In the battle of the bulge, there is no shortage of alarming statistics: Ireland has the second-highest rate of adult obesity in Europe with three in five adults either overweight or obese. Our rising obesity levels are contributing to 80% of diabetes and 40% of cancer cases, and more than 4,000 deaths recorded every year in this country are from obesity-related illnesses.

Our children’s health is also under attack from expanding waistlines. Ireland has one of the world’s highest rates of childhood obesity. One in four children is now overweight or obese – an estimated 300,000 youngsters – according to the Irish Nutrition and Dietetic Institute (INDI). That’s almost an entire generation of children in danger of dying younger than their parents.

The negative impact of obesity in childhood includes respiratory, cardiovascular, musculoskeletal and metabolic effects, poor self-image and poor quality of life. Obese children are also more likely to have disease such as heart disease and type 2 diabetes in adulthood.  

Alarmingly, two in five children who were recently treated for obesity by specialists at the weight-control programme in Dublin’s Temple Street Hospital already had risk factors for heart disease. One in three had physical comorbidities such as knee pain and breathlessness when walking, and 60% reported psychological difficulties, including poor self-esteem and depression. Analysis by the UK government’s Foresight programme shows that over half of the adult population could be obese by 2050, if not sooner.

The Irish government has been engaging with stakeholders and interest groups in its war on obesity, promoting healthy eating and fitness initiatives and proposing legislative changes, including calorie menu labelling and a 10% tax hike on sugar-sweetened drinks – the latter priority action would lead to a reduction in the number of obese adults by 10,000 and overweight adults by 14,000, according to an Irish Health Impact Assessment report.

But, in any crusade, it is the foot soldier that takes the fight to the front line. Pharmacists and GPs living and working in the community are more than qualified to help people recognise when they are overweight or obese, explain the adverse health effects, and encourage small, realistic lifestyle changes that will help to maintain a healthy weight.

Since safefood launched its two-year public awareness campaign, ‘Stop the Spread’, in May 2011, more than 1,700 pharmacists and 1,300 GPs have come on board, urging adults to take the first step towards weight loss by finding out their waist measurements. 

Measuring waist circumference helps to screen for possible health risks that come with overweight and obesity. If most of the fat is around the waist rather than the hips, the risk for heart disease and type 2 diabetes is higher. This risk goes up with a waist size that is greater than 32 inches for a woman or 37 inches for a man.

The measurement of waist circumference provides information regarding fat topography – where body fat is stored. A protruding pot belly is often caused by intra-abdominal visceral fat, which develops between and around internal organs, and has been linked to many chronic diseases, including heart disease, diabetes and some cancers.

Research by safefood (2012) revealed that despite three in five adults being either overweight or obese, only 40% of adults would classify themselves as such. One hypothesis as to why we appear to have entered a collective state of denial about how big we are getting is that people base their judgements on what is healthy with reference to what is normal. 

Fortunately, even a modest amount of weight reduction can lead to substantial health benefits. A loss of 5-10% of initial body weight is sufficient to reduce the risks associated with the obese state. 

“Because we have edged up in weight over the past 20 years, most people who are overweight think they are just fine because they look ‘normal’. If you are overweight, all you might need to lose is six or eight pounds – a couple of inches at the waist – to make a big difference to your long-term health. Too often, the focus is on the severe end of the scale where it can be really hard to make progress,” advises Prof Donal O’Shea, consultant endocrinologist and director of the Weight Management Clinic at St Columcille’s Hospital, Dublin.

Pharmacist participation

Pharmacists around the country were keen to join safefood’s ‘Stop the Spread’ campaign and most were already offering advice about losing weight as part of their services. Some pharmacies also run weight management services that include diet plans and even group or one-to-one counselling. 

Consultations would take place in the privacy of the pharmacy consultation room, usually beginning with measuring the patient’s waist size as well as calculating body mass index (BMI) – a measurement that compares weight with height. Overweight is defined as a BMI of 25-30 and obesity is defined as BMI of 30 or more. During counselling, pharmacists are advised to seize the opportunity to educate patients about the health complications associated with being overweight or obese, while also showing empathy and motivating patients to embark on a realistic weight-loss management plan, providing them with key strategies for effective weight loss. 

O’Donoghue’s pharmacy in Virginia, Co Cavan, developed a successful weight-loss programme three years ago. Proprietor and pharmacist Brian O’Donoghue believes that while fad diets and quick solutions have preoccupied the media, medically proven techniques still rely on making appropriate dietary choices, increasing physical activity, and modifying behaviours.

“In my opinion, meal replacement products and weight-loss medications don’t always work in the long term. They may work 90% of the time initially but then often people revert back to old habits and the weight creeps back on, perhaps even more than originally,” he remarks.“So rather than giving tablets or food supplements or substitutions, customers on our programme are set realistic weight-loss goals, achieved by eating a little less and being more active. It’s actually that simple: this isn’t rocket science.”

Brian explains that the assessment begins by using a Tanita Body Composition Analyser scales to measure not only weight but also the percentage of fat, percentage of muscle, visceral fat, metabolic age and the basal metabolic rate (BMR). 

“The BMR is very important, it’s basically the number of calories your body burns at rest to maintain normal body functions. Eating below your BMR can put your body in starvation mode, slowing down your metabolism. So, for example, if your BMR is 1,800 calories per day but you’re eating 1,200, the weight lost per week will become increasingly less or may eventually stop altogether,” he says. 

His weight-loss programme also uses the latest in sport medicine technology, the Cosmed machine, to measure the resting metabolic rate (RMR). 

Critical to the success of any weight-loss programme, it is important to remind patients that there is no quick route to weight loss. A reasonable goal for most overweight and obese patients is a 10% loss of body weight over a six-month period, which averages to a loss of 1-2lbs per week. After six months, the decline will plateau because of changes in RMR; basal energy expenditure typically decreases as weight decreases. At this point, readjustments may be necessary, such as further reducing caloric intake and/or increasing physical activity.

The role of weight-loss products

There is a plethora of weight-loss products on the market from meal plans to meal supplements and slimming aids. The only clinically proven product contains orlistat, which works by preventing the absorption of fat in the body. Alli – a reduced-strength 60mg version of the prescription-only orlistat 120mg – became available over the counter in participating pharmacies in Ireland from April 2009. 

Controversy surrounded this initial launch when an investigation by the Consumers’ Association of Ireland (CAI) found that many pharmacies were breaching the terms of sale. Eight out of 20 pharmacies, which were visited at random, were willing to sell Alli despite the CAI’s researcher having a BMI of 19.1 – nine points under the manufacturer’s guideline BMI of 28. 

Last year, the Irish Pharmacy Union (IPU) strongly refuted a claim made by the Irish Heart Foundation that “pharmacists are in danger of encouraging a cycle of failure in people attempting to manage their weight”, by selling over-the-counter meal replacement products. 

“The reality is that individuals have used meal replacement products as part of a sensibly controlled balanced diet, which has resulted in long-lasting weight loss,” the IPU’s Rory O’Donnell said at the time. His comments are backed up by research published in the Journal of the American Pharmacists Association, which compared a meal replacement programme with a conventional reduced-calorie diet for weight management in the pharmacy setting. The study found that patients in both groups lost weight and maintained their weight loss, concluding that successful weight management can be achieved in a pharmacy setting.

Yet, it would be naive to underestimate the sway the weight-loss market has over consumers. The global weight management industry is a lucrative one, estimated to be more than €287 billion in 2010 and expected to reach in excess of €485 billion in 2015, according to international market research.

Pharmacists offer an additional valuable resource for overweight and obese patients attempting to manage their weight, the cornerstones of which are a healthy diet with reduced fat, exercise, will power and determination.