Helping patients find their best weight

“Instead of thinking of a specific number on a scale or a specific Body Mass Index, Best Weight means looking at the weight that your body will allow you to get to while living the happiest life that you possibly can.”- Michael BoivinApproximately 1 in 4 Canadians are affected by obesity. Obesity is an incredibly complex issue. This will come as no surprise to healthcare professionals who often see patients struggling not only to lose weight but also to maintain weight loss. These patients often feel like obesity is a self-induced problem, or that they simply are too weak-willed to solve this problem on their own. Many of those who struggle with obesity are unaware that their body is actually fighting them when it comes to sustained weight loss. I recently spoke with pharmacist and Certified Diabetes Educator Michael Boivin to explore obesity further and unveil some of the most common misconceptions about the issue, even among healthcare professionals. Here we will summarize some of the key moments from the interview. You can watch the full interview with Michael here.Health implications: beyond weight challengesBeyond the visible struggle with weight, obesity introduces a host of associated health challenges. These individuals are also commonly burdened with health issues including metabolic disorders like type 2 diabetes, polycystic ovarian syndrome (PCOS), fertility issues, mental health issues, sleep apnea, chronic pain, and incontinence, all of which consequently affect the individual’s overall ability to lose weight. Certain medications can also cause weight gain, and this is where the role of a pharmacist becomes critical in identifying which medications might be contributing to weight gain. Alternative therapies that are either weight neutral or that promote weight loss should be considered for these individuals.So why is it so difficult to lose weight?The natural instinct of the body is to maintain the current weight at the neurological set point. As the individual ages, weight loss naturally becomes more difficult. Resetting this set point may be achievable through sustainable, long-term interventions, though again, this is often quite difficult to do and the majority of patients are often unable to maintain sustained weight loss. Cognitive behavioural therapy has shown some success in this area, however patient access to this very specialized therapy is unfortunately limited. Genetic predisposition: unraveling the underlying factorsInterestingly, a substantial number of individuals grappling with obesity exhibit a genetic predisposition to the condition. This is something that is still not fully understood though we do know that there is likely a strong genetic component to obesity that encompasses both family history and ethnicity, among other considerations.What then is the ‘best weight’ for an individual to achieve?A healthy body weight at which chronic conditions can be controlled or reversed without compromising the quality of life is what an individual should aim for, rather than a specific number on the scale or a certain BMI value.What options do we have for obesity management currently?Pharmacological interventions are available for this purpose. Semaglutide, a GLP-1 agonist, has most often been the drug of choice and has received unprecedented media attention under the brand names Wegovy and Ozempic. Ozempic, however, is not indicated for weight loss. Wegovy is not currently available in Canada. Studies have shown a remarkable reduction in risk of cardiovascular events in patients on Wegovy as a result of the weight loss associated with its use. Bariatric surgery is also an option and can reduce body weight from 10-40%. This has also been shown to cause reversal of chronic conditions such as hypertension and diabetes in some cases. Michael explains briefly the two most common types of bariatric surgery: sleeve gastrectomy and gastric bypass. These surgical interventions are irreversible, require additional nutrition supplementation, and sometimes require special dietary changes due to compromised absorption issues; therefore, they are generally reserved as a last resort.Key takeawaysValue-based goals: It is advantageous to focus on obesity management and weight loss using value-based goals such as the benefit of improved chronic conditions, or personal goals such as improved abilities. For example: What would you like to do that you cannot do now? What would you like to be able to do in 10 years that your weight might not allow you to do if you are not able to make some changes in your lifestyle now? These questions can help the patient to understand that even small changes made now could positively impact their current and future quality of life.Identify patients who are motivated to make a change: It’s essential to foster an environment where your patients feel comfortable discussing weight loss. Try to be attentive to when your patients might be more motivated to lose weight or make a lifestyle change. It is much easier to help a patient who is motivated, versus someone who is not looking for help or not feeling that there is a problem. A new diagnosis or new prescription may be an appropriate time to offer solutions or support as these are the times when a patient may be more motivated to make a change or listen to possible non-drug interventions.Educate on what to avoid: As pharmacists, we can educate our patients on the importance of making choices that will be sustainable for them. Short-term diets and high intensity exercise might sound appealing at first, but in the long term might not be the best choice for the individual at that particular time. In addition, we can counsel patients about the lack of efficacy and potential dangers when it comes to weight loss supplements, and detoxes, which these patients might be tempted to consider.Best weight: Rather than focusing solely on BMI, working with patients to achieve the healthiest weight that keeps chronic conditions under control without compromising quality of life is more likely to have success in the long term.How can we address the stigma associated with obesity management?There are three types of observed stigmas surrounding obesity, including explicit, implicit and self-bias, which are explained further in the video. Destigmatization in this case can only be achieved when obesity is viewed and treated from a chronic disease perspective rather than a choice or lifestyle.You can listen to the interview in full here Access expert interviews and evidence-based health content at your fingertips on the Friendly Pharmacy 5 Channel, also on Spotify and Apple PodcastsLindsay Dixon is a pharmacist, consultant, health content creator, and public health ambassador for Heart Pharmacy Group. She is also the founder of Friendly Pharmacy 5 & CreateRx. For collaborations or consulting services: www.friendlypharmacy5.comShaheena Fakir is a registered pharmacist practising in Ontario as a pharmacy manager at Shoppers Drug Mart in Waterloo, ON. She obtained her Bachelors in Pharmacy from Rhodes University, South Africa. She is also a Certified Diabetes Educator, injections and immunizations certified, specialty molecules injections trainer and a candidate for pharmacogenomics certification through APMA.

Helping patients find their best weight

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