This study explored the attitudes, perceptions and experiences of women pharmacy consumers in Victoria, Australia and Nottingham, England with currently available weight management products. Overall, similar groups of women in Victoria and Nottingham were surveyed. Approximately 50% of women in Victoria (153/319; 47.9%) and Nottingham (97/188; 51.6%) were classified in the overweight or obese BMI category. The sample is slightly under-representative of the overweight and obese population, which may be explained by the use of self-reported height and weight to calculate the women’s BMI. Studies have previously shown that self-reported height tend to be overestimated and weight is underestimated
Women in Nottingham were found to have visited a health care professional in the last 12 months, significantly less than women in Victoria. In Nottingham, close to 50% of women reported visiting their pharmacist for health advice in the last 12 months, significantly less (P < 0.001) than the women in Victoria. In England, it is estimated that 95% of the population visit their community pharmacy once a year
. Pharmacy visits are not always related to health and can be for non-medicine purchasers such as toiletries. Our result indicates that visits to the pharmacy may still be associated with prescription drop-off and pick-up rather than a location to receive health care advice. Women who had visited the pharmacist to seek health advice in the last 12 months were significantly more likely to want a pharmacist involved in their ideal weight management program or for their ideal weight management program to be located in a pharmacy. This is in line with previous studies that found people who have had positive experiences with pharmacy services are more likely to feel comfortable approaching pharmacists about health advice
[30, 31]. Um et al.
 also highlighted that members of the general public were more likely to indicate pharmacies as a potential weight management program location if they had previously received weight management advice by their community pharmacist
. Collectively, these results highlight the importance of promoting pharmacists as public health advisors.
Women in Victoria were significantly more likely to be able to demonstrate an understanding of what the benefits of weight loss are in an overweight or obese person. This could be due to the population group in Victoria being significantly more tertiary educated than the women in Nottingham. Decreased blood pressure was the least recognised benefit of weight loss in both women in Victoria and Nottingham. This result is similar to a study conducted in Germany that found obese individuals aged 50–62 were significantly more likely to underestimate their risks of arthritis and hypertension
; thus, indicating that people may not understand the importance of weight control on blood pressure and health in general. Pharmacists are in an ideal position to provide information and awareness regarding the benefits of weight loss in an overweight or obese person. Pharmacists should include brief diet and exercise counselling when they first dispense a medication for a condition related to overweight and obesity including commonly dispensed antihypertensive medications. Pharmacists should also reinforce these weight management recommendations with repeat medication dispensing every three to six months. This would encourage a wider understanding of the benefits of weight loss on an overweight or obese person’s health, and for individuals who are in the healthy weight category it would provide a greater understanding of the importance of weight maintenance.
Over 70% of both groups had attempted to lose weight in the past. As in other studies, diet and exercise were commonly used to help achieve weight loss
[33–36]. In Victoria, women were significantly more likely to utilise physical activity as part of their weight management strategy compared to women in Nottingham (P < 0.001). Reasons for this finding may include the differences in demographics; women in Victoria were more likely to be educated to a higher level and thus may recognise the importance of including physical activity in a weight management program more readily than the women in Nottingham
. Other reasons may include the differences in locations and differences in weather patterns; women in Victoria may be exposed to more parks and outdoor exercise options than women in Nottingham.
Women in Victoria were significantly more likely to utilise pharmacy based programs in the last five years compared to women in Nottingham (P = 0.006). A recent review in Australia revealed 13 different pharmacy weight management programs
. The differences between the number of women utilising pharmacy weight management programs in Victoria and Nottingham could be related to the types of pharmacies in which women were surveyed. In Nottingham, women were surveyed only at independently owned pharmacies, whereas in Victoria both privately owned pharmacies and those that are part of a buying group were visited. Women pharmacy consumers surveyed in pharmacies that are part of a group may have utilised pharmacy-based weight management programs more frequently, as many of these programs are run through pharmacy groups and are not available through privately owned pharmacies. Compared to other studies investigating weight management strategies, women in this study were more likely to state that they had utilised herbal products to assist in weight loss in the last five years
[33–35]. This could be due to the population sampled. Women pharmacy consumers may be more influenced by the types of products pharmacies sell and thus may be more likely to utilise pharmacy based weight management programs or herbal products compared to the general population.
The weight loss goals, weight loss attainment and duration of the last weight loss attempts differed between the two population groups. Compared to women in Victoria, women in Nottingham were significantly more likely to want to lose more than 10 kgs in their last weight loss attempt (P < 0.001), were significantly more likely to have lost more than 10 kgs (P < 0.001) and were significantly more likely to use their last weight loss method for longer than six months (P = 0.002). Weight loss goal setting has been shown to be a positive influence on achieving weight loss, with national guidelines advising that individuals be encouraged to set realistic weight loss goals (5-10% of their body weight) prior to commencing a weight loss approach
[6, 8]. Women in Nottingham were also significantly more likely to utilise weight loss support meetings in their weight loss attempt compared to women in Victoria, a strategy that has been shown to achieve more weight loss than diet and/or exercise alone
[39, 40]. These meetings offer a support network, and provide participants with an environment to learn about different foods, calorie intakes, exercise activities, goal setting, behavioural modification techniques and motivational strategies. Pharmacists and other health care providers can play a role in helping women set realistic weight management goals, offering motivational techniques and strategies to help change behaviour. Pharmacists also see individuals on a regular basis and thus can play a special role in supporting them throughout their weight loss journey. Maher et al. found that women viewed pharmacies as a convenient location to receive nutrition advice but highlighted the need to change pharmacy settings, so that they are able to have a more active and supportive role in health prevention
Women in Victoria were significantly more likely to have received advice in their last weight loss attempt from any health care professional (P = 0.001). Nevertheless, the majority of women in both population groups had not received any advice from their health care professional. Primary health care providers are in a special position to offer women weight loss advice. Studies have shown that individuals who have received advice from a health care professional are more likely to be successful in their weight loss approaches
[42, 43]. Pharmacists, unlike other primary health care providers, also come into contact with both healthy and non-healthy individuals and thus are able to interact with a large population group. Unlike results reported in other studies, women in Nottingham and Victoria felt comfortable receiving advice from their community pharmacist regarding weight management [24, 25_ENREF_25, 30]. The difference may be due to the population group in this study being solely pharmacy consumers, already exposed to the pharmacy environment and likely to be more receptive to receiving advice from their pharmacist. Nevertheless, this shows that pharmacists should feel comfortable offering weight management advice to their consumers. Studies have shown that pharmacists and pharmacy staff may feel uncomfortable providing weight management advice to their consumers due to their lack of training
[19, 21, 22, 44]. Increased pharmacy-specific training and education in weight management strategies has been highlighted as an important strategy to improve pharmacy involvement in weight management
Overall, women in Victoria and Nottingham had similar ideas on what they wanted in their ideal weight management program. There were however, some reported differences; women in Nottingham were significantly less likely to want a health care professional involved in their ideal weight management program compared to women in Victoria (P = 0.008). Women in Nottingham were less likely to have received advice from a health care professional in their last weight loss attempt compared to women in Victoria (P = 0.001), this may explain why women in Nottingham were more likely to not want any health care professionals in their ideal weight management program. Women in Nottingham may not understand the benefits of having a health care professional as part of their weight management program. In addition, women in Victoria were significantly more likely to want their ideal weight management program to be located in a pharmacy compared to women in Nottingham (P = 0.001). This may be attributed to more women in Victoria having previously tried a pharmacy weight management program in their last weight loss attempt, for this reason women in Victoria may be more familiar or more accepting of weight management programs located in community pharmacies. Although there were some differences the majority of the women in both Victoria and Nottingham wanted advice to be received face-to-face, involve a multi-disciplinary health care team with doctors, dieticians, pharmacists and exercise consultants, and for the program to be available at a convenient location.
Finally, the results from this study have shown that future weight management educational resources developed for women pharmacy consumers in Australia or England have the potential to be used in either country. Furthermore, community pharmacies in countries other than Australia and England may also benefit from pharmacy weight management educational resources to assist pharmacy staff counsel women pharmacy consumers seeking weight management advice. Recently, Richard H. Carmona (17th Surgeon General) in the United States of America, highlighted the importance of pharmacists being involved in chronic disease management and the provision of healthy lifestyle advice
. He emphasised that pharmacists are in an ideal position to be health coaches to their consumers
. The results from this study have illustrated that women pharmacy consumers in both Victoria and Nottingham are comfortable with pharmacists being involved in the provision of weight management recommendations and have also illustrated the areas in which, women pharmacy consumers need additional advice. Future educational resources for both populations should focus on evidence-based weight management approaches, weight loss goals, weight loss duration and benefits of weight loss. These results may also be used to guide other countries similar to Australia and England to develop their own pharmacy weight management educational resources.
This study only surveyed women pharmacy consumers and thus one of its limitations includes the potential bias towards pharmacy involvement in weight management. A further limitation of this study is that the questionnaires relied on participants remembering information regarding their last weight loss attempt and thus recall bias may be present. The results are, however, similar to other studies that have surveyed the general population regarding previous weight loss experiences
[33, 46, 47].