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• W2801474292 abstract "Obesity in the United States is widespread, with an estimated prevalence of 36.5% of adults and 17% of youth.1Ogden C.L. Carroll M.D. Fryar C.D. Flegal K.M. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. National Center for Health Statistics, Hyattsville, MD2015Google Scholar In 2016, all states were estimated to have self-reported adult obesity rates of at least 20% of the population, according to the Centers for Disease Control and Prevention.2Adult obesity prevalence maps. Centers for Disease Control and Prevention.https://www.cdc.gov/obesity/data/prevalence-maps.htmlDate: 2017Date accessed: March 22, 2018Google Scholar Obesity increases the risk of osteoarthritis, type 2 diabetes, hypertension, coronary heart disease, and all-cause mortality. It also increases the risk of suffering from anxiety, depression, and decreased quality of life.3Jensen M.D. Ryan D.H. Apovian C.M. et al.for the National Heart, Lung, and Blood InstituteManaging overweight and obesity in adults: systematic evidence review from the Obesity Expert Panel. National Heart, Lung, and Blood Institute. NIH, Bethesda, MD2013https://www.nhlbi.nih.gov/sites/default/files/media/docs/obesity-evidence-review.pdfDate accessed: March 22, 2018Google Scholar, 4Centers for Disease Control and Prevention Adult obesity causes and consequences.https://www.cdc.gov/obesity/adult/causes.htmlDate: 2018Date accessed: March 22, 2018Google Scholar Obesity can be costly, too; patients with obesity account for 46% more inpatient costs, 27% more outpatient costs, and almost 80% more prescription drug costs.3Jensen M.D. Ryan D.H. Apovian C.M. et al.for the National Heart, Lung, and Blood InstituteManaging overweight and obesity in adults: systematic evidence review from the Obesity Expert Panel. National Heart, Lung, and Blood Institute. NIH, Bethesda, MD2013https://www.nhlbi.nih.gov/sites/default/files/media/docs/obesity-evidence-review.pdfDate accessed: March 22, 2018Google Scholar Several factors, including behavioral, biological (i.e., genetic or familial), and environmental factors (e.g., cultural, geographic location), can lead to obesity; therefore, the treatment and management of obesity cannot rely on a singular approach.4Centers for Disease Control and Prevention Adult obesity causes and consequences.https://www.cdc.gov/obesity/adult/causes.htmlDate: 2018Date accessed: March 22, 2018Google Scholar Team-based approaches to patient care have been shown to improve outcomes, particularly for chronic conditions, and these should be considered in the management of obesity. Collaborative treatment with primary care physicians and at least one other health professional can increase the likelihood of significant weight loss.5Fitzpatrick S.L. Wischenka D. Appelhans B.M. et al.on behalf of the Society Behavioral MedicineAn evidence-based guide for obesity treatment in primary care.Am J Med. 2016; 129: 115.e1-115.e7Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar The Society of Behavioral Medicine supports a team-based approached to obesity management and treatment, especially in primary care. Pharmacists are well situated to be a part of this primary care team. Literature supports pharmacists' involvement with obesity and weight management.6Jordan M.A. Harmon J. Pharmacist interventions for obesity: improving treatment adherence and patient outcomes.Integr Pharm Res Pract. 2015; 4: 79-89Crossref PubMed Google Scholar, 7Harmon M. Pogge E. Boomershine V. Evaluation of a pharmacist-led, 6-month weight loss program in obese patients.J Am Pharm Assoc. 2014; 54: 302-307Abstract Full Text Full Text PDF Scopus (11) Google Scholar Pharmacist-led interventions, such as behavioral counseling, have resulted in patients losing 5%-10% of initial body weight. In addition, pilot programs in which pharmacists have collaborated with physicians to conduct annual wellness visits, follow-up after medication initiations, and to provide disease state education and management have resulted in improved patient outcomes, such as weight loss, decreased blood pressure, and decreased cholesterol.6Jordan M.A. Harmon J. Pharmacist interventions for obesity: improving treatment adherence and patient outcomes.Integr Pharm Res Pract. 2015; 4: 79-89Crossref PubMed Google Scholar Many opportunities exist for pharmacists to become more involved with obesity management. Pharmacists can integrate the “5 A's” (Ask, Assess, Advise, Agree, and Assist/Arrange) of weight management counseling into routine practice as recommended by the Society of Behavioral Medicine, American Heart Association, the American College of Cardiology, and the Obesity Society.5Fitzpatrick S.L. Wischenka D. Appelhans B.M. et al.on behalf of the Society Behavioral MedicineAn evidence-based guide for obesity treatment in primary care.Am J Med. 2016; 129: 115.e1-115.e7Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 8Jensen M.D. Ryan D.H. Apovian C.M. et al.2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and The Obesity Society.J Am Coll Cardiol. 2014; 63: 2985-3023Crossref PubMed Scopus (1400) Google Scholar Aligning the 5 A's with the Pharmacists' Patient Care Process (Collect, Assess, Plan, Implement, and Follow-up: Monitor and Evaluate) facilitates incorporation into a variety of professional practice settings. The table highlights the similarities of the 5 A's with the Pharmacists' Patient Care Process, and some specific suggestions for each step follow.Tabled 15 A's of obesity managementPharmacists' patient care processAskCollectAssessAssessAdvisePlanAgreePlanAssist/ArrangeImplementAssist/ArrangeFollow-up: Monitor and Evaluate Open table in a new tab ASK: Pharmacists should ask to discuss weight and determine the readiness to change behavior to lose weight by using motivational interviewing techniques.ASSESS: Pharmacists can measure height and weight during health screenings to calculate body mass index, to screen for obesity and related disorders, and to monitor progress as well. Other components related to ASSESS involve reviewing medication records to identify agents that could affect weight, particularly those leading to weight gain, and evaluating patients for obesity-related conditions, such as diabetes and osteoarthritis.ADVISE: Pharmacists may provide education and counseling to patients on the benefits of weight loss and ways to maintain weight when appropriate.AGREE: Pharmacists can discuss available treatment options and work with patients and other providers to set Specific, Measurable, Attainable, Relevant, and Timely (SMART) goals.ASSIST/ARRANGE: Pharmacists are able to assist with intensive lifestyle and weight reduction strategies and monitoring medication therapy. Lastly, pharmacists can follow up regularly with patients to evaluate progress and to refer patients to other available resources. Additional opportunities for pharmacists to be involved in obesity management extend to patients who are planning to have, or have undergone, bariatric surgery. Bariatric surgery is becoming a more common treatment modality for obesity because of its efficacy and positive benefits for other comorbid chronic conditions.9Bland C.M. Quidley A.M. Love B.L. Yeager C. McMichael B. Bookstaver P.B. Long-term pharmacotherapy considerations in the bariatric surgery patient.Am J Health-Syst Pharm. 2016; 73: 1230-1242Crossref PubMed Scopus (29) Google Scholar Pharmacists can proactively develop plans for monitoring and management of medications and other comorbid conditions. Many medications are likely to need adjustment after surgery. Patients may need to be assessed routinely for adherence to lifestyle modifications as well. Pharmacists are equipped with training and expertise to modify therapy and to enhance adherence as needed. Pharmacists are encouraged to explore ways to confront and assist with the obesity epidemic in their current practices. One way is to develop partnerships or collaborative arrangements with local health care, providers, dietitians, and social workers. Second, expand current agreements with health care providers to include weight management. Third, monitor medication appropriateness in bariatric patients. Fourth, educate patients on the proper use and expected outcomes of medications, including over-the-counter drugs and supplements. Lastly, incorporate at least 1 of the 5 A's into routine practice because frequent, brief interventions can elicit behavior change. Start small, as small interventions can have huge effects. Kayce M. Shealy, PharmD, BCPS, BCACP, CDE, Associate Professor and Chair of the Department of Pharmacy Practice, Presbyterian College School of Pharmacy" @default.
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• W2801474292 title "The “5 A's” of weight management counseling" @default.
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