Fact Card outlines the
therapeutic and adverse effects of various
components of OTC analgesics, and refers
to guidelines for the appropriate use of
CACC. Counter connection emphasises
the need for pharmacy assistants to refer
CACC requests to the pharmacist.