/publications/issue/2010/May2010/OutlookObesity-0410

Outlook: Obesity Epidemic

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Pharmacists Aid Bariatric Surgery Patients
The results of 2 recent studies at different hospitals have shown that pharmacists are a vital part of the health care team in ensuring that patients who have weight-loss surgery receive adequate vitamins and appropriate medication therapy. Although bariatric surgery helps obese patients lose excess weight, the surgery can interfere with certain patients’ ability to absorb medications and important vitamins/nutrients.

For the first study, which took place at the Department of Veterans Affairs Loma Linda Healthcare System, Susan Jacob, PharmD, and a team of pharmacists, physicians, nurses, and a dietitian, showed how a pharmacistdesigned supplementation protocol could replenish bariatric patients’ low vitamin D levels. It also reduces the long-term risk for bone loss, osteoporotic fractures, and other adverse events that have occurred when vitamin levels fall below normal (30-100 ng/mL).

The second study, from Brigham and Women’s Hospital (BWH) in Boston, Massachusetts, showed how pharmacists can help bariatric surgery patients become more adherent to their medication therapy. Clinical pharmacists at BWH began a pharmacy consultation service, where they evaluated patients’ medication regimens and changed if necessary (based on the kind of procedure they were having) to ensure therapeutic continuity through the procedure and after the discharge.

Before the program, medication management was handled solely by bariatric surgeons. The researchers explained, “An increased number of complicated cases prompted the surgeons and the Department of Pharmacy to initiate a collaborative effort to more effectively manage these patients.” Pharmacists documented 181 interventions, and the surgeons accepted 99% of their recommendations. Patient response was very positive—Deborah A. Cios, PharmD, BCPS, senior clinical pharmacist at BWH, said that they found through a survey that patients loved the service. “They felt they knew what was going on and how to transition their medications. They felt more comfortable taking them” because of pharmacist counseling, she said.

Both studies were presented at poster sessions at the American Society of Health-System Pharmacists Midyear Clinical Meeting.


Overweight Kids Affected Differently by OTC Medications
Researchers recently found that overweight or obese children metabolize OTC drugs differently than children of normal weight. This could mean that obese children’s bodies end up with either excess or insufficient concentrations of a drug. If the agent is metabolized into an active form and the child has high concentrations of the drug, potentially severe adverse effects could occur.

L’Aurelle Johnson, PhD, assistant professor of experimental and clinical pharmacology at the University of Minnesota College of Pharmacy and senior author, and a coauthor looked at how both dextromethorphan (DXM; the active ingredient in OTC Robitussin DM) and caffeine (delivered via a cola drink) were metabolized by 16 normalweight and 9 obese black children, aged 6 to 10 years old. The authors specifically looked at activity levels of 2 key enzymes involved in drug metabolism and found higher enzyme activity among obese children who were given caffeine, but not DXM.

Dr. Johnson concluded, “This means that there is variability in enzyme activity, which has implications for furthering personalized medicine,” and added that a child’s physiologic condition may impact dosing in the future.

The research was presented April 27, 2010, at the American Society for Pharmacology and Experimental Therapeutics annual meeting in Anaheim, California.


Obesity May Shrink Americans’ Life Spans—Epidemic Continues
The combination of 2 factors—that Americans are becoming obese at an earlier age and are retaining the weight for more of their lifetime—is more of a lethal mix than first thought, according to researchers. Researchers believe that this will have a drastic impact on life expectancy and the incidence of chronic diseases, like type 2 diabetes.

After examining data from the National Health and Nutrition Examination Survey (1971-2006), Joyce Lee, MD, MPH, and coauthors found that 20% of the individuals born between 1966 and 1985 were obese by 20 to 29 years of age. This cohort was the youngest to hit that obesity level—individuals born between 1946 and 1965 did not reach that level until they were in their 30s; those born between 1936 and 1945 did not reach obesity until their 40s. In addition, the researchers noted that the trend was particularly noticeable in women compared with men and black compared with white cohorts. Their results were published in the April 12, 2010, issue of the International Journal of Obesity.