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Boost your OTC knowledge on a wide range of conditions and be able to provide product recommendations, treatment and advice at the counter.
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For many women, their relationship with weight is a complicated and personal one. Many find that discussing the subject, with friends or family, can be tricky. Concerns are often met with reassurance that ‘you look fine’ or it’s ‘nothing to worry about’. And yet, it’s vitally important that women can talk openly about it, because being overweight – or indeed underweight – increases the risk of health issues.
Luckily, pharmacy staff are in an excellent position to encourage patients who might want more advice, whether that’s by signposting to their GP or a local support group, sharing healthy lifestyle tips, or helping them to understand the risks associated with obesity.
Impact on health
More than half of adult women (58.4 per cent) are estimated to be overweight or living with obesity, according to statistics published last year by the Office for Health Improvement & Disparities – and this can put their health in jeopardy in more ways than one:
Heart problems
Obesity is a well-known risk factor for heart disease, says Tracy Parker, senior dietician at the British Heart Foundation (BHF) (bhf.org.uk). “It can also increase your risk of high blood pressure, high cholesterol and type 2 diabetes.
“Excess weight, especially around the waist, can contribute to the build-up of fatty material in the arteries.
The build-up can cause them to narrow, reducing blood flow to the heart and body. When one of the coronary arteries becomes blocked, it can lead to a heart attack.” More than half of deaths related to obesity in the UK are from heart disease and stroke, adds Tracy.
Certain cancers
“A woman’s breast cancer risk increases if they are overweight or obese after the menopause as the disease is linked to higher levels of oestrogen in the body, which may encourage the growth of some breast cancers,” says Victoria Kessell, clinical nurse specialist at Breast Cancer Now (breastcancernow.org). While oestrogen levels typically drop during menopause, Victoria explains that the hormone is also made by fatty tissue. “Being overweight also alters the level of other hormones and these changes might increase the chance of breast cancer developing.”
Meanwhile, a study published in the British Journal of Cancer found that 11 per cent of bowel cancer cases were linked to being obese/overweight. “People with obesity have different levels of chemical signals, known as metabolites, in their blood,” says Claire Coughlan, clinical lead at Bowel Cancer UK (bowelcanceruk.org.uk). “These metabolites can cause cells in our body to divide more often. This increases the chance of a cancer cell developing, which can continue to divide and eventually cause a tumour to form. “Being overweight or obese doesn’t mean that someone will definitely develop cancer, but it does increase the risk.”
“While we know that being overweight isn’t good for health, being underweight can also lead to issues”
Type 2 diabetes
There is a close link between obesity and type 2 diabetes, a condition caused by problems with the hormone insulin. Symptoms may start mildly and include feeling very thirsty, urinating more than normal, blurry vision, unintentional weight loss, or cuts taking longer to heal than usual. It’s often picked up during routine blood tests – some pharmacies already offer blood glucose testing – but, as with all of the conditions mentioned above, patients should see their GP as soon as possible if they are experiencing symptoms.
Keeping a food journal can be a good starting point for those wanting to lose weight to get them thinking about what they are eating.
What is a ‘healthy weight’?
One common way for people to determine if their weight is in a healthy range for their height is by checking their body mass index.
While BMI can be a helpful guide, it’s not always accurate, says Tracy, as it cannot differentiate between excess fat, muscle or bone. “It also doesn’t consider age, gender, different body shapes or that muscle weighs more than fat,” she adds. If patients think that measuring their BMI might not be the right approach for them, they can ask their doctor or practice nurse to help assess their weight.
Tracy says it’s also recommended that those with a BMI below 35 check their waist-to-height ratio. “A larger waist measurement is often a sign that you have too much visceral fat,” she says. “This increases your risk of health problems. It’s healthy to keep your waist to less than half your height.”
The recommended daily calorie intake depends on factors such as age and activity levels, but typically it’s around 2,000 calories for women and 2,500 for men.
Care for down there
Like weight, another topic that women may find hard to talk about is vaginal wellness. Common issues can include dryness, bacterial vaginosis (BV), thrush and cystitis. “Some may feel uncomfortable discussing this type of intimate problem in a pharmacy,” says Karen Baker, Care’s expert pharmacist. “Teams should ensure they are considerate of this and offer the use of the consulting room for a private chat. Male pharmacy assistants can also offer the services of a female assistant if that would make the customer more comfortable, providing one is available.
“The vagina is a delicate area with a balance of bacteria and fungi that are naturally present to keep it healthy, but lifestyle factors can disrupt this,” continues Karen. “Wearing cotton underwear, wiping front-to-back, using water to wash the vulva daily and drying properly after washing can help prevent problems.” She also recommends avoiding the use of perfumed products or soap around the vulva.
Unfortunately, problems do occur with around three-quarters of women getting thrush at least once in their lives, while around half will experience cystitis. “Some women may be confused whether they have thrush or cystitis, as both conditions can cause soreness and stinging when urinating,” says Karen. “If this is the case, teams should ask about other symptoms to determine the cause, such as frequency and discharge. If a urinary tract infection is suspected, consider whether they may qualify for the new Pharmacy First service.
“If it is thrush, it is important to use an internal product to treat the cause, such as a pessary or internal cream, or oral capsules. External creams, such as those containing clotrimazole, are helpful to relieve the symptoms of itching and irritation but won’t clear the infection alone and they should be used in addition to an internal antifungal product.”
As with any OTC products, always consider the patient’s age and any contraindications, and remind them to read the patient information leaflet. The following patients may need to be referred to a GP:
- Children
- Those with thrush symptoms for the first time
- Those aged 60 and over
- Pregnant customers
- Those with recurrent or severe problems
- Patients with suspected BV will also need to see a GP; treatment is usually with antibiotics.
“The vagina is a delicate area with a balance of bacteria and fungi that are naturally present to keep it healthy”
Education and motivation
There are many reasons why a woman may gain weight, especially around major life changes such as childbirth and the menopause. “When we step away from the science and study of nutrition, we almost always arrive at behavioural factors that can trigger snack eating, or feelgood drinks that have a tendency to almost sneak calories past us,” says Emese Flick, a personal trainer and nutrition and weight management coach (funmumsfitness.co.uk). “Of course, there are other conditions that play their role, such as several nights’ poor sleep, work or life stresses and hormonal factors.”
For women who want to lose weight but don’t know where to start, Emese suggests the following steps:
- Become aware of eating behaviours using a food journal
- Understand the difference between protein, carbohydrates and fats and how these can impact nutrition
- Limit or avoid sugary drinks
- Review alcohol intake and cut down if necessary
- Exercise regularly.
“Have a plan. It’s better to get upstream of things such as hunger by having an idea of how the day will look when it comes to eating. This might mean factoring in a little bit of extra time to have breakfast, and maybe even bringing in some food for lunch so you have greater control over the quality and proportions of what you’re consuming,” she explains.
Other tips include setting achievable, measurable goals with realistic expectations; finding a support network such as family, friends or a professional; being kind to yourself and being prepared for setbacks.
“Imagine two ways of travelling in a downward direction: one is a slide, the other is a staircase,” says Emese. “Most people would like weight loss to look like the slide – a rapid and smooth journey where it is only possible to go in one direction.
“Every professional will tell you that it’s more like the staircase: you commence taking steps downwards, but often there will be a pause for a bit longer than you would like on one of the steps, and sometimes you may even have to temporarily find yourself taking one step back up before you resume going down.”
Overweight customers or customers struggling with health problems should speak to their GP for advice before beginning a specific programme.
How you can help
“Speak to patients about different ways they can lose weight, to help people find a way that works for them, that they enjoy and can stick to,” says Tracy. “Pharmacies can direct them to expert resources on health and weight management, such as the BHF website. You could also encourage people to take part in the Healthy Hearts Programme, created by expert dieticians, nurses and fitness specialists from PureGym, a BHF partner. The holistic approach combines heart-healthy food, lifestyle tips and exercises to help people manage their weight and overall health. Some pharmacies also offer weight-management services which customers can enquire about.”
When to worry about weight loss
While we know that being overweight isn’t good for health, being underweight can also lead to issues. “It may sound like being too slim could only be a good thing; however, the reality of a prolonged calorie deficit leading to someone being very slim can result in problems such as low energy levels, fertility issues, excess tiredness, hair loss, irregular periods, a weaker immune system and a loss in bone mineral density,” says Emese.
An eating disorder such as anorexia nervosa (see more information on page 10) can result in unhealthily low body weight. In other cases, sudden or unexplained weight loss could be a red flag for cancer. “Losing weight, but you’re not sure why, is a common symptom of many cancers, including bowel cancer,” says Claire.
“Weight loss may be due to a loss of appetite, which may be caused by pain, nausea, or feeling generally unwell. However, some people may lose weight even while eating normally.
“Other symptoms of bowel cancer can include bleeding from your bottom, blood in your poo, a change in how often you poo, or regularly having diarrhoea or constipation, feeling very tired all the time, and a pain or lump in your stomach.” Patients experiencing any of these symptoms should contact a GP without delay and can be signposted to: cancerresearchuk.org/about-cancer/bowel-cancer.
“More than half of adult women are estimated to be overweight or living with obesity”
Managing dry eye
Many conditions can arise due to the menopause, but one that may be less known about is dry eye.
“One survey found that almost two-thirds of women who were going through the menopause, or in the lead up to it, had dry eyes,” says Jessica Toms, Santen UK sales and strategy controller, OTC. “But only 16 per cent of them realised that dry eye is a symptom of the menopause.”
“Dry eye disease is where the eyes are drier than they should be because they don’t make enough tears, or the tears are evaporating too quickly,” she adds. “During the menopause, levels of oestrogen and other hormones change. These hormones are involved in making tears (and getting the ingredients right) and making sure they drain away properly. Therefore, it’s unsurprising that when hormone levels are changing the eyes can be impacted and left dry and sore.”
Dry, sore eyes are a common symptom of the menopause.
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Boost your OTC knowledge on a wide range of conditions and be able to provide product recommendations, treatment and advice at the counter.