Men’s life expectancy is getting closer to that of women but gender health gaps remain, particularly in the areas of obesity, diabetes and mental health. Why is this?

A man's life expectancy is now roughly five years lower than that of a woman. Reasons for this lower lifespan include the fact that more men than women are overweight but men typically account for less than one third of those attending weight loss programmes. Men also comprise only 38 per cent of NHS talking therapy referrals, yet, shockingly, 78 per cent of suicides are male.

Another major issue is that men are much less likely to visit their GP than women, possibly because they dislike discussing sensitive issues or, in some cases, put problems aside rather than face them – all factors that offer community pharmacy an opportunity to help male customers address sensitive health issues, such as those around obesity and mental health.

Facing fat

There is no easy way to talk about someone’s weight, but you can tactfully bring up the subject of obesity by talking about the associated health problems – particularly if there is something you know your customer is already experiencing.

Dr Sally Norton, NHS consultant and weight loss surgeon, and founder of the weight loss website Vavista Life, says healthcare professionals are duty bound to raise the issue of obesity and can not afford to avoid the topic for fear of offending, “because people may not know just how much obesity contributes to diabetes, heart disease, sleep apnoea, liver disease and even such things as male infertility”.

Pieter de Meer, spokesperson for the Men’s Health Forum, says that his organisation is particularly worried that men with pre-diabetes are not being adequately identified and diagnosed. This is something that community pharmacy weight management services could pick up on, he says.

“Men are less likely to go for a NHS health check and to a GP – the main routes for diagnosis – yet they are more likely to be affected by type 2 diabetes than women, and men over 50 years of age are nearly twice as likely to have undiagnosed type 2 diabetes than their female counterparts,” he says. “That is why it is important to talk to men about the symptoms and advise them to take up their NHS health check.”

Pieter de Meer says overweight men “are most motivated to lose weight following a health scare or diagnosis of a weightrelated problem,” and that encouragement from a health professional at this point can make all the difference. However, he advises against simply talking about losing weight with men.

“Men need to be convinced of the health benefits they gain by losing weight such as feeling fitter, the possibility of coming off medication, or reduced incidence of erectile dysfunction. Avoid talking about what men don’t want: for instance, they don’t like strict diets and some men are anxious about looking too thin, so talk about improving fitness rather than becoming slim.”

Fighting fit

According to Sally Norton, research shows that men respond well to a competitive, often sports or activity-related, weight loss programme and, by focusing on fitness rather than weight, “they can see more benefit and are less demotivated if the scales don’t respond as quickly as they would like”, she says.

“Conventional diets don’t work long-term and men do better when combining activity challenges with healthy eating, so a couch-to-5k challenge is a good way to engage men, [using] pedometers to build to 10,000 steps a day, and buddying up with a friend or partner to work together on weight loss.”

She also recommends suggesting halving alcohol intake, limiting takeaways or ready meals to once a week and focusing on non-processed food as “small and sustainable habit changes” that may be better for many men trying to lose weight. “Deep down they often know they need to address issues caused by their weight, and by helping them to understand how obesity impacts on them right now and how they can improve their lives by losing weight, they will be more responsive to discussions.”

Mental health markers

While it is easy to spot obesity, it can be harder to identify customers who are struggling with less physically obvious issues, such as mental health problems. Numark information pharmacist Hilary Cunningham believes all pharmacists should have a baseline knowledge of mental health conditions.

Different people have various symptoms of depression, she says, which may include:

• Feeling sad or ‘empty’
• Feeling hopeless, irritable, anxious or angry
• A loss of interest in work, family or once-pleasurable activities, including sex
• Feeling very tired, not being able to sleep, or sleeping too much
• Not being able to concentrate or remember details
• Overeating or not wanting to eat at all
• Thoughts of suicide or suicide attempts
• Aches or pains, headaches, cramps or digestive problems
• The inability to meet the responsibilities of work, caring for family or other important activities.

There doesn’t seem to be a completely separate type of ‘male depression’, but Cunningham says some symptoms, such as irritability, greater risk-taking and aggression, are commoner in men than in women. Shy men seem to be more likely to become depressed, and men are also more likely to commit suicide.

Ways of coping

While the underlying biological processes affecting mental health will be similar for men and women, seeking help and using services may seem so difficult to some men that they prefer either to struggle on unaided or find their own ways of coping, often abusing drugs or alcohol instead of talking with friends and family or seeking professional help.

“Some men are particularly competitive and concerned with power and success,” says Hilary Cunningham, “so if a man is like this, it may be harder to tell someone that they feel fragile or that they need help. These attitudes can stop them from talking to loved ones and doctors about how they are feeling, so they simply don’t get the help that they need.”

Pharmacy support

Pharmacists are well placed to recognise depression in male customers as a consequence of requests for OTC products, such as sleep aids for early morning waking. Simply asking a man how he is feeling or even commenting ‘you don’t seem yourself at the moment – are things OK?’ could be all that they need to speak up about how they are.

Once you have opened up a dialogue, there is a lot you can do to point your customer on the road to recovery or to more help via a referral to primary care. In the meantime, you can advise them about the various treatments for depression, and that many work well in partnership with each other.

Treatment options

Antidepressant medicines are commonly used to treat moderate or severe depression but can take up to six weeks before the person will notice the full effect. It should be noted that antidepressants do not work in everybody. A useful leaflet on depression is available here.

Psychological (talking) treatments, such as cognitive behavioural therapy (CBT) and counselling, have also been shown to be helpful in dealing with depression, with many health professionals considering the combination of an antidepressant with a psychological treatment to be more effective than either treatment alone.

An explanation of the benefits of CBT for mental health problems may encourage male uptake, along with an understanding that these issues, especially depression, are not “all in the mind” or that sufferers should “get a grip”, says Hilary Cunningham. Pointing out that depression is caused by an imbalance of neurotransmitters, which makes it as much a disease as diabetes or asthma, would enable much of the stigma to be removed.

Pieter de Meer says positive stories about men with mental health problems “may encourage seeking help among the male audience, [so] it would be good to have some leaflets with these stories in the pharmacy”. He stresses the importance of creating “a safe and friendly environment for men to talk and ask questions” and offering support that might just save their lives.