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CONTINUING PROFESSIONAL DEVELOPMENT
Overweight obesity and
BY KATIE BROOKES
Mrs M is a 70-year-old lady who lives alone. She has a medical history
• type 2 diabetes mellitus
• gastro-oesophageal reflux disease (GORD)
• chronic obstructive pulmonary disease (COPD).
Mrs M’s medicines
Mrs M’s weight has steadily increased
in recent years to a maximum of 94 kg
despite the fact that she walks to
complete her weekly tasks, such as
walking to the local shops. She is
160 cm, resulting in a body mass
index (BMI) of 36 kg/m2
. Her waist
circumference is 101 cm. Recently Mrs
M has lost ‘a couple of kilos’, which she
attributes to being more conscious
about her diet. Mrs M’s most recent
blood pressure was 137/84 mmHg,
recorded by her GP approximately three
months ago. Her most recent HbA1c
was 6% (42 mmol/mol), however it had
been about nine months since this was
measured. An isolated blood glucose
level was 10.3 mmol/L, measured
six months ago. Mrs M has stopped
self-monitoring her blood glucose,
as she said the meter had stopped
working and she wasn’t yet able to
purchase another one.
Cholesterol levels nine months
HDL – 1.5 mmol/L
LDL – 2.2 mmol/L
Total Cholesterol – 4.8 mmol/L
Triglycerides – 2.3 mmol/L.
Mrs M has a good understanding of the
purpose of her medications but was
not sure how they all work to undertake
their effects. Mrs M had good adherence
to taking all of her medications except
for tiotropium which she was taking at
night. Celecoxib was used infrequently
as confirmed by her dispensing history.
Mrs M’s greatest concerns (in order of
priority) at the interview were her weight,
the number of medications she is taking,
and her current cold and chest congestion.
Overweight (BMI 25–29.9 kg/m2) and
obesity (BMI ≥30 kg/m2) contribute a
significant cost to the economy, with
the direct and indirect cost of obesity
in 2008 estimated to be $8.3 billion,
with $2.0 billion of this as a cost to the
Costs of overweight
were not calculated and therefore would
further increase this amount.
of overweight and obesity continue
to rise in Australia with three in five
Australian adults overweight or obese.
Overweight and obesity increase the risk
of cardiovascular disease, type 2 diabetes
mellitus, musculoskeletal disease, GORD,
and some cancers.
It is estimated that
there is a reduction in life-expectancy of
2–4 years in patients with a BMI of
30–35 kg/m2 and a reduction of 8–10
years in those with a BMI of 40–50 kg/m2
Overweight and weight gain are closely
associated with higher blood pressure.
Loss of weight is often associated with
a reduction in blood pressure.
reduction in body weight reduces
systolic blood pressure by an average
of 1 mmHg.
The risk of elevated blood
pressure due to excess weight is greatest
Katie Brookes is a consultant pharmacist and manager
of the Risdon Vale Pharmacy in Southern Tasmania.
After reading this article, pharmacists should be
Recognise the effect that overweight and
obesity can have on increasing the risk of
Identify disease states where a multidisciplinary
approach to weight loss may be beneficial to
Describe the mechanism by which weight loss
in overweight or obese patients will benefit
current medical conditions.
Competency standards (2010) addressed:1.3, 4.2,
7.1, 7.2, 7.3 .
Accreditation number: CAP150101E
Current medication being taken at the time of the interview were:
Medicine and dose
amlodipine/atorvastatin 10 mg/40 mg
1 tablet daily
celecoxib 100 mg capsules
1 capsule twice daily with food when
esomeprazole 40 mg tablets
1 tablet in the morning
frusemide 40 mg tablets
1 tablet in the morning
paracetamol 665 mg tablets
2 tablets three times daily
perindopril/indapamide 4 mg/1.25 mg tablets 1 tablet twice daily
1 teaspoon in water in the morning
salbutamol 100 mcg MDI
2 inhalations every four hours when required
sitagliptin/metformin 50 mg/850 mg tablets 1 tablet twice daily
tiotropium 18 mcg capsules
1 capsule inhaled via Handihaler daily
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