|
Hilary Davies, BPharm, MRPharmS,
is a community pharmacist in Nottingham
|
Hilary Davies: a slimmer pharmacist
|
The House of Commons Health Committee’s report on obesity,1 published
last year, should have made disturbing reading. For example, it states
that 8.7 per cent of all deaths in the UK are attributable to excess
weight. But this is not news. All pharmacists know the dangers of being
overweight or obese and most are ideally placed to play a valuable public
health role in advising people who wish to lose weight. However, tackling
the complex causes of obesity and supporting weight loss (see Panel,
p18 below) requires time so many pharmacists find they can only give
basic advice (eg, being fat is bad for you, eat less unhealthy foods
and exercise
more, etc).
The Health Committee looked at “interesting evidence
from commercial slimming organisations” and its report recommends
that the NHS examines whether the expertise of these organisations can
be “brought
to bear in devising strategies to combat obesity holistically”.
After a number of years of being obese myself I joined a slimming club,
at the end of June 2004. The information and support provided was enormously
helpful. So far, I have lost three and a half stones and my body mass
index (BMI) has reduced from 33 to just below 25.
Panel: Understanding eating habits — a
personal perspective
The more aware pharmacists are of the complex causes
of obesity, the more they can support those who need to lose
weight. Joining a slimming club made me look seriously at my
eating habits and instigate and maintain changes.
On a personal level, I was particularly
interested to read a comment in the House of Commons Health Committee
report on obesity1 regarding the often-quoted recommendation to eat five portions of fruit
and vegetables per day:
“… it is clear that as solutions to the obesity
epidemic, the fruit and vegetable promotion schemes favoured by the government
have
significant limitations. First, although the consumption of five portions
of fresh fruit or vegetables per day is accepted as being beneficial
in its own right, it is difficult to see precisely how this will help
tackle obesity, unless it is assumed that consuming more fruit and vegetables
will displace calories from other sources. The government’s fruit
and
vegetable campaigns only stress the importance of consuming fruit and
vegetables — they make no suggestion that these should be consumed
as snacks instead of, for example, chocolate or crisps.” This sounded
familiar — before joining a slimming club, I was managing to eat
at least five portions of fruit and vegetables daily, but I was also
eating far too much else.
I identified a number of other issues both from personal experience and
from discussion with
others.
Inherited patterns Eating habits can be established
over many generations. For example, many of us were brought up
to clear our plate and not waste food, as a result of a time
when food was relatively expensive and sometimes in short supply.
A colleague of mine remembers the days of post-war rationing.
She experienced going to bed feeling hungry and, as a consequence,
finds it hard to see food “wasted”. But, it could
be argued, that it is just as wasteful to consume food we do
not need.
In the days when food had to be stretched to provide a meal, pastries,
crumble toppings and dumplings became popular because they were cheap.
However, at a time when we use up far fewer calories, these foods provide
surplus calories that can contribute to being overweight.
We cannot, however, blame our problems
entirely on the habits handed down from parents and grandparents. We
have managed to add plenty of inappropriate eating habits of our own.
Refrigerators and freezers, a move away from the habit of shopping for
daily needs and an increase in the range of convenience food available,
have all led to an increase in the variety and quantity of food kept
in the house. At the first hint of hunger there is normally plenty around
to satisfy our
appetite. Even when it is appropriate to snack
between meals, often it is too easy to reach for crisps or biscuits rather
than healthy alternatives, such as fruit.
“Convenience food” and food from restaurants and takeaways can contain
more calories than
expected, but we need to acknowledge that not everyone has the time (or
inclination) to cook from basics. The different systems followed by the
slimming clubs I know of still allow people to use these foods when necessary.
Social aspects The social aspect of food and
drink should also be considered. We share meals or evenings at the pub
with friends, give gifts of chocolates, biscuits or wine and we bring
something to eat or drink back from holidays. We use food and drink
to say thank you and to celebrate. All these ways of using food enrich
our lives in a positive way. Although occasional treats do no harm,
we need to remember that they are just that — treats — otherwise
they will contribute to over-consumption of calories. It also helps
to be aware that some people indulge in comfort eating when they
feel unhappy. Replacing high calorie snacks
with lower calorie alternatives can be recommended. We also need to remember
that excess alcohol consumption contributes excess calories.
Lifestyle change is difficult when people are finding life hard for whatever
reason. Just as for stopping smoking, people might need to work on their
weight when there are not too many other stresses in life.
|
Finding a slimming club
There are several national networks of slimming clubs, for example,
Slimming World (the one I joined), Weight Watchers and the Rosemary Conley
Diet
and Fitness Club and information, such as location of groups, is available
on the web. Although these clubs are well-known (some even publish
their own magazines), smaller locally based organisations do exist.
Club members attend weekly meetings, run by a “consultant” who
has been trained to facilitate the group. This training includes general
nutrition, exercise and some health matters but slimming club consultants
are not expected to act as health care professionals. Meetings usually
start with a weighing in
session. They can be held in the day or evening, and are usually located
in community buildings. Groups vary in size and a smaller group might
be easier for new members to join. Some groups are run specifically for
men.
The “rules” The general aim is to encourage not just weight
loss through healthy eating but maintenance of a healthy weight. However,
different ways to achieve this have been devised. For example, Slimming
World lists an extensive range of what it calls “free food”.
This is food you can eat as much as you like (eg, fruit). It is relatively
low in calories, nutritious and, according to the theory, filling enough
for your appetite to regulate the amount eaten naturally. “Healthy
extras” (eg, a portion of cheese) are added to maintain a balanced
diet and other food is given a “syn” (synergy) value. A limited
number of syns are
allowed each day.
The Weight Watchers system is similar in that it does not count calories.
It works on a points system where different foods are allocated a number
of points and you are allowed so many points a day,
as agreed with the consultant. Compared with Slimming World, less food
is “free” but the points
allowance (similar to Slimming World syns) is more generous. The Rosemary
Conley club does count calories and emphasises the importance of monitoring
the fat content of food. Group meetings include an exercise class.
Motivation All groups will aim to encourage and support weight loss.
Awards, such as “slimmer of the week” are given and achievement
of milestones, such as every half stone or 10 per cent of body weight
lost, are celebrated. Some groups offer additional incentives, such as
a raffle ticket for each pound lost.
Although much motivation is derived from being in a group, a person’s
initial weight is kept confidential. However, the
difference in a person’s weight since the last weigh-in may not
be kept secret. Some groups discuss weight change openly, in a supportive
way. For other groups, the only mention made of an individual’s
weight change is in the marking of the various milestones and the slimmer
of the week award.
Practical advice During meetings, recipes and ideas for healthy yet
enjoyable eating are exchanged. Such discussions can be extensive because
there is plenty of time available. Topics include replacing unhealthy
foodstuffs with healthier, yet just as satisfying, alternatives. For
example, Fry Light, a low calorie spray can be used instead of oil or
fat for frying or cooking — spraying it on to part boiled potato
slices and adding herbs or spices before oven baking produces an acceptable
alternative to chips. And it is not all about home cooking. Discussions
have included the merits of different brands of pot noodles,
yoghurts and sweets and how to manage party food and drink.
Sometimes either the consultant or members will bring in food for the
group to sample. The atmosphere is positive and cheerful. People are
encouraged to succeed and nobody is blamed for failure. Doom and gloom
about the dangers of being overweight or obese are not part of the programme.
Costs It costs about £8-£10 to join a slimming club and
then around £4-£5 per week to attend meetings. Members who
have achieved target weight can often attend for free, providing their
weight stays within a target range. They can, therefore, weigh in from
time to time to ensure their target weight is maintained. In some areas,
schemes such as Slimming World’s “Slimming on referral” exist,
where for selected patients the NHS will pay the joining fee and for
up to 24 weeks’ attendance.
Weight loss
The method to determine a target weight varies. In some groups the
consultant sets it; in others the member. Not all clubs emphasise BMI
or waist
measurements and this is something of which health care professionals
need to be aware.
Many people will lose around one to two pounds per week but some group
members will lose weight more slowly. This can be discouraging, but a
good consultant will understand and keep up the encouragement. People
also differ in how they wish to follow the rules. Some would rather lapse
from time to time and take longer to lose weight. Others prefer to stick
to the system strictly. Provided weight is being lost then either approach
is acceptable — even a weight loss averaging half a pound each
week adds up to about two stones in a year.
Slimming clubs should have minimum acceptable target weights (according
to height and sex) to prevent people becoming underweight. Conclusions
Good health involves far more than what is provided by the NHS. Commercial
slimming clubs are a useful way for some people to lose weight and
pharmacists should bear this in mind when advising people who are overweight
but otherwise healthy. I say this from personal experience. Customers
have commented on the new, slimmer shape of the pharmacist behind the
counter. I am delighted to have achieved a healthy weight for the first
time in nine years and feel confident that the new eating habits I
have learnt from joining a slimming club will help me to maintain this.
In my opinion, a recommendation to join a slimming club should be part
of the pharmacist’s armoury. In addition, one of the essential
services in the new contract is that pharmacists act as signposts, pointing
people in the appropriate direction. I recommend that pharmacists interested
in obesity management find out what slimming club groups are running
in their local area. I was able to locate 12 groups meeting near me in
Beeston, Bramcote, Chilwell and Toton, an area served by 11 pharmacies
and eight GP practices.
Before recommending a particular group, pharmacists need to find out
a bit about it. For example, they should know which organisation the
group is part of, as well as its weight loss strategy. Pharmacists could
contact groups in their area and ask to see samples of the written information
they give to their members. It is also worth asking opinions of existing
group members.
Of course, if there are any doubts about a person’s health (eg,
suspected hypothyroidism, fluid retention) referral to his or her GP
is appropriate.
Reference
1. House of Commons Health Committee. Obesity (HC23-I). London: The
Stationery Office; 2001. Resources
· Rosemary Conley Diet and Fitness Club,
www.rosemary-conley.co.uk
01509 620 222
· Slimming World,
www.slimming-world.co.uk
0870 3307733
· Weight Watchers UK Ltd, Millennium House, Ludlow Road, Maidenhead,
Berkshire, SL6 2SL
www.weightwatchers.co.uk |
The
Pharmaceutical Journal