1. health and fitness
2. weight loss

CPD Tom Maher MPSI
Reflection and
self-assessment
Evaluation
RECORD
(e.g. portfolio)
Learning plan
Action
(e.g. CE)
CPD: Setting up
a weight loss
management service
We’ve all seen the statistics countless times. We have been reminded about the
obesity epidemic for years through the papers, radio, TV and online. The strange
thing is, despite everybody’s knowledge and awareness, Ireland’s obesity levels
have still doubled in the last 10 years. Is there an opportunity for pharmacy?
“Almost one in four Irish adults
are obese, a rate worse than
most of Europe”
– The Journal (May 2014)
“Four out of five over 50s in
Ireland are overweight or obese”
– Irish Longitudinal Study on
Ageing (July 2014)
“We now know that obesity
causes every disease and makes
every disease worse. Nothing
does that bar ageing,”
– Prof Donal O’Shea,
Consultant Endocrinologist
(May 2014)
Why set a Weight Loss
Management Service?
There are many different
weight loss products and
services out there already,
with varying degrees of
success but how many of
them empower people to
make significant permanent
changes to their lifestyle?
A weight loss management
service is easily set up and,
if done correctly, can bring
additional custom and
revenue to your pharmacy.
IPUREVIEW DECEMBER 2014/JANUARY 2015
Background
and preparation
1. Motivation
What is motivation? I
believe it’s when a person
needs to see and feel a
real reason to them to do
anything, especially anything
challenging. So, for example,
your house needs tidying but
you couldn’t be bothered, it
will do as it is. You get a call
that Barack Obama is on his
way over and, in a flash, you
have found all the energy
and determination you need
to have the place spotless.
How can you create that for
any given circumstance?
How can you create that for
your patients? This is where
Motivational Interviewing (MI)
plays a key role in dealings
with your patients. If an
asthma patient can’t see
why he/she should bother
about using the preventer
inhaler, what are the chances
it will be used correctly
going forward? Similarly,
smokers must see and feel for
themselves why they should
quit. The same also applies
for weight loss. Changing
long-standing bad eating
habits and lack of exercise
can be difficult to accomplish,
but is possible if you create
your own motivation and, as
pharmacists, we can help our
patients do that.
Motivational
Interviewing Questions
Motivational interviewing is a
style of counselling developed
to identify and engage the
patient’s intrinsic motivation
for changing health-related
behaviours. The technique
takes practice, but it can
be a very effective tool for
identifying realistic goals,
feasible approaches and
opportunities for progress with
all patients, especially those
who are resistant to change or
struggle to acknowledge their
health problem. The method
is non-judgemental, nonconfrontational and allows
the patient and pharmacist
to assess readiness to change
together, instead of being
directed by the pharmacist.
Five general principles of
motivational interviewing:
1. Express Empathy – see the
world through patient’s
eyes. Be non-judgemental;
leave aside your own views
and values.
2. Develop Discrepancy –
facilitate patient to identify
the discrepancy between
current behaviour and
future goals.
3. Avoid Argument – it’s
counterproductive. Look
for inconsistencies and
consequences that conflict
with important goals.
4. Roll with Resistance –
defuse the resistance.
Be empathetic and nonjudgemental and encourage
patient to develop their
own solutions and examine
new perspectives.
5. Support Self-Efficacy –
patient is responsible for
choosing and carrying out
personal change. Belief in
the possibility of change
is a good motivator and
previous efforts and
successes can be elicited to
build self-confidence.
33
CPD overview
Reflect and Self-Assessment
o Is there a need in my locality for this service?
o Have I sufficient pharmacist cover to provide this service?
o Have I a good working relationships with local GPs,
Public Health Nurse, etc.?
o Have I a SOP in place for this service?
o Is the consultation area adequate?
o How will I record this patient service – paper or electronically?
o Have I identified the appropriate equipment, professional and
patient resources materials?
Learning Plan
Including a list of desired learning outcomes in a personal
learning plan is a helpful self-analytical tool.
o Create a list of desired learning outcomes, e.g. MI techniques,
healthy eating, physical activity, body measurements.
o Identify professional resources available to achieve
learning objectives.
o Identify patient support material and online patient resources.
o Develop a realistic time line for plan.
Action
Activities chosen should be outcomes based to meet
learning objectives.
o Read this article.
o Create SOP for weight loss management service.
o Evaluate professional resource materials available in the
pharmacy and source additional material if necessary.
o Evaluate patient support material and source additional
material if necessary.
o Promote this new patient service.
Evaluate
Consider outcomes of learning and impact of learning.
o Do I now feel confident to set up a weight loss
management service?
o Do I now feel confident to engage with my patient about
weight loss?
o Should I consider including cardiovascular screening as part of
weight loss management service? ]
o Have I met my desired learning outcomes?
o Have further learning needs been identified?
Record
o Create a record in my CPD portfolio. As part of this record,
complete an evaluation, noting whether learning outcomes
were achieved and identifying any future learning needs.
34
Effective motivational
interviewing encompasses
the following communication
techniques commonly
referenced by the acronym
OARS:
• Some people talk about
part of them wanting
to change their eating
patterns and part of them
not really wanting to
change. Is this true for you?
n Open ended questions –
allows patient to express
their perspective and
provides insights for the
consultation.
• On a scale from one to ten,
how ready are you to make
changes in your eating
patterns?
n Affirmations – shows
appreciation and
support for the patient’s
statements. They can be
verbal or non-verbal.
n Reflective listening
– adds direction to
the consultation and
helps focus on change
statements.
n Summarising – draws
a number of strands
together and clarifies
and reflects the patient’s
own thoughts back to
them.
Asking permission has also
been shown to be a powerful
tool. It communicates respect
for the patient and results
in increased likelihood of
discussing change.
In motivational
interviewing, the focus shifts
from giving information
and advice, to helping
patients explore concerns,
uncertainties, reasons
for change and ideas and
strategies to make change
happen.
What does Motivational
Interviewing look like?
Subtle differences in how
pharmacists elicit information
from patients can make very
meaningful differences. As
an example, instead of asking
closed questions such as, “Do
you want to lose weight?” or
“How much weight do you
want to lose?” an MI approach
would instead ask, “How ready
do you feel to change your
eating patterns?” or “How is
your current weight affecting
your life right now?”
• How much of you is not
wanting to change?
• What was your life like
before you gained weight?
• What do you think will
happen if your health
behaviours don’t change?
• What are your hopes for
the future if you are able to
become healthier?
• How would your life be
different if you lost weight
or adopted a healthier
lifestyle?
• What kinds of healthy
changes do you think you
could make this week?
2. Collaborative goal setting
Patients who need to lose
weight are often asked to
make a lot of changes to their
diet and activity levels. There
is evidence that if patients
are given the opportunity to
choose one behaviour change
goal to focus on, success is
more likely. When patients
achieve a goal, their selfefficacy and confidence goes
up and then more ambitious
goals are set; for example,
patients who set a goal to
walk half a mile each day
and succeed are likely to set
a higher goal, for example to
walk one mile each day.
Other MI type questions:
• What kinds of changes
have you made in the past
to improve your eating (or
physical activity)?
• What strategies have
worked for you in the past?
IPUREVIEW DECEMBER 2014/JANUARY 2015
Collaborative goal-setting
is a process where both the
pharmacist and patient
negotiate a health-related
goal. Research has shown that
when patients participate
in decisions, they are more
likely to adopt the behaviours
decided upon. Collaborative
goal-setting does not involve
the pharmacist telling the
patient what to do. Telling
a patient that their goal
“should be to lose 10kg” is not
collaboration. Instead, it is
better to explore how much
weight loss the patient can
realistically achieve and to
work on achieving that goal.
3. Considerations
n Time – do you have the
time to put a service like
this into place?
n Drop-in service or by
appointment? In my view,
scheduled appointments
on one particular day
of the week works best,
as both pharmacist and
patient will be prepared.
n Adequate consultation
room?
n Advertise – posters and
flyers in the pharmacy,
also online, in GP
surgeries, community
halls, local Spar,
Centra, etc.
n Are you familiar with
all the activities in your
local area to suggest
to patients who may
be unaware and might
consider, e.g. walking
group, ramblers, exercise
IPUREVIEW DECEMBER 2014/JANUARY 2015
classes in parish halls,
aqua aerobics, etc.
n Is this a free service,
or are you going to
charge? Bear in mind
that organisations such
as Weight Watchers and
Slimming World have a
joining and weekly fee
– does this help focus
some motivation?
n Can this service have
added value by adding
in a Blood Pressure
check also?
n Knowledge and
information –
become familiar with
motivational interviewing
techniques, healthy waist
measurement, BMI, ideal
weight, average calories
per day required for men
and women, food calorie
counting, detail on
healthy eating, alcohol
intake, recommended
physical activity levels.
n Documentation – create
a SOP for a Weight Loss
Management Service.
Equipment needed
n Print out leaflets on
healthy eating, exercise,
suggested diet plans, e.g.
Healthy Eating and Active
Living for Adults, Teenagers
and Children over 5 Years
available on www.fsai.
ie, Lose weight and reduce
your risk of heart disease
and stroke available
on www.irishheart.ie
Structure
n Appointment once
a week for 12 weeks
followed by review
thereafter.
n Week 1 – Assessment
(40 minutes).
1.Measurements
- height, weight,
waist measurement.
Calculate BMI and
pinpoint on the
chart. Explain about
significance of waist
measurement.
2. Motivational Interviewing technique
(aiming to find out
about eating habits
and physical activity).
n Digital weighing scales
3. Collaborative goal
setting (aiming for
a maximum weekly
weight loss of 0.5kg1kg / 1lb-2lb).
n BMI chart – available on
www.healthpromotion.ie
4. Review and agree
next meeting.
n Waist and height
measure – available from
e.g. Fleming Medical
n Record patient consent,
details, measurement
statistics and progress.
(Choose paper or
electronic format)
n Weeks 2-12 Ongoing
support (20 minutes)
1.Measurements,
review and reaffirm
motivation.
2. Topics, e.g. food diary,
reading food labels,
increasing physical
activity, calorie
counting.
3. Collaborative goal
setting.
4. Encouragement and
set rewards for goals
achieved, e.g. buying
music, new clothes,
book a massage.
Remember!
An effective weight loss
programme:
n Addresses the reasons
why someone might find
it difficult to lose weight
n Is tailored to individual
needs and choices
n Is sensitive to the
person’s weight concerns
n Is based on a balanced,
healthy diet
n Encourages regular
physical activity
References
Safefood – Stop the Spread
Healthy Eating and Active Living
for Adults, Teenagers and Children
over 5 Years – www.fsai.ie
NHS 12 week weight loss pack –
www.nhs.uk/LiveWell
Weight Management Treatment
Algorithm, Reference guide &
Support Information – HSE/ICGP
www.healthpromotion.ie
Medscape – Motivational
Interviewing of Obese Patients
35