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Journal ArticleDOI

A comparison of the provision of the My Choice Weight Management Programme via general practitioner practices and community pharmacies in the United Kingdom

01 Apr 2014-Clinical obesity (Clin Obes)-Vol. 4, Iss: 2, pp 91-100

TL;DR: The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months, suggesting that such programmes may not be sufficient to tackle the obesity epidemic.

AbstractThis study aimed to assess the effectiveness of a novel, community-based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non-randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty-four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow-up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow-up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.

Topics: Weight management (53%), Weight loss (52%)

Summary (2 min read)

INTRODUCTION

  • Obesity is a significant health and social problem that has reached pandemic levels.
  • 6-8 Based on current trends, it is estimated that by 2050 over half of the UK adult population could be obese costing the NHS £9.7 billion and, when higher rates of sickness absence from work associated with being obese, and reduced productivity and overall costs to business are taken into account, £49.9 billion to society as a whole.
  • UK National Institute for Health and Care Excellence (NICE) guidance on obesity highlights that the identified evidence did not appear to suggest that the health professional who provides advice and support was important, the key issues being whether the health professional is motivational and the maintenance of support to the patient.
  • 17 While community pharmacy-based provision of weight management services has been limited in the UK, a number of studies have been conducted elsewhere.
  • Among participants followed up at one year weight loss was marginally greater in GPs (0.8 kg) than in pharmacies (0.6 kg).

MATERIALS AND METHODS

  • Providers of the programme were responsible for the recruitment of participants over the course of the programme (up to a maximum of 30 participants per provider).
  • To provide an indication of the level of socioeconomic deprivation in the geographical area where the participant resided, the Indices of Multiple Deprivation (IMD) 2010 score2 for the Lower Layer Super Output Area (LSOA)3 corresponding to the participants’ postcodes were added to the dataset using data linking postcode to LSOA available in the UKBorders dataset.25-27.
  • In addition to this monitoring, in conjunction with a member of staff at their provider, participants were set ‘realistic’ weight loss targets (a weekly weight loss of 0.5-1 kg per session with the aim of losing 5-10% of original weight by session 12) and lifestyle, behaviour, diet and activity were also assessed.
  • To determine whether there were relationships between variables the following statistical tests were applied to the data:.

RESULTS

  • A total of 451 individuals were recruited to the programme (i.e. attended at least one session).
  • GP providers (n=268) recruited more participants than pharmacy providers (n=183).
  • Overall, 86% of participants were female and the mean age of the cohort was 41 years.
  • There was no statistically significant difference between the IMD 2010 score of the LSOA corresponding to the participants’ postcode between pharmacy participants and GP participants.
  • Additionally, the ethnic composition of the two groups differed significantly (see Table 1).

Attendance

  • The mean number of sessions attended per participant in the programme was seven.
  • Thirty seven per cent of participants attended the first twelve sessions and less than one-in-five participants attended all 15 available sessions.
  • Attendance was uniformly better at pharmacy providers than at GP providers (see Table 2).
  • At baseline, there was considerable heterogeneity in weight, BMI and waist circumference between participants recruited through pharmacies and those recruited through GP practices.
  • When considering weight loss between session 12 and session 15, it is apparent that GP participants failed to maintain their weight status achieved at session 12 (recording a mean weight gain of 0.9%) whereas participants attending pharmacies continued to lose weight between session 12 and session 15 (a mean weight loss of 1.2%).

Costs of providing the service

  • Table 5 shows the costs of delivering the programme.
  • As the majority of payments were based on the number of sessions hosted and GP providers recruited more participants than pharmacy providers, total costs were higher for GP providers than for pharmacy providers.
  • This was true throughout the course of the programme but the gap in costs between pharmacy and GP providers narrowed as participants continued through the programme to the point where there was no statistically significant difference in costs between providers among participants attending session 15.
  • Again, this is a result of the larger number of participants recruited by GPs (thus allowing for distribution of, for example, training costs across a larger pool of participants).

DISCUSSION

  • Four hundred and fifty one participants were recruited to the My Choice Weight Management Programme.
  • GP providers recruited more participants than pharmacy providers.
  • Completers attending the My Choice Weight Management Programme at pharmacies appeared to be more successful at maintaining weight loss after completion of session 12 than completers attending at GPs.
  • At session 15, weight loss (both absolute and as a percentage value) and BMI reduction was higher among pharmacy completers than GP completers.

CONFLICT OF INTEREST

  • This research was funded by a grant from the commissioning organisation (NHS Heart of Birmingham teaching Primary Care Trust).
  • This organisation, which no longer exists, was a public body which was responsible for the commissioning and provision of primary care NHS services to the population of central Birmingham.
  • The authors declare no personal conflicts of interest.

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The My Choice Weight Management Programme
1
A COMPARISON OF THE PROVISION OF THE MY CHOICE WEIGHT MANAGEMENT
PROGRAMME VIA GENERAL PRACTITIONER PRACTICES AND COMMUNITY
PHARMACIES IN THE UNITED KINGDOM
Running title: The My Choice Weight Management Programme
Dr Joseph Bush, PhD, Aston Pharmacy School, Aston University
Professor Chris Langley, PhD, Aston Pharmacy School, Aston University
Sarah Mills, MSc, Arden, Herefordshire and Worcestershire Area Team, NHS England
Linda Hindle, MSc, Birmingham Public Health, Birmingham City Council
Keywords: community-based, general practitioners, lifestyle modification, pharmacy,
socioeconomic deprivation, weight management.
Dr Joseph Bush
Senior Lecturer in Pharmacy Practice
Aston Pharmacy School
Aston University
Birmingham
B4 7ET
UK
Telephone: +441212044016
Facsimile: +441212044187
Email: j.bush2@aston.ac.uk
This research was funded by a grant from the commissioning organisation (NHS Heart of
Birmingham teaching Primary Care Trust).

The My Choice Weight Management Programme
2
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
Obesity has been highlighted as one of the major public health challenges facing the
UK in the 21
st
Century.
There is insufficient evidence to recommend the provision of structured weight
management interventions via general practitioner practices or community
pharmacies.
WHAT THIS STUDY ADDS
The My Choice Weight Management Programme, delivered via general practitioner
practices and community pharmacies in one city of the UK, produced modest
reductions in weight.
Such programmes alone are unlikely to be sufficient to combat the obesity epidemic.

The My Choice Weight Management Programme
3
ABSTRACT
Objective: To assess the effectiveness of a novel, community-based weight management
programme delivered through general practitioner (GP) practices and community
pharmacies in one city in the United Kingdom.
Design: Non-randomised, retrospective, observational comparison of clinical data collected
by participating GP practices and community pharmacies.
Subjects: 451 overweight or obese men and women resident in areas of high
socioeconomic deprivation (82% from black and minority ethnic groups, 86% female, mean
age: 41.1 years, mean BMI: 34.5 kg/m
2
).
Measurements: Weight, waist circumference and BMI at baseline, after 12 weeks and after
9 months. Costs of delivery were also analysed.
Results: Sixty-four per cent of participants lost weight after the first twelve weeks of the My
Choice Weight Management Programme. There was considerable drop-out. Mean
percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at
final follow-up (9 months). There was no significant difference in weight loss between
participants attending GP practices and those attending pharmacies at both twelve weeks
and at final follow-up. Costs per participant were higher via community pharmacy which was
attributable to better attendance at sessions amongst community pharmacy participants than
amongst GP participants.
Conclusion: The My Choice Weight Management Programme produced modest reductions
in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the
obesity epidemic.

The My Choice Weight Management Programme
4
INTRODUCTION
Obesity is a significant health and social problem that has reached pandemic levels. Several
prospective studies have demonstrated the relationship between obesity and premature
death from coronary heart disease, cancers and other diseases as well as psychosocial
problems, such as negative self-esteem, social withdrawal and discrimination.
1-5
Obesity now presents as one of the largest health problems facing the UK today and has
been highlighted as one of the major public health challenges facing the UK in the 21
st
Century.
6-8
In the 20 years to 2001, the prevalence of obesity tripled.
9
Based on current
trends, it is estimated that by 2050 over half of the UK adult population could be obese
costing the NHS £9.7 billion and, when higher rates of sickness absence from work
associated with being obese, and reduced productivity and overall costs to business are
taken into account, £49.9 billion to society as a whole.
10
There is a paucity of evidence on the effectiveness of both general practice (GP)-led and
pharmacy-led weight management interventions. UK National Institute for Health and Care
Excellence (NICE) guidance on obesity highlights that the identified evidence did not appear
to suggest that the health professional who provides advice and support was important, the
key issues being whether the health professional is motivational and the maintenance of
support to the patient.
11
One randomised controlled trial of a nurse-led, general practice-based weight management
programme for individuals with a BMI of ≥27 kg/m
2
reported that, at 12 weeks, 34% of
participants in the intervention arms of the trial lost at least 5% of their initial weight
compared to 19% in the usual care arms.
12
In the Counterweight Project, 31% and 32% of
participants respectively had maintained a weight loss of at least 5% of initial weight at 12
and 24 months respectively while in a randomised controlled trial of a primary care-based

The My Choice Weight Management Programme
5
weight management intervention, delivered by physicians and tailored to the needs of 144
obese, low-income, African-American women in the US, 13% of participants remaining in the
intervention arm at six months lost 5% of their initial weight compared to 5% of participants
remaining in the control arm.
13-15
However, other GP-based interventions have proven less
successful in reducing the weight of obese patients.
16
Pharmacy involvement in tackling obesity in the UK has been limited to date but with the
high priority now afforded to tackling the obesity epidemic, the community pharmacy-based
provision of weight management services is likely to be given increasing consideration by
commissioners of health services. Available data on the effectiveness of such services are
largely absent but a service delivered by community pharmacies in Scotland produced
weight loss amongst 458 participants of 1.3 kg at 12 weeks and 1.7 kg at one-year follow-up
(using last observation carried forward). Ten per cent and 16% of participants achieved the
target weight loss of 5% at 12 weeks and one year respectively.
17
While community pharmacy-based provision of weight management services has been
limited in the UK, a number of studies have been conducted elsewhere. In a randomised
controlled open-label trial conducted in a single community pharmacy in the United States
the efficacy of a meal replacement programme (Slim-Fast®) was compared to the efficacy of
a conventional reduced calorie diet.
18
Participants in both arms of the trial attended
consultations with a pharmacist every two weeks where advice and counselling were
provided. Statistically significant weight loss was observed in both arms of the trial at 10
sessions (mean weight loss was 4.9 kg in the intervention arm and 4.3 kg in the control arm)
with no significant difference in weight loss between the two arms. In total forty-one per cent
of participants lost at least 5% of their initial weight at 22 sessions. A further study conducted
in a single, university campus pharmaceutical care centre in the USA assessing the
effectiveness of pharmacist education and counselling (and in some cases counselling plus
pharmacotherapy) produced mean weight loss of 3.6 kg.
19
Interventions in Denmark and

Citations
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TL;DR: This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies and participants achieved targeted weight loss.
Abstract: Background Pharmacies represent a valuable opportunity to deliver weight management services, rather than just the routine supply of weight-loss products. In order to provide optimal services and translation of evidence-based weight management in community pharmacy, a best practice model program was designed and pilot tested to facilitate implementation of such services in pharmacies in Australia. Objective To develop and pilot a pharmacist-delivered, evidence-based, non-product-centred weight management service for community pharmacy in Australia. Setting Sydney, New South Wales, Australia. Method A pharmacy-based weight management service called the A Healthier Life Program (AHLP), for overweight and obese individuals, was developed based on current Australian weight management guidelines and recommendations made by key stakeholders. The pharmacist undertook training to acquire specific competencies to deliver the program. The AHLP involved six individual face-to-face sessions with the pharmacist over 3 months. The intervention targeted three areas: diet, physical activity and behavioural change. Main outcome measures Weight, BMI, waist circumference, blood pressure, dietary intake, and physical activity levels at 3 months were compared with values at baseline. Qualitative feedback on participants’ satisfaction and willingness to pay were also analysed. Results Eight pharmacies provided the AHLP between February and December 2013. Thirty-four participants were enrolled in the AHLP; mean age 50.7 years (SD 15.7) and mean BMI 34.3 kg/m2 (SD 5.3). Of the 22 (65 %) participants who completed the program, six had achieved the target weight loss of ≥5 %. The mean change in weight was −3.5 kg (95 % CI −4.8, −2.2) and waist circumference −2.0 cm (95 % CI −2.8, −1.3) for program completers at 3 months. Furthermore, participants reported overall positive experiences of the program, and identified accessibility of the pharmacy and high comfort level with the pharmacist, as the major advantages. Conclusion The AHLP was well received and participants achieved targeted weight loss. This study demonstrated that an evidence-based patient-centred weight management program can be implemented in Australian pharmacies.

19 citations


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  • ...The contribution that pharmacy can make has also been recognised by the United Kingdom’s government, with local primary care organisations commissioning pharmacies to provide enhanced weight management services [9]....

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  • ...than the cost for services provided in the general practitioner practice [9]....

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TL;DR: A scoping review of studies of community pharmacy‐delivered weight and obesity management services from January 2010 to March 2017 finds no significant difference in the quality of these services between the two periods.
Abstract: OBJECTIVES To complete a scoping review of studies of community pharmacy-delivered weight and obesity management services from January 2010 to March 2017. METHODS A scoping review was conducted to obtain an overview of research related to the study objective. The PubMed, EBSCO and CINAHL databases were searched from January 2010 to March 2017 for articles examining obesity/weight management in community pharmacies. Included studies had to contain an obesity/weight management programme delivered primarily by community pharmacies. All non-interventional studies were excluded. KEY FINDINGS Nine articles were eligible for data extraction. Across the nine included studies, 2141 patients were enrolled. The overwhelming majority of patients enrolled in the studies were female, approximately 50 years of age, had a mean weight of 92.8 kg and mean BMI of 33.8 kg/m2 at baseline. Patients in these various programmes lost a mean of 3.8 kg, however, two studies demonstrated that long-term (>6 months) weight loss maintenance was not achieved. The average dropout rate for each study ranged from 8.3% to 79%. CONCLUSIONS Obesity has a significant impact on the health and wellness of adults globally. Recent research has shown that community pharmacies have the potential to positively impact patient weight loss. However, additional research is needed into the specific interventions that bring the most value to patients and can be sustained and spread across community pharmacy practice.

6 citations


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  • ...Three studies had additional support from either general practitioners([30,33,35]) and/or dietitians....

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  • ...Four studies utilized between 12 and 34 pharmacies.([32,33,36,37]) One study did not specify how many pharmacies were involved in their study....

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  • ...3% to 79% (see Table 2).([30,32,33,36]) Four studies included some formal training of pharmacists in the administration of the weight management programme to patients....

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  • ...The Bush et al.([33]) study did a 6-month poststudy follow-up and found an average of 1 kg of additional weight loss after the study was completed....

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  • ...There were five pre-/post-studies,([31,32,35,37,39]) two RCTs,([34,38]) one nonrandomised retrospective comparison([33]) and one prospective cohort study....

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TL;DR: Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components.
Abstract: BACKGROUND Beyond the essential but somewhat artificial conditions that typify formal clinical studies, real-world evidence (RWE) of weight loss program effectiveness is paramount for an accurate assessment of such programs and refinement of best practices. OBJECTIVES To evaluate the current state of RWE studies and publications on weight loss, identify the range of weight loss components being used in RWE programs, and to provide a general overview of the consistency or lack of consistency with regard to measuring and reporting outcomes. METHODS A structured search of PubMed was performed to identify relevant English-language publications from 2006 to December 2017 that reported real-world studies of weight loss among adults. Duplicates, non-relevant publications, articles on weight loss surgery, pediatric studies, randomized controlled trials, studies with self-reported weight loss, no objective weight measures, or that failed to include weight loss results were excluded. RESULTS This review included 62 RWE publications. Forty-nine studies included dietary intervention, 37 included exercise, 29 included motivational counseling, and 5 contained some patients who had pharmacologic treatment as part of their weight loss regimen. The numbers of participants per study ranged from 10 to more than 3 million. The interventions reported in the publications included diet, exercise, counseling to promote diet and/or exercise, motivational counseling, and pharmacotherapy, and various combinations of these. CONCLUSIONS Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies.

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  • ...One weight management program in the United Kingdom showed no significant difference in the amount of weight loss between patients who attended programs managed by general practitioners and patients who attended programs managed by pharmacists.(6) In addition, there are a lack of strategies for pharmacists desiring to implement obesity management services....

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Abstract: Background: obesity is a huge health problem in Egypt. Its prevalence is the double among Egyptian females as compared to males. It is estimated that 75% of females over the age of thirty are overweight or obese. However, 95% of Egyptian females are not taking any measures to control their weight; additionally there is no national program to address the problem. Methods: following specific appraisal criteria, this research article provides a critical appraisal of strategies that could help in addressing the problem of obesity among females. This article includes an appraisal of interventions of promoting healthy lifestyle changes; healthy diet and physical activity. It also provides an appraisal of using social media, primary healthcare clinics, and pharmacies as delivery strategies of the proposed interventions. Findings: the research article reveals the feasibility of the proposed strategies based on the criteria of effectiveness, cost-effectiveness, organizational feasibility, and gender appropriateness.

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Frequently Asked Questions (2)
Q1. What contributions have the authors mentioned in the paper "The my choice weight management programme 1 a comparison of the provision of the my choice weight management programme via general practitioner practices and community pharmacies in the united kingdom" ?

In this paper, a randomised controlled open-label trial conducted in a single community pharmacy in the United States was compared to the efficacy of a conventional reduced calorie diet. 

Any future research should examine whether the intervention is replicable in a larger cohort, over a longer period of time and attempt to account for any possible sampling bias and reduce the possibility of confounding via randomisation of participants to distinct control and intervention arms.