Friday, September 8, 2017

The Elephant in the Room – Obesity Management

Obesity is a tough topic to discuss with patients and many pharmacists may not feel they are adequately prepared to initiate the conversation.  It’s a daunting task because if it is not approached correctly, we risk alienating the patient and possibly making things worse.
  
There are many wrong ways to start the conversation: using scare tactics, generic advice, or guilt. However these approaches have shown not to be effective.1  Instead, start the conversation with an open question, something like “I’m sure you’re aware of how weight can affect your health. Do you have any concerns about your weight and health that you’d like to talk about?”1.  This allows the patient to take control of the conversation and voice their concerns at the beginning of the interaction.

Once you’ve spent some time with the patient discussing their concerns, motivation and goals, it’s time to develop a plan.  Too often clinicians will give generic advice like “eat less and exercise more”, which is ineffective advice for a patient who may have already heard that a dozen times. Specific simple interventions are effective ways to help patients get started towards healthier living.   

Here are 10 simple tips that you can suggest to your patients:2
  1. Keep a meal routine - Eat at roughly the same times each day, whether this is two or five times a day.
  2. Go reduced fat - Choose reduced fat version of foods such as dairy products, spreads and salad dressings where you can. Use them sparingly as some can still be high in fat.
  3. Remember to Walk - Walk 10,000 steps (equivalent to 60-90 minutes moderate activity) each day. You can use a pedometer to help count the steps throughout the day.
  4. Pack a healthy snack - If you snack, choose a healthy option such as fresh fruits or low calorie yogurts.
  5. Look at the labels - Be careful about food claims. Check the fat and sugar content on food labels when shopping and preparing food. “Eat Right Ontario” has a great patient resource to help read nutrition labels.
  6. Caution with your portions - Don’t heap food on your plate (except vegetables).
  7. Up on your feet - Break up your sitting time. Stand up for ten minutes out of every hour.
  8. Think about your drinks - Choose water or sugar-free drinks. Unsweetened fruit juice is high in natural sugar so limit it to 1 glass per day (200mL). Alcohol is high in calories so try to limit the amount you drink.
  9. Focus on your food - Slow down. Don’t eat on the go or while watching TV. Eat at a table if possible.
  10. Don’t forget your 5 a day - Eat at least 5 portions of fruit and vegetables a day (400g in total).
If you are interested in learning more on obesity management, stay tuned for my eNewsletter, “Uncomfortably Common – Obesity Management”, which will be sent to rxBriefCase members early next year.  Advancing Practice also offers continuing education, and a Certified Bariatric Educator Exam:

- Ajay Chahal

References
1. Freedhoff, Y., & Sharma, A. M. (2010). Best weight: a practical guide to office-based obesity management. Canada: Canadian Obesity Network.
2. Beeken, R. J., Leurent, B., Vickerstaff, V., Wilson, R., Croker, H., Morris, S., . . . Wardle, J. (2016). A brief intervention for weight control based on habit-formation theory delivered through primary care: results from a randomised controlled trial. International Journal of Obesity, 41(2), 246-254. doi:10.1038/ijo.2016.206



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