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Cancer

While it is well known that smoking is the biggest cause of cancer, may people do not know that obesity is the second biggest preventable cause. According to the BNF, the strongest dietary links are with cancers of the digestive tract – mouth, food pipe (gullet or oesophagus), stomach and bowel (colon), but the good news is that it is estimated that healthier diets and staying at a healthy weight could help prevent one in 10 cancers in the UK. 

Indeed, research suggests people should reduce their consumption of red and processed meats, and salt, and eat plenty of fruits, vegetables and foods high in fibre, as this may help reduce the risk of mouth, throat and colorectal cancer.

A team approach

If people are overweight or living with obesity, losing weight has many health benefits but – done safely – it can be a slow process that, for some, can seem like an insurmountable challenge. This is where the expert and accessible support from pharmacy teams can help customers looking to lose weight healthily through diet and exercise.

“Pharmacy staff should approach conversations around weight loss by first emphasising the importance of adopting a holistic approach to weight loss, which includes a balanced diet, regular exercise, stress management, and sufficient sleep,” says Jacquie Lee, Numark medication safety officer and information pharmacist. “They are well placed to offer general dietary advice – based on reputable sources such as the UK Health Security Agency or the NHS’s Eatwell Guide (nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide) – and may be able to signpost customers to websites that offer support for diet and exercise, too.”

Reshma Malde, superintendent pharmacist at John Bell & Croyden, says a great place to start conversations with people wanting to lose weight is by understanding their goal. “Setting weight loss goals is really important,” she says. “Not just how much do they want to lose within what space of time but why are they doing this? If they are clear about their motivations for weight loss, then they’ve got something to remind them why they are doing this in the first place.”

Slow and steady

Social media is awash with seemingly miracle quick fixes for both weight loss and exercise ‘hacks’ but these, mostly, are not successful, healthy or even safe ways to lose weight. 

“It’s particularly important that pharmacy staff can advise customers against ‘crash diets’,” says Reshma. “Although you will lose weight really quickly, it’s what I call ‘an elastic band effect’ since the moment you go back to your previous eating habits you tend to put on more weight – and that’s definitely not a safe or sustainable approach to weight loss.”

Instead, Reshma says a better place to start supporting customers who want to tackle their weight is to keep a food diary. “This helps them track what they are eating and then make simple diet changes,” she adds. “Swapping white bread for wholegrain, and white rice and pasta for brown rice and wholemeal pasta are small switches that can make a big difference and adding more healthy protein – such as from beans and lentils – is another good way.”

Encouraging hydration is also important, according to Jacquie. “Explain the importance of staying hydrated and suggest drinking water throughout the day, especially before meals, to help control appetite,” she says. “Customers often think they are hungry when in actual fact they are dehydrated, and a drink will suffice.”

Work it out

When it comes to physical activity, Government guidance is to aim for at least 150 minutes of moderate-level activity per week as well as doing weight bearing activities twice a week, but Bridget Benelam – nutrition scientist at the BNF, says: “Even if customers are a long way from meeting this recommendation, staff can highlight that even a little activity is better than none and that people can build up to doing more over time.”

Examples of moderate intensity activities include brisk walking, riding a bike, dancing, pushing a lawn mower and hiking. Vigorous activities include running, swimming, walking up stairs, skipping, aerobics, sports like football, rugby, netball and hockey, and martial arts.

Physiotherapist and advisor to the Deep Heat and Deep Freeze expert hub Sammy Margo, says just a few of the proven health benefits of regular exercise are: 

• Type 2 diabetes risk cut by up to 50 per cent
• Coronary heart disease and stroke risk cut by up to 35 per cent
• A 46 per cent reduction in all-cause cancer risk
• Colon cancer risk cut by as much as half
• Up to a 20 per cent lower risk of breast cancer
• Depression risk cut by up to 30 per cent
• Odds of developing dementia cut by as much as a 30 per cent.

“We know that even a very moderate increase in activity means you’re burning more calories and, as with diet changes, there are plenty of small switches people can make to their daily exercise levels,” says Reshma. “For example, if you commute to work, get off public transport a couple of stops earlier to add a 15-minute walk at both ends of your day and that adds up to the recommended 150 minutes a week on its own.”

What else can help?

Since staff in community pharmacies have a great opportunity to ‘make every contact count’ to support customers who want to move towards a healthier weight, Bridget says another important step is to “ensure that staff are aware of local weight management services and how customers can be referred, which may include services run by their pharmacy. There is also the free NHS weight loss app (nhs.uk/better-health/lose-weight) and a number of NHS supported apps to get active including Couch to 5K and Active10, which could be recommended for customers who prefer digital approaches”.

For customers living with obesity who also have diabetes and/or high blood pressure, the pharmacist – or their GP – can refer them onto the NHS Digital Weight Management Programme (england.nhs.uk/digital-weight-management/how-to-access-the-programme) which is another free 12-week digital programme.

But perhaps the most important thing for pharmacy teams to bear in mind is that helping people address obesity or overweight needs to be done on an individual basis, as there is no single approach that works for everyone. 

“It’s about seeing each person as an individual and helping them build all this into their life without them feeling they’ve made changes that they can’t commit to,” says Reshma. “Life doesn’t have to be different; life can still remain the same – just make clever switches that are easier to stick to.”