Q&A: How Pharmacists Can Address Structural Barriers in Obesity Care

In an interview with Pharmacy Times, Stephanie T. Chung, MBBS, FAHA, the Lasker Clinical Scholar at the National Institute of Diabetes, Digestive and Kidney Diseases at the National Institutes of Health, emphasized that obesity is shaped by socioeconomic, structural, and community-level factors that extend well beyond individual choice. Chung was the chair of an American Heart Association writing group that released a scientific statement on the numerous obstacles that individuals with obesity face when treating and managing their condition, including limited access to healthy foods and weight stigma.

Chung highlighted pharmacists’ unique role as accessible health care professionals who can address barriers such as medication affordability, limited health literacy, time constraints, and weight stigma. Chung noted that obesity contributes substantially to cardiometabolic disease worldwide and that poorly recognized barriers—such as stigma and fragmented access to care—can undermine prevention and treatment efforts. She stressed that pharmacist-led education, particularly around anti-obesity pharmacotherapy dosing, device use, and cost-effective treatment selection, can significantly improve patient uptake and outcomes.

Pharmacy Times: The scientific statement highlights that obesity is influenced strongly by socioeconomic and structural factors, not just individual choices. How should pharmacists integrate this understanding into their approach when counseling patients about weight management?

Stephanie T. Chung, MBBS, FAHA: Pharmacists are health community leaders and integral community support, including supporting individuals with healthy weight management. Knowing the breadth of the social and community level factors that influence obesity will help pharmacists tailor their counseling by providing information on:

• Pharmacy assistance programs, including programs that can help with reducing co-pays, especially in select groups (eg, older adults). Programs such as GoodRx are available nationwide, and Medicare Part D is a federal program for Medicare beneficiaries. Pharmacists are also poised to gather the most up-to-date information on applicable local or temporary programs (eg, drug pricing programs).
• Promoting health literacy and education in prescription management. Sometimes the prescription refill process may be daunting to the individuals in transitional life stages (eg, young or older adults). Pharmacy teams who can engage and support these groups and help guide them in understanding how and when to refill prescriptions can directly impact patient satisfaction, care, and safety, while promoting efficiency to maximize time.
• Encourage community-level program participation to support diet and lifestyle interventions.

Pharmacy Times: Given that obesity is a major risk factor for cardiovascular disease and related conditions, what are the key clinical implications of this statement that pharmacists should know when assessing cardiometabolic risk in their patients?

Chung: Worldwide, 1 in 8 people are living with obesity and over 2.5 billion adults have excess body fat that may adversely impact health. Obesity contributes to ~3.7 million deaths from major diseases such as diabetes, heart disease, cancers, neurological disorders, and respiratory and digestive disorders, with the burden high in children and adolescents. This statement highlights the factors, beyond individual control, that impede obesity prevention and management. Clinically, if we can all work together to address poorly recognized barriers, eg, limited time and weight stigma, that have large impacts on the success of healthy weight programs.

Pharmacy Times: What concrete steps can pharmacists take to help patients overcome common barriers to obesity prevention and treatment, such as limited access to healthy food or time constraints?

Chung: While pharmacists will not be primarily responsible for addressing limited access, their community support is critical for successfully identifying and supporting under-resourced individuals (eg, food and housing insecurity). Pharmacy fellowship and residency programs should integrate social and structural considerations to attaining medications into their training curriculum and discuss solutions.

• Advocate and volunteer with local organizations and community groups—share your expertise and advice.
• Incorporate education for pharmacists on weight stigma and time restraints.
• Develop partnerships between pharmacy leaders, industry partners, and coalitions within the community to promote prescription access and affordability.

Pharmacy Times: From a pharmacy perspective, what strategies can help improve appropriate prescribing and patient uptake of anti-obesity pharmacotherapy?

Chung: One of the patient care barriers to use is the dose escalation needed and the different pens used for some of the incretin analogues with different doses. Also, it is often confusing to patients when and how to administer or switch between single-use versus. multi-use pens. Pharmacist-led education will go a long way for effective patient-centered communication. Collaborate with physicians, when possible, to identify efficacious and cost-effective agents/ brands for patients. Collaborative teams, especially within hospital and medical systems, have the greatest success in getting meds to patients and identifying the lowest cost and most feasible options.

Pharmacy Times: How can pharmacists create a supportive environment and communicate about weight in a way that reduces stigma and encourages patients to seek help?

Chung: Key strategies include:

• Emphasizing the importance and need for specific training on weight stigma and unconscious bias among pharmacists that influence the way we communicate with our patients and those around us.
• Using first-person language—”a person with obesity,” rather than saying “an obese person.”

Pharmacy Times: What specific partnerships or referral strategies should pharmacists consider to expand weight management support for patients?

Chung: Beneficial partnerships or strategies could mean:

• Keeping up to date with prescription assistance programs, especially industry-sponsored programs.
• Easily accessible educational and promotional material for patients and customers. Smaller mom and pop pharmacies would have a lot more leeway in developing these options as compared to chain pharmacies. But corporate level pharmacy leaders could take the lead on this and develop tools, which would provide a positive corporate image and possibly lead to increase sales.
• Partnerships between large pharmacies and community organizations or health insurance companies.

Pharmacy Times: Is there anything else that you would like to add or that I forgot to mention?

Chung, Nationwide, there is increased focus on the importance of healthy diet, activity, and adequate sleep combined with obesity medications to prevent and treat obesity. This is a great opportunity for pharmacists to leverage this momentum and to support and improve health systems engagement that directly impacts obesity care. Pharmacists are poised to:

• Bridge the knowledge gap and reduce stigma around medication use and prescription refills.
• Assist with disseminating information to improve medication access.
• Encourage engagement in lifestyle and diet activities by showcasing community resources at the point of prescription pickup when patients are standing in line waiting on prescriptions.
• Help save time for patients through efficient education and systems processes.