The measure of healthy lifestyles

The pandemic has made its mark on the lifestyles of adults across the nation, but what advice can pharmacy teams give to support customers in maintaining healthy habits? 

In the last year, nearly two thirds of UK adults (62 per cent) have made a change to their diet to get healthier, according to a new survey by the British Nutrition Foundation (BNF). Participants said they have been eating more fruit and vegetables, checking nutritional information on food labels, planning meals in advance, cooking healthier meals and drinking more water. In addition, half of the respondents (50 per cent) said they had started a new activity to stay active – 29 per cent started walking regularly and 12 per cent started exercising regularly in general.

Helena Gibson-Moore, nutrition scientist at the BNF, says there has been increased public interest in nutrition and health during the pandemic. “About two thirds of UK adults are overweight or obese, which can increase the risk of type 2 diabetes, cardiovascular disease and some cancers,” she explains. “Pharmacy teams have many daily interactions with the public, so are in a unique position to offer help and advice about weight management and healthy lifestyles.”

It is important that any advice given is reliable and evidenced-based, she adds, as well as being delivered in a way that is sensitive to the individual

Diet and exercise

Guidance on achieving a healthy, balanced diet is set out in the NHS Eatwell Guide.

It recommends people should try to:

• Eat at least five portions of a variety of fruit and vegetables every day
• Base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• Have some dairy or dairy alternatives (such as soya drinks)
• Eat some beans, pulses, fish, eggs, meat and other protein
• Choose unsaturated oils and spreads, and eat small amounts
• Drink plenty of fluids – at least six to eight glasses a day.

People can check whether they are a healthy weight using a body mass index (BMI) calculator. If they need to lose weight, they can do so safely using a community pharmacy weight management service or something like the NHS weight loss plan.

To help achieve and maintain a healthy weight, the NHS says people should do some type of physical exercise every day. Physical activity guidelines for adults aged 19-64 recommend that adults should do strengthening activities that work all the major muscles. They advise at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity a week, as well as reducing time spent sitting or lying down and breaking up long periods of not moving with some gentle activity.

NHS exercise programmes such as the Couch to 5K, 5K+ and Strength and Flex podcasts can help people to gradually and safely build up their exercise levels. Between March 2020 and July 2021, the NHS Couch to 5K app was downloaded 2.36 million times, bring the total downloads to more than five million and marking an increase of 92 per cent from 2019, highlighting the positive impact of the Covid-19 pandemic on people’s attitudes to exercise.

There is no one size fits all approach to diet and lifestyle, and losing weight and maintaining weight loss is not easy, says Helena. “Different strategies work for different people, so it’s important to fi nd an approach that can be sustained. Weight loss programmes that provide peer support tend to be more successful in the longer term, so it’s helpful for pharmacy teams to be aware of what weight loss services are available in the local area to help someone find a suitable weight loss group or weight management programme,” she explains. “If face-to-face services are more difficult to access, an online community or weight loss app, such as the one developed by the NHS, may also be helpful.”

Vitamins and minerals

When giving weight loss advice, don’t forget the importance of maintaining a healthy vitamin and mineral intake, says dietitian Carrie Ruxton from the Health and Food Supplements Information Service (HSIS). “Once people cut down on what they eat, their vitamin and mineral intake will fall, even if their diet is healthy.”

Many people take the opportunity when improving their diets to cut down on animal products and fish. A 2020 report for HSIS found that if these sorts of diets are poorly planned, they can reduce vitamin D, B12, iron, zinc, iodine, calcium, selenium and omega-3 fatty acid intakes, increasing risks to health through deficiencies of these essential nutrients. The same report also found that a large number of people making these dietary changes did not understand the reality of what this meant for their micronutrient intake.

“It’s important for the pharmacy team to recommend a multivitamin and mineral supplement and an omega-3 fish oil supplement. Make sure that customers take the Government recommended 10mcg vitamin D daily, which can either be included in the multivitamin supplement and/ or in addition to a total of 10mcg,” says Carrie.

She also agrees with Helena that pharmacy teams need to be aware that one size does not fi t all when giving advice on healthy eating and weight management. “Be alert and sensitive to cultural and social norms around food and weight. Learn from customers and colleagues in the pharmacy team why people eat the foods and portions they do and why being overweight may be acceptable in their family or culture,” Carrie advises. “Changing diet may be difficult in a household where someone is not the main food provider, although it can be a great opportunity to change the household diet in a healthier direction. Members of the pharmacy team may live locally and understand at least parts of the local food culture well. This can be of significant help to customers.”

Getting stuck in

One of the key ways in which pharmacy staff can help customers is by asking themselves how they could improve their own diets and discussing this among their teams. “This is not only about considering and practising what team members would say to customers on this topic, but it’s about learning from one another with the barriers and opportunities to improve diet,” says Carrie. “If the team is working towards healthier eating, it then becomes more inspiring to customers.”

Briony Cox, pharmacist at LloydsPharmacy Inside Sainsbury’s in Frome, Somerset, recommends that pharmacy teams hand out leaflets to customers to raise awareness of weight loss services provided in store as a way of starting conversations about the support and information that is available and how they can access this.

In-store and national campaigns can also help. “If a pharmacy team gets fully on board with a campaign, I believe that they can be really beneficial,” Briony says. “The team need to start those conversations, hand out information, engage with the patients and get people talking about the campaign.”

There is a wide variety of support and guidance available for pharmacy teams to help them keep up to date on nutrition and healthy lifestyles. The latest guidance and information about products can be accessed direct from manufacturers, pharmacy training magazines or continuing professional development programmes.

Ben Parker, pharmacist manager at Well Pharmacy in Martock, south Somerset, says making sure that everyone in the team is knowledgeable about the weight loss products their pharmacy stocks, and feels empowered to have private and professional conversations with patients about these products, is essential in providing customers with a good experience in their pharmacy.

“It’s really important to stay up to date and informed about nutritional products and healthy lifestyle advice as customers will often ask about the latest product they’ve seen advertised on TV, in the newspaper or on social media,” he advises. “We are often the first port of call for advice in community pharmacy for someone wanting a trusted healthcare opinion on whether certain products are safe, suitable and right for them. This is a great thing to get all the team involved with. Research these products with the team to make sure everyone stays aware of the indications of each product and other advice that can be given to patients to support them with their personal health journey.” 

Calorie labelling for restaurant menus 

Calorie labelling on menus is to be introduced in larger cafés, restaurants and takeaways in England from April 2022. The Government’s aim is to ensure people have access to accurate information about the food and drink they order.

Public health minister Jo Churchill says: “Our aim is to make it as easy as possible for people to make healthier food choices for themselves and their families, both in restaurants and at home.”

But the eating disorders charity Beat warns that there is clear evidence that calorie counts on menus exacerbate eating disorders. Beat’s chief executive Andrew Radford says: “Although we recognise the importance of reducing obesity, research shows that anti-obesity campaigns that focus on weight instead of health are counter-productive, while the number of calories consumed is not a reliable indicator of health.” 

Sensitive conversations

Issues such as weight management can be a sensitive topic for some, and broaching these conversations with customers in an empathetic and open-minded way is crucial. TM’s experts have these top tips for pharmacy teams:

Briony Cox, pharmacist at LloydsPharmacy Inside Sainsbury’s in Frome, Somerset

“Look out for opportunities to start the conversation, such as linking in talking about a healthy diet alongside a sale of vitamins. Handing out leaflets and talking through what services the pharmacy provides, including free healthy lifestyle advice, can also be a good starting point. Use healthy living pharmacy boards to focus on diet and weight management, with leaflets and visual aids to grab people’s attention.”

Carrie Ruxton, dietitian at the Health and Food Supplements Information Service

“Be a listening ear. If a customer could benefit from a chat about diet and weight, open the discussion in a respectful and non-judgmental way. For example, ask the customer if they want to talk about their health, diet and weight. Prefer terms like ‘weight’ rather than ‘BMI’, which they may not understand. Avoid terms like ‘fatness’, ‘too fat’ and ‘obesity’. Explain the health risks associated with weight. Keep the door open to further discussions.” 

Ben Parker, pharmacist manager at Well Pharmacy in Martock, Somerset

“If a patient is looking at nutritional products or weight loss items, don’t be afraid to speak to them respectfully, ensuring that the focus of the conversation is centred on what they want to achieve. Use the pharmacy’s consultation room to make sure the patient can speak freely without being overheard in the pharmacy, as this can often be a very personal exchange. Be sensitive in the words and phrases used.”