Chapter 14. Obesity—Weight Management Services

After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:

1. List three variables contributing to the increased prevalence of obesity.

2. Calculate a patient's body mass index (BMI) when given a patient's height and weight.

3. Assess a patient's risk for other comorbid disease states.

4. Compare nonpharmacologic and pharmacologic treatment options/alternatives for patients, including contraindications and side effects, and formulate a treatment plan.

5. Identify various roles community pharmacists can have in weight management as well as the benefits and barriers for patients who want to participate in a community pharmacist managed weight management clinic.

6. Develop a business plan for implementing a weight management service.

The problem of obesity is a nationwide crisis. The Centers for Disease Control and Prevention (CDC) reported that in 2009–2010, 35.7% or over 78 million adults were classified as obese.1–5 This is a problem that extends into the pediatric/adolescent population with the 2004 overweight prevalence ranging from 5% for children aged 2–5 and 17.4% for adolescents up to 19 years of age and obese prevalence for 2009–2010 for adolescents aged 2–19 at 16.9%.1,5 The prevalence of obesity is higher among certain ethnic groups. Figure 14-1 highlights some ethnic groups and their incidence of obesity.3 Native American and Alaska natives are also ethnic groups that tend to have high obesity prevalence (32.4%).3

The economic impact of obesity is staggering. The CDC reported that the total medical costs of obesity in adults reached $147 billion in 2008 with people who are obese paying 42% more in health-care costs than normal-weight individuals.1,3,6 These costs are attributed to the conditions and health risks associated with obesity and not the medications used for treating obesity.7 Both Medicare and Medicaid pay about $1000–1700 more for obese patients than normal-weight patients.3 In children, the costs are estimated to be $14.3 billion.8 Other areas of impact include productivity, transportation, and human capital costs.8 Studies have demonstrated the productivity loss for obesity-related “absenteeism” and “presenteeism” to be as high as $11 billion annually.8 Productivity costs are also increased due to higher rates of disability costs and premature mortality.8 Transportation costs are increased due to higher weight-based fuel needs. It is estimated that in 2000, the extra fuel costs for airlines due to higher numbers of obese passengers were about $275 million.8 Major airlines such as Southwest Airlines and American Airlines now request customers of “certain size” to purchase two seats on the airplane. Studies have also shown that there is a link between education experience and obesity with obese students having increased absenteeism and in the end, lower income or education attainment.8

This problem is so severe and widespread that the CDC's Division ...