Expert Q&A: Expanding the Pharmacist's Role in Community-Based Weight Management

In an interview with Pharmacy Times®, Emilie Collongette, PharmD, CPh, BCMTMS, pharmacy clinical ambulatory specialist, primary care and PGY-2 ambulatory care residency coordinator at Baptist Health South Florida, discussed the role pharmacists play in weight management, emphasizing their accessibility and expertise in medication and lifestyle counseling.

Collongette highlighted the common challenges individuals face when trying to lose weight and suggested how pharmacists can address these through personalized support and education. She also explored the use of medications like glucagon-like peptide 1 (GLP-1) receptor agonists and the importance of dietary changes, recommending that pharmacists provide guidance in these areas. Ultimately, Collongette advocated for pharmacists to be more involved in long-term patient support for sustained healthy food choices and overall wellness.

Emilie Collongette, PharmD, CPh, BCMTMS, pharmacy clinical ambulatory specialist, primary care and PGY-2 ambulatory care residency coordinator at Baptist Health South Florida.

Pharmacy Times: How do you stay current with the latest guidelines, research, and medications related to weight management?

Emilie Collongette, PharmD, CPh, BCMTMS: Weight management is a trending topic in the pharmacy space as of late, with new evidence emerging. It is vital for pharmacists to stay current on the topic. Medical guidelines, such as the American Association of Clinical Endocrinology, the American Diabetes Association, the American Heart Association, Kidney Disease: Improving Global Outcomes, etc., provide a framework for weight management. These guidelines take a comprehensive approach to disease-specific recommendations and associated weight-loss benefits. Subscriptions to medical journals provide notification of new evidence that is published on the topic. This is a great way to be in the loop; just this week I received an email notifying me of a study showing improved metabolic outcomes associated with weight loss. Professional pharmacy associations and colleges of pharmacies provide members and preceptors with resources for continued education and clinical resources. There is also a great benefit in networking with colleagues and connecting with representatives from the pharmaceutical industry.

Pharmacy Times: What are some of the common challenges patients face when trying to lose weight, and how do you help them overcome these challenges?

Collongette: Weight loss is a highly personal journey, and while some challenges may overlap among patients, it's crucial to tailor and individualize each plan. Recognizing that shared challenges should not be generalized, we must delve into the specific details of each patient's experience to provide effective support. Many patients struggle with where to begin their weight loss journey and often feel daunted by the process. Time constraints and access to resources such as dietary and exercise coaching can present challenges. Health conditions like asthma, osteoporosis, thyroid disorders, diabetes, and hormone imbalances can also make it difficult for individuals to lose weight. Additionally, mental health issues and weight-related stigmas can further complicate weight loss efforts.

Pharmacists and health care professionals can act as a support system for patients and collaborate with patients to create individualized goals. These goals should be realistic for the patient and focus on measurable and accountable actions. Encouraging patients and supporting them to make small changes that, over time, will have a large impact on their health and wellness is key.

Pharmacy Times: How do you approach a patient who expresses interest in over-the-counter weight loss supplements? What information do you provide them?

Collongette: When a patient expresses interest in over-the-counter weight loss supplements, it's important to approach the conversation with empathy and provide clear, evidence-based information. Start by understanding why the patient is interested in these supplements and what their expectations are. Explain that many over-the-counter weight loss supplements lack high-quality clinical evidence supporting their efficacy and safety and may not have been reviewed or approved by the FDA. Patients should be directed to a primary care provider to discuss the initiation and use of over-the-counter weight loss supplements to promote appropriate use and safety.

Pharmacy Times: In what ways can a pharmacist play a proactive role in community-based weight management initiatives and education?

Collongette: Pharmacists can play a proactive role in community-based weight management initiatives and education through several key activities. As the most accessible health care provider, pharmacists can counsel and educate patients on weight loss medications and supplements. I have been invited to chamber of commerce meetings and insurance-sponsored education series to present and educate the community on weight management, discussing guideline-directed recommendations and the safe and appropriate usage of weight loss medications. My colleagues have also led similar presentations, and we regularly participate in health fairs and community screenings to help educate and support our communities.

Pharmacists can collaborate with an interdisciplinary team of physicians, dieticians, personal trainers, and mental health practitioners to provide a holistic approach to weight management. As a pharmacy clinical ambulatory specialist, I have an established collaborative practice agreement with the primary care providers in weight management.

Pharmacy Times: Given the increasing popularity of GLP-1 receptor agonists for weight loss, how do you stay informed about potential drug shortages, cost considerations, and access issues that patients might face?

Collongette: Staying informed about potential drug shortages, cost considerations, and access issues that patients might face has proven to be a valuable strategy when navigating the increasing popularity of GLP-1 receptor agonists. One way is to keep tabs on the announcements from the FDA and monitor its medication shortage list. The pharmaceutical companies also regularly update their websites and communication avenues, such as email correspondence, marketing material, and provider outreach, to keep the public informed. Maintaining relationships with local community pharmacies to help communicate expectations and potential shortages locally with patients has been helpful. It is also very important to establish open lines of communication with patients and set expectations for potential shortages, affordability, and other treatment-related factors.

Pharmacy Times: What is your understanding of the role of GLP-1 receptor agonists in managing both weight and type 2 diabetes? How do you address patients who may have both conditions?

Collongette: GLP-1 receptor agonists have proven benefits for both weight management and type 2 diabetes due to their mechanism of action. These medications enhance insulin secretion in response to food intake and reduce glucagon secretion, which lowers blood sugar levels. They also slow gastric emptying and suppress appetite, promoting smaller portions, reduced caloric intake, and ultimately weight loss. The American Diabetes Association recommends GLP-1 receptor agonists as a first-line treatment option for patients with type 2 diabetes who are overweight or obese. Integrating GLP-1 receptor agonists into treatment plans allows healthcare providers to effectively manage both weight and type 2 diabetes. A weight loss of 5% or more has been shown to improve blood glucose levels, insulin sensitivity, and overall metabolic health.

Pharmacy Times: Considering recent studies showing that GLP-1 drugs can significantly reduce cravings for processed foods, how do you advise patients on making sustainable dietary changes while on these medications?

Collongette: Considering recent studies showing that GLP-1 receptor agonists can significantly reduce cravings for processed foods, advising patients on making sustainable dietary changes while on these medications is crucial. As a pharmacist, I recommend a high-protein, low-carb diet, focusing on lean proteins like chicken, fish, ground turkey, and legumes, along with low-carb vegetables such as leafy greens, broccoli, and cauliflower. Patients should avoid greasy, fried, spicy foods, and those with high sugar content, as these can exacerbate common side effects of GLP-1 receptor agonists, including nausea, indigestion, heartburn, and diarrhea. To manage potential constipation, patients should ensure adequate hydration and increase their fiber intake through whole grains, fruits, and vegetables. Additionally, smaller, more frequent meals throughout the day, ideally 4-6 meals, can help manage hunger and prevent overeating.

Mindful eating practices are also important. Encouraging patients to make proactive choices by planning their meals and snacks ahead of time, which can help them avoid impulsive eating and stick to their dietary goals. Teaching patients to eat slowly, savor their food, and pay attention to hunger and fullness cues can improve digestion and enhance their overall eating experience. By following these guidelines, patients can make sustainable dietary changes that complement their GLP-1 receptor agonist treatment and support their long-term health goals.

Pharmacy Times: What role do you see for pharmacists in guiding patients towards healthier food choices in the long term?

Collongette: Pharmacists play a crucial role in guiding patients towards healthier food choices in the long term. Although primarily known as medication experts, pharmacists are well-equipped to provide generalized counseling on dietary and lifestyle modifications. One effective approach is educating patients on which foods to avoid based on their prescribed medications, helping to prevent adverse interactions and side effects. Additionally, pharmacists can raise awareness about the expertise of other healthcare professionals, such as dietitians, nutritionists, and wellness coaches, encouraging patients to seek specialized advice when needed. By helping patients navigate credible resources for health-related information, pharmacists can empower them to make informed decisions about their diet and overall wellness. Ultimately, pharmacists support patients in becoming proactive stewards of their health, fostering long-term healthy habits and improved quality of life.