1. Community Pharmacy as a setting for weight management service pilot Herefordshire PCT

2. Why weight management? Herefordshire has an adult obesity rate significantly above the English average at 26.4% The estimated cost of diseases related to obesity in Herefordshire was £24m in 2007 and is predicted to rise to £29.9m by 2015 Personalised support for overweight and obese individuals is one of the key 5 themes in the government’s “Healthy Weight, Healthy Lives” strategy and we need an “increasing national understanding of what works”

3. Why community pharmacy as a setting? “More support needs to be provided to those who wish to move towards a healthier weight”, and Healthy Weight, Healthy Lives, 2008 “Pharmacists are one of the key professional groups identified by NICE as in a good position to help patients make healthy lifestyle choices due to their credibility and accessibility within the Community” NICE obesity, 2006

4. Key partners PCT Public Health  Associate Director  Health Improvement Manager (Obesity)  Public Health Secretary PCT Primary Care  PEC Governance Pharmacist Acute Trust Dietetic Department  Dietitian (Obesity) Local Pharmaceutical Committee

5. Funding Jointly between Primary Care and Public Health Pilot scheme for 104 patients Rate negotiated with LPC Cost approximately £7850, excluding officer time and weighing scales

6. Programme objectives To pilot and evaluate the process of running a weight management service in the pharmacy setting To offer a unique support programme to help patients understand weight management. To tailor timing and level of discussion according to individual patient needs. To combine advice on diet and physical activity with a behavioural change approach to encourage long term lifestyle change. To reduce patients’ weight by 5% at 3 months with a view to maintaining this weight loss at 6-12 months.

7. Programme design Week 1Assessment by Pharmacist50 mins Weeks2-10 20 mins Topics, such as food diary; achieving 10% weight loss; goal setting; reading food labels; increasing physical activity; use of pedometer with Assistant Week 12 Support options10 mins

8. Training Two evening meetings for pharmacist and at least one pharmacy assistant from 5 pilot site pharmacies 1.assessment; raising the issue; goal setting; dietary advice; behaviour change 2.weight maintenance; physical activity; food labelling; comfort eating; follow-on support

9. Educational Resources Your weight, your health series Eatwell BMI wheels and waist circumference measures Food labelling guide Fact sheets on emotional eating; eating out Physical activity leaflets Food and activity diaries

10. On recruitment Ages 18-80; higher than expected rate from 41-60 year old group Gender – 87% Female Socio economic status – higher than expected from semi-routine occupations Weight – 90.8kg; range 64-134kg BMI – 34.3 Waist circumference – all at increased risk

11. Table summarising results Completers to Weeks 1- 8 only “early finishers” Completer s to Weeks 9-12 “pretty much made it” Completer s to week 12 “hung on in there” Those who lost >5% “goal hitters” Overall populat ion (n=97) 41 patients56 patients40 patients29 patients 97 patients Average weight on recruitment (kg)92.7kg89.3kg88.4kg88.3kg90.8kg Average weight on last reading (kg)91.4kg86.2kg83.5kg81.8kg87.8kg Average weight loss (kg)1.3kg3.1kg4.9kg6.5kg 3kg Average % weight loss per group of patients1.4%3.5%5.5%7.4%3.3% Average BMI on recruitment 35.333.6 32.734.3 Average BMI end of programme33.131.831.530.232.3 Average waist measurement on recruitment106.5cm104cm104.1cm102.2cm 104.9c m Average waist measurement reduction at end of programme 2.3cm7.9cm8.2cm9cm7.9cm Percentage population achieved 5-10% weight loss 5%48%55%100%30%

12. Outcomes At 3 months - statistical analysis - Paired t test result and the Wilcoxon signed-rank test provided values of less than p<0.0001 at the 95% confidence interval At 6 months, 23 (24%) presented for we- weighing. 19 had maintained >5% weight loss; 5 had put on weight since last recorded weight; none regained weight over their original weight; and further mean waist reduction of 3cm

13. Learning What went better than expected:  recruitment of sites and patients  weight loss  waist measurement reduction What went less well:  Retention (appears comparable)  Follow-up measurements Next time tips:  Joint working  key stakeholders  evidence base  visit the pharmacies for quality control  ensure higher profile to importance of follow-up measurement

14. Further thoughts The Pharmacy White Paper Pharmacy in England: Building on strengths- delivering the future-proposals for legislative change and the proposals. April 2008 Vascular Checks described in Primary Care Service Framework. Primary Care Contracting available at: http://www.pcc.nhs.uk/news/531 http://www.pcc.nhs.uk/news/531 Primary Care Service Framework: Management of Obesity in Primary Care available at: http://www.pcc.nhs.uk/uploads/medical/april_07/ obesity_framework_march_07.doc http://www.pcc.nhs.uk/uploads/medical/april_07/ obesity_framework_march_07.doc