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Keywords:

  • obesity;
  • overweight;
  • pharmacist intervention;
  • public health

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

Obesity and overweight is a continuing public health crisis. This health threat respects no boundaries or economic strata, and is a pervasive universal threat with short- and long-term negative sequelae associated. Pharmacists and other health professionals need to structure interventions from individual patient and population-based standpoints. Documentation of effects of programmes needs to be disseminated and incorporated into educational, research and practice-based efforts.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

The negative influence of obesity and overweight on numerous health indicators is staggering both in terms of the rapidity of the occurrence of its escalation and the sheer dimensions of the issues. Societal implications due to obesity affect health expenditures, healthcare insurance schemes and funding available for other services (both health-related and non-health-related). Obesity is also no longer a problem for developed countries; it is universal in its reach and negative impact.

The World Health Organization (WHO) defines the terms overweight and obesity as ‘abnormal or excessive fat accumulation that may impair health’.[1] Body mass index (BMI) is a commonly used population-based measure of overweight and obesity as it is measured the same for age and gender strata. The WHO defines overweight as a BMI equal to or more than 25, and obesity as a BMI equal to or more than 30.[1] Although BMIs of 25 and 30 are useful benchmarks, BMIs in excess of 21 have been shown to be predictive of chronic diseases. The WHO cautions that BMI should be considered only as a rough guide, as it may not correspond to the same degree of fatness in different individuals.[1] Zhu et al.[2] have also suggested that further research is necessary to help determine if BMI is a direct cause of mortality or perhaps a concomitant factor of pre-existing chronic diseases that lead to death. Finally, measuring BMI in children and adolescents is problematic as standard cut-off points have not been developed for these age strata.[1]

Global reach of obesity and overweight

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

The latest projections (2008) from the WHO estimated that approximately 1.5 billion adults over the age of 20 years were overweight and 200 million men and 300 million women were obese.[1] The WHO projects that by 2015 approximately 2.3 billion adults will be overweight and more than 700 million will be obese.[1]

The WHO suggests that although obesity traditionally has been assumed to occur in the developed world, overweight and obesity are now increasing in prevalence in low- and middle-income countries, most often in urban settings.[1] Similarly, obesity is not restricted by location, gender, economic well-being or age.[3] Nearly 43 million children under the age of 5 years were overweight globally in 2010.[1]

Health effects of obesity and overweight

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

Estimates of chronic disease causation point to the pervasive reach of obesity; 60% of the cases of diabetes, 40% of hypertension and 20% of coronary heart disease and stroke have been suggested to be attributable to obesity.[1] Obesity has been directly linked to the occurrence of a range of other conditions including gallstones, respiratory disease, varying cancers, acid reflux and oesophagitis. Obesity has also been referred to as a silent killer in developing countries, as limited resources supporting needed interventions are more focused on infectious and parasitic diseases.[3]

Economics of obesity and overweight

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

Obesity extracts a dire toll from an economic perspective. Barkin et al.[4] have quantified the US costs of obesity via a projection of future costs. The assessment by Barkin et al.[4] was an evaluation of the lifetime impact of obesity upon those in the ‘Millennial’ generation born between the years 1982 and1993. The authors evaluated the projected influence of obesity on aggregate lifetime earnings for the Millennial generation and the subsequent influence on employers and employees.[4] For an obese 20-year-old individual, lifetime medical expenditures (US) attributable to obesity are estimated to be between $5340–$29 460 with increases proportionate with increasing BMI.[4] The findings from this projection are that obese men and women will earn $998 billion less due to obesity over the course of their lifetime.[4] This is a problem of gigantic proportions for employees and employers alike. Barkin et al.[4] suggest that using the chronic-care model of disease management[5] which incorporates multiple chronic-care components such as self-management, decision support and clinical resource utilization can be applied in a business environment for management and self-management as a framework for help for obese employees. Barkin et al. end their assessment by encouraging the fostering of a culture of health in the workplace in order to deal with obesity.[4]

Multidisciplinary professional discussions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

In the USA, a multidisciplinary Healthy People Curriculum Taskforce[6] was formed with a focus to implement specific tenets of the US Healthy People 2010 Objective 1.7: ‘To increase the proportion of schools of medicine, schools of nursing and health professional training schools whose basic curriculum for healthcare providers includes the core competencies in health promotion and disease prevention.’ Encouraging health professionals to implement health promotion and preventive components into their professional practices is not a new suggestion, but the Healthy People Curriculum Taskforce has specifically mentioned obesity as a critical public health area of emphasis for inclusion in health professions' educational curricula incorporating health promotion and disease prevention tenets.[6]

Societal efforts

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

Hanlon et al.[7] in the UK have made a case for a ‘fifth wave’ in public health concerned with the problems of obesity, social inequalities, and loss of well-being. The first wave of public health responses improved public health after the industrial revolution; the second wave impacted public health based upon the scientific method and subsequent discoveries; the third wave emanated from the implementation of the UK National Health Service and the fourth wave was influenced by medical care interventions affecting mortality.[7] Hanlon et al.[7] view obesity as something that can be treated by impacting the secondary clinical consequences of obesity, a task that they view as very expensive and not dealing with an underlying problem. Hanlon et al.[7] view the impact upon the unhealthy, societal acceptance of obesity as ‘normal’ as the key focal point for change. Changing the view of obesity will entail a complete shift in how societies view the issue of obesity to one examining root causes that have commercial and social impacts.[7]

What can pharmacy practice provide?

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References

George et al.[8] suggest that there are opportunities to extend weight management services from community pharmacies, but findings from a study they conducted in 2010 indicate that expectations on the part of the public will need to be altered for acceptance.

Pharmacists can play a much more active role in dealing with the public health problem of obesity and overweight. There remains a need to produce evidence from pharmacy practice research for the benefit of pharmacists' involvement in directed obesity and overweight patient counselling, pharmacist-directed weight management protocols and the impact of these research endeavours on patient outcomes. Research can inform practice and provide for a much more proactive involvement for pharmacists' interventions. Pharmacists can serve as a public health resource providing information and referrals for help for patients. Pharmacists can, at every visit, calculate BMIs and counsel patients with elevated BMIs regarding the continuing and potentials risks associated with high BMIs and the negative influence elevated BMIs has upon the therapeutic options provided by medications to treat chronic conditions.[9] Pharmacists can collaborate with other health professionals within a medical home[10] and/or primary care practice to share information with other providers and the patients on means to help patients take advantage of self-help options available. Within professional societies and organizations, pharmacists can collaborate locally, regionally, nationally and internationally to focus other professional and the pharmacy profession's attention towards the problem of obesity and overweight and keep this dramatic public health concern in the spotlight. Ultimately, all health professionals including practising pharmacists should address obesity and other public health prevention issues in the course of their dealings with patients, other health professionals and advocacy groups in the wider public health context.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Global reach of obesity and overweight
  5. Health effects of obesity and overweight
  6. Economics of obesity and overweight
  7. Multidisciplinary professional discussions
  8. Societal efforts
  9. What can pharmacy practice provide?
  10. References