Consumer perspectives about weight management services in a community pharmacy setting in NSW, Australia

Abstract

Background  Obesity is a public health challenge faced worldwide. Community pharmacists may be well placed to manage Australia’s obesity problem owing to their training, accessibility and trustworthiness. However, determining consumers’ needs is vital to the development of any new services or the evaluation of existing services.

Objective  To explore Australian consumers’ perspectives regarding weight management services in the community pharmacy setting, including their past experiences and willingness to pay for a specific pharmacy‐based service.

Design  An online cross‐sectional consumer survey was distributed through a marketing research company. The survey instrument comprised open‐ended and closed questions exploring consumers’ experiences of and preferences for weight management services in pharmacy. It also included an attitudinal measure, the Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale.

Setting and participants  A total of 403 consumers from New South Wales, Australia, completed the survey.

Results  The majority of respondents had previously not sought a pharmacist’s advice regarding weight management. Those who had previously consulted a pharmacist were more willing to pay for and support pharmacy‐based services in the future. Most consumers considered pharmacists’ motivations to provide advice related to gaining profit from selling a product and expressed concerns about the perceived conflicts of interest. Participants also perceived pharmacists as lacking expertise and time.

Conclusion  Although Australian consumers were willing to seek pharmacists’ advice about weight management, they perceived several barriers to the provision of weight management services in community pharmacy. If barriers are addressed, community pharmacies could be a viable and accessible setting to manage obesity.

Background

Obesity is a chronic disease which is one of the most significant public health challenges faced worldwide. It has reached epidemic proportions in both developed and developing countries, including Australia. ¹ Obesity is defined as a body mass index (BMI) (kg/m²) of 30 or more, and overweight is defined as a BMI of 25–30. ¹ However, BMI cut‐offs differ for Asians, Indians and other ethnic groups. Additionally, waist circumference is considered a useful measure of fat distribution and disease risk. Therefore, a combination of measures should be used. In 2007, the Organization for Economic Cooperation and Development found that Australia had the fifth highest rate of adult obesity in the world; approximately 68% of adult men and 55% of adult women were overweight or obese in 2007. ² , ³ It was estimated that the overall cost of obesity to Australian society and governments was AU$ 58.2 billion in 2008 alone. ² This estimate includes productivity costs, direct financial costs to the Australian health system and the net cost of lost well‐being.

Excess weight predisposes individuals to develop metabolic abnormalities and increases their risk of multiple chronic diseases. ² , ⁴ In Australia, obesity is responsible for causing almost one‐quarter of type 2 diabetes and osteoarthritis and around one‐fifth of cardiovascular disease and colorectal, breast, uterine and kidney cancer. ² A modest reduction of 5–10% in body weight may be sufficient to favourably affect cardiovascular risk factors, essentially reducing morbidity and improving quality of life. ⁵

Primary health care has been identified as a crucial setting for managing Australia’s obesity epidemic. ⁴ Pharmacists are knowledgeable and trustworthy healthcare professionals who are currently underutilized in the Australian primary healthcare team. ⁶ Community pharmacies are considered an excellent setting in other countries such as the United Kingdom for providing weight management services owing to their accessibility and opportunity to capture those who are not motivated to use other health services. ⁷ It is estimated that over 90% of the Australian population visit a pharmacy during 1 year. ⁸ Australian pharmacists are now extending their role from dispensing medicines to providing a broad range of health promotion services. ⁹ In a recent qualitative study, twenty interviewed Australian pharmacists unanimously expressed a keen interest in assuming more influential roles in weight management. ¹⁰

Previous studies have provided some evidence that pharmacists’ involvement in weight management is associated with positive outcomes. In 2007, the Coventry Primary Care Trust funded a pilot weight management service delivered in ten pharmacies in Coventry. ¹¹ The service included initial consultation and assessment by a pharmacist, monitoring of weight, BMI, waist circumference and other health indicators such as blood pressure, blood glucose and cholesterol and ten follow‐up sessions. Of the 34 patients who had completed the service over a 12‐month period, 26.5% had achieved a weight loss ≥5% of their initial weight. However, this study used single‐group repeated measures design with no control group, and only 34 of the 160 patients recruited completed the service.

Similarly, pharmacists were involved in delivering a weight management programme, which comprised an initial assessment and follow‐up consultations, in a pharmaceutical care centre on a college campus in the United States of America (USA) between 1996 and 2006. ¹² A retrospective review of the data showed 226 patients achieved a mean individual weight loss of 3.6 kg at 26 weeks. Improvements in blood pressure and triglyceride concentrations were also demonstrated. However, as this study was a retrospective analysis and used single‐group pre‐test post‐test design, the cause–effect relationship between the programme and outcomes may be unreliable.

Many Australian pharmacies supply over‐the‐counter weight loss products or have implemented weight loss programmes as part of their pharmacy business. ¹³ Australia’s National Pharmacy Database Project found 20–40% of pharmacies offered weight management services in 2002. ⁹ The majority of these programmes provided in pharmacies are product‐based, typically involving meal‐replacement products or diet‐assisting supplements. ¹⁴ Lifestyle issues are addressed to some extent; however, this is primarily to supplement the sale of products. ¹⁴

Weight loss products are very popular; however, they usually result in large short‐term weight changes that are not sustainable long‐term. ⁵ These products require minimal legislation, which has added to the growing scepticism about the lack of evidence regarding the safety and effectiveness of the available products. ¹⁵ , ¹⁶ Pharmacists have also come under scrutiny, as anecdotally in the public media; some consumers have expressed concerns about the perceived conflicts of interest of pharmacists selling such products to increase their profit margin. ¹⁷ In addition, studies conducted in the UK have suggested that consumers were not willing to discuss healthy eating with pharmacists as they did not see this as part of the role of the pharmacist or that it did not occur to them that pharmacists could provide such advice. ¹⁸ , ¹⁹

To date, Australian pharmacists have expressed strong interest in developing pharmacy‐based weight management services in the community. ¹⁰ However, no prior studies have explored Australian consumers’ perspectives. Feedback from the public is an important component in the design of any new services or the evaluation of existing services. Therefore, the aim of this study was to elicit consumer perspectives regarding weight management services in the community pharmacy setting in New South Wales (NSW), Australia. The objectives of this study were:

• 1To explore consumers’ opinions about seeking help for weight management.
• 2To explore consumers’ views of and experiences with weight management services offered in pharmacies.
• 3To investigate consumers’ willingness to pay for weight management services in a pharmacy.
• 4To validate a measure of Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale.

Methods

Ethics approval was obtained from the Human Research Ethics Committee of the University of Sydney, in 2010.

Survey instrument

An electronic self‐completion survey (e‐survey) was designed to explore the study’s objectives. The e‐survey method was chosen for ease of access by potential participants, to overcome the difficulty in recruiting sufficient numbers of randomly selected consumers and to alleviate costs related to printing and distribution of hard‐copy surveys.

The topics to be addressed in the survey were based on the literature and explorative in nature. The survey was initially pilot‐tested with a number of randomly selected consumers at a community pharmacy (n = 12), and with minor adjustments, was considered to meet face and content validity. The survey consisted of five components and ten questions (Appendix 1): (i) an open‐ended question about seeking help for weight management; (ii) closed and open‐ended questions about experiences with weight management services offered in pharmacies; (iii) closed questions related to pharmacists’ motivations to deliver weight management advice; (iv) open‐ended questions about the advantages and disadvantages of pharmacy‐based weight management services; (v) the CAPWMS scale, comprising six items measured on a five‐point Likert scale from ‘1’ strongly agree to ‘5’ strongly disagree. The CAPWMS scale was developed as a measure of consumers’ attitudes to the delivery of weight management services in pharmacies.

Sample and data collection

An online marketing research company (Pureprofile), with a sample of adult Australian consumers (N = 197 579) voluntarily enrolled on their database, was employed to distribute the e‐survey during October 2010, without the involvement of the researchers.

A significant sample size of 383 was estimated using the following formula:

• 1 N = Population size 197 579
• 2 Z = Z value corresponding to α error, α is 0.025 so Z value is 1.96
• 3P = Proportion of those predicted to have used pharmacy services in the past which is 0.20
• 4E = Error is 0.04

Participants were included if they were over 18 years of age and lived in New South Wales (NSW). A 25% response rate was assumed, and Pureprofile were asked by the researchers to randomly select 1600 consumers enrolled on their database who would fit the criteria. Pureprofile sent the selected consumers reminders until the sample size was reached, which took 3 days. Participants were provided with an electronic version of the Participant Information Statement outlining the purpose of the survey. All responses were de‐identified.

Quantitative data analysis

Descriptive statistics including the means, medians, standard deviations and frequency distributions were generated to describe the sample characteristics, experiences with weight management services in pharmacy, willingness to pay and attitudinal responses.

Factor analysis using principal components analysis with Varimax rotation was used to investigate the dimensionality of the CAPWMS scale (Appendix 1 – Question 6). A Kaiser–Meyer–Olkin measure of sampling adequacy was calculated to determine the extent to which variables correlated together and were appropriate for factor analysis. Factors selected for rotation had Eigenvalues >1.0 and this was confirmed with the visual inspection of the Scree plot. Subscale scores corresponding to each factor were created with weighted factor scores, which were computed by summing the score on each item with a loading > 0.4 and then weighted by the number of items loading on each factor. The internal consistency of the subscales was assessed using Cronbach’s α.

Criterion validity of the CAPWMS scale was also tested by comparing mean subscale scores using independent sample Student’s t‐tests, with respondents’ past experiences, future intention with respect to a pharmacy‐based service and perceived pharmacists’ motivations including profit from selling product, improving clients’ health and providing a professional service. Statistical significance was set at P < 0.05. We hypothesized that consumers who had past experiences with a pharmacist would be more supportive of a pharmacy‐based weight management service, and those who perceived pharmacists’ motivations to be profit‐driven would be more unfavourable towards such services. All analyses were conducted using the IBM SPSS Statistics 10 program (SPSS Inc., Chicago, IL, USA).

Qualitative data analysis

Qualitative data were analysed using the QSR NVivo 8 program (QSR International Pty Ltd, Doncaster, Vic., Australia). An iterative process was used to derive the codes and themes, which were then compared with the literature. Any emerging themes were discussed within the research team, until consensus was reached.

Results

Participants and responses

In total 403 consumers completed the survey (response rate 25.2%), 51% of them were women and 49% were men. The median age of the participants in this study was 39 years (range, 18–68 years old). A summary of results is provided in Table 1.

Table 1.

Participant responses

Items for which a closed response was elicited	Yes (%)
Sought pharmacist’s advice regarding weight management in the past	13.9
Type of weight management advice sought from a pharmacist:*
About a product	85.7
Nutrition	25.0
Exercise	7.1
Monitoring	5.4
Form of provision of pharmacist’s advice on weight management:*
One‐on‐one consultation	78.6
Written information	25.0
Group session	1.8
Pharmacists’ motivations to deliver weight management advice:
Profit from selling product	63.5
Improve clients’ health	45.7
Provide professional service	44.9
Weight product advertisements and promotions help me make decisions	29.5
Willing to seek pharmacist’s help for weight management in the future†	36.4
Amount you would pay for a specific weight management programme, with six or more half‐hour sessions:
Nothing	49.6
AU$ 10	24.1
AU$ 20	13.2
AU$ 30	10.4
AU$ 40	1.0
AU$ 50	2.0

*Answered by 56 participants (only those who had sought the advice of a pharmacist regarding weight management in the past).

^†Percentages do not total 100 because of missing responses, 56 (13.9%) did not answer.

The majority of consumers (86.1%) had not sought a pharmacist’s advice regarding weight management in the past. Of the 56 (13.9%) participants who had previous contact, product advice followed by nutrition was the most commonly sought information; few consumers sought advice about exercise or monitoring. One‐on‐one consultation was the main form of the pharmacist’s advice. Consumers’ perceptions of the quality of the advice provided and the satisfaction of the interaction with the pharmacists were given a mean rating of 3.5/5. However, of these past experiences, only half of these participants were served by a pharmacist, with the remainder being served by a pharmacy assistant or both assistant and pharmacist.

Most consumers believed that pharmacists’ motivations to provide weight management services was to profit from selling a product, followed by motivation to improve clients’ health and provide a professional service.

Many of those surveyed stated they would not be willing to seek pharmacists’ help for weight management in the future. Moreover, only a third of the participants thought that the community pharmacy is a suitable environment for the provision of weight management services and the pharmacist has the skills to offer a service (Table 2). Almost half of the participants were not willing to pay for a pharmacy‐based weight management programme; however, some were willing to pay up to AU$ 50 per session with a median of AU$ 10 (Table 1).

Table 2.

Participant responses to Consumer Attitude to Pharmacy Weight Management Services (CAPWMS) scale and factor loadings^*,†

CAPWMS scale items	Strength of agreement (%)*			Factor†
	Strongly agree and agree	Neither agree nor disagree	Strongly disagree and disagree	1	2
Support for Service
I think the community pharmacy is a suitable environment for the provision of weight management services	30.3	42.4	27.3	0.786
I think the pharmacist has the skills to offer a weight management service	33.5	36.5	30.0	0.812
I think a pharmacist should provide a dedicated weight management programme to clients	29.0	36.0	35.0	0.774
Willingness to Pay
I would be willing to pay for personal weight management advice from the pharmacist	17.4	28.5	34.1		0.771
I would be willing to pay for the pharmacist to refer me to another expert if needed for weight management purposes (such as a dietician)	26.6	28.0	45.4		0.870
I would be willing to pay for a pharmacist to monitor my weight management regularly	19.4	33.0	47.6		0.840

*Assessed using a five‐point Likert scale: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 5 = Strongly Disagree.

^†Higher loadings on each factor have been provided.

Factor analysis results

The Kaiser–Meyer–Olkin measure of sampling adequacy for the factor analysis was 0.80, indicating appropriateness for factor analysis. Using the criterion of an Eigenvalue >1.0, two factors were extracted. The items included in each factor are shown in Table 2. The first factor labelled ‘Support for Service’ consisted of high loading items on Factor 1. The second factor labelled ‘Willingness to Pay’ consisted of three other items with high loadings on Factor 2. The internal consistencies of both subscales (factor scores), as measured by Cronbach’s α, were 0.87 and 0.84, respectively, which indicated strong reliability.

The results of the comparison of subscale scores with respondents’ past experiences and future intention with respect to a pharmacy‐based service showed that participants who had sought a pharmacist’s advice on weight management in the past and those who would seek a pharmacist’s help in the future were more favourable towards a pharmacy‐based service and willing to pay for these services (Table 3). Similarly, consumers who thought pharmacists’ motivations were to improve clients’ health and provide a professional service were also more favourable. However, participants who felt pharmacists’ motivations to be profit‐driven from selling product were unfavourable towards pharmacy‐based services and were less willing to pay. These results supported the criterion validity of the CAPWMS scale.

Table 3.

Mean scores for ‘Support for Service’ and ‘Willingness to Pay’ scales^*,†

Items	Support for Service			Willingness to Pay
	Response	Mean scores†	Sig.	Mean scores†	Sig.
Sought pharmacist’s advice regarding weight management in the past	Yes	2.48	0.00	3.14	0.01
	No	3.09		3.51
Willing to seek pharmacist’s help for weight management in the future	Yes	2.57	0.00	3.06	0.00
	No	3.47		3.83
Pharmacists’ motivations to deliver weight management advice:
Profit from selling product	Yes	3.14	0.00	3.58	0.00
	No	2.76		3.25
Improve clients’ health	Yes	2.76	0.00	3.25	0.00
	No	3.21		3.62
Provide professional service	Yes	2.69	0.00	3.18	0.00
	No	3.25		3.68

*Measured on a five‐point Likert scale: 1 = ‘Strongly Agree’, 2 = ‘Agree’, 3 = ‘Neither Agree nor Disagree’, 5 = ‘Strongly Disagree’.

^†Equal variances assumed.

Qualitative results

All 403 consumer participants provided comments for the open‐ended questions. Two major themes emerged from the qualitative analyses, which are described below with illustrative quotes.

Advantages of a pharmacy‐based weight management service

Accessibility was commonly cited to be a facilitator in a pharmacy‐based weight management service. A notable result was that consumers felt community pharmacies were conveniently located, allowing for regular contact and counselling.

Pharmacies are convenient and easily accessible to most people, [it] might encourage people to manage weight who hadn’t thought about it but were there on unrelated health issues.

[Survey no. 398]

Furthermore, a considerable number of consumers thought such services build on the trusting relationship shared between pharmacist and patient and viewed it to be easier to discuss weight issues with a pharmacist compared to a general practitioner.

People often already have a relationship with and trust their pharmacists; I think it would be more comfortable.

[Survey no. 397]

Consumers tended to value the expertise of healthcare professionals; however, they generally did not consider pharmacists to have the knowledge or training in nutrition or exercise compared to dieticians or exercise physiologists, respectively. Rather, pharmacists were considered to have the ability and experience in referring when necessary to the appropriate healthcare professional.

Pharmacists are not dedicated solely to weight management, so it’s not their area of expertise.

[Survey no. 158]

Trained to refer you to specialists.

[Survey no. 49]

Consumer needs

Consumers proposed what they considered to be in an ideal pharmacy‐based weight management service. They predominantly recognized weight loss and management needed a collaborative approach involving various healthcare professionals specializing in their own fields. They also recognized pharmacists did not have the appropriate training and accreditation.

With a qualified nutritionist who can advise on how to eat better and with a qualified personal trainer and also with a doctor‐ together, I can work with them to lose and manage my weight.

[Survey no. 226]

… I would have to be assured that the pharmacist had the relevant knowledge available.

[Survey no. 181]

Generally, consumers wanted pharmacists to conduct regular monitoring to keep track of their progress including weight measurements and other indicators such as cholesterol and blood glucose levels. While a few consumers expressed a pharmacist’s role should extend to providing motivational support and assisting in goal setting.

… monitoring my progress and other related measurable health indicators such as cholesterol and blood sugar levels…

[Survey no. 403]

Provide me with support and help me to keep on track.

[Survey no. 129]

Importantly however, many raised the importance of confidentiality and privacy when dealing with weight issues. Furthermore, some pharmacists were perceived to be unable to provide comprehensive advice because of time constraints.

It is all a bit public at the average pharmacy. I would think that a service such as weighing and monitoring progress would need to be conducted in a screened area to be successful.

[Survey no. 117]

Most pharmacists seem extremely busy; I don’t know that they would have time.

[Survey no. 391]

Discussion

In this study, we explored consumers’ attitudes and views of pharmacists’ involvement in weight management initiatives. While few had sought a pharmacist’s advice about weight management in the past, 36% of participants stated they would be willing to seek a pharmacist’s advice about it in the future. Our findings concord with previous research, which reported that the public do not recognize the extent of pharmacists’ training and skills and view them as shopkeepers and not as health educators. ¹⁹ Another consumer study conducted in the UK demonstrated that the public did not consider pharmacy as their preferred point of contact for weight management. Respondents in that study also showed limited awareness of local NHS‐provided weight management programmes. ²⁰

However, a pharmacy health promotion project conducted in the UK found many customers, who had not intended to visit the pharmacy for advice, discovered that once they had received advice felt it had been of benefit. ²¹ This mirrors our results, which indicated those who had previous contact with a pharmacist regarding weight management were more supportive of the proposal for a pharmacist‐led weight management service as compared to those who had no past experience of such a service. This suggests the need to better promote pharmacists’ abilities and services to increase consumer demand and awareness. ²²

Consumers in our study considered the pharmacist’s advice is usually given free of charge, and nearly half of those surveyed were unwilling to pay for a specific pharmacy weight management service. Clients involved in a Central Lancashire pilot pharmacy weight management service (2008–2010) stated one of the reasons they liked the service was because it was free. ²³ In this particular service, although there was no direct cost to the clients involved, the pharmacy was reimbursed and received a total of GBP£ 160 per client who completed the service.

Pharmacists in Australia have previously cited that a major barrier to providing enhanced pharmacy services was the lack of remuneration to recompense them for their time and expertise. ⁹ The need for additional reimbursement was also identified as a major barrier to providing healthy weight management services by pharmacists in Scotland. ²² A solution is needed to address both consumers’ and pharmacists’ needs and to provide the most cost‐effective care. To minimize the cost to the consumer, governments may need to provide financial support to community pharmacists who provide such services. Some health insurance companies already reimburse consumers enrolled in some commercial weight loss programmes in Australia. Alternatively, such services could be introduced via stages, so consumers become accustomed to a value‐added pharmacy service and then appreciate the costs of the service.

An interesting finding of this study was the consumers’ perception of the pharmacists’ conflicts of interest in the arena of weight management. Some consumers described how a pharmacist’s advice, which should be honest and professional, may be biased in order to profit from the sale of products. Consumers who believed pharmacists’ motivations to provide weight management advice was for profit were unfavourable towards a pharmacy‐based service and were less willing to pay for the service. This perception may have contributed to the decline in patient uptake and hence poor sustainability of the Lifeweight^™ programme in Australia. Lifeweight^™ was a programme launched in 2004, specifically designed for Australian community pharmacies that combined cognitive services with the product Xenical^® (orlistat). ¹⁴ However, over time, the programme lost momentum, as it reportedly began to be perceived as being product‐based and lacking in quality of the cognitive services. ²⁴ In line with this perception, more recently, Burrell et al. ¹⁷ published an article in Choice (a consumers’ magazine produced by the Australian Consumers’ Association), which anecdotally evaluated some pharmacy‐based weight management programmes in Australia using a “shadow patient” (i.e. someone simulating the role of a patient) method with three patients. Burrell et al. ¹⁷ described the level of training as ‘grossly inadequate’ and portrayed these programmes as product‐focussed and of ‘obvious financial benefit to the pharmacies’.

There is an inherent duality of interests in the role of the pharmacist: both patient care and viability of the business need to be maintained. This is a normal state of affairs in all professions, including healthcare providers. It may be more pronounced in a community pharmacy setting as there is a sale of product involved, not just a service. The imperative in pharmacy is to separate the two aspects carefully and prioritize if there is a clash or ethical dilemma in decision making or in the provision of services.

In return for the trust and privilege a professional enjoys, society expects patient care to take priority if the duality of interest becomes somewhat of a conflict of interest. Consumers in our study expressed that they wanted the pharmacist to be knowledgeable on the safety and efficacy regarding the range of weight loss products on the market. This emphasizes the importance of unbiased practices. It is clear then that the provision of any weight management services in pharmacy should not be based on any one product and practiced with evidence‐based principles, at the same time upholding professional and ethical values in the process.

Determining the views and needs of the public to whom a pharmacy‐based weight management programme would be targeted is crucial. An advantage of our study was that the sample was considered to be reasonably representative of the NSW population. According to the Australian Bureau of Statistics, in June 2010, the median age of the NSW population was 37.2 years, and there were 98.3 men for every 100 women, ²⁵ which is similar to the sample characteristics. The other strength lies in the demonstrated criterion validity of the CAPWMS scale, which suggests that we can be confident of the validity of the participants’ responses to the survey. The six items used in the CAPWMS scale regarding consumers’ support and willingness to pay for pharmacy services were positively worded items, which may have introduced acquiescence bias. However, as the survey was administered anonymously and electronically, response bias was unlikely. This was supported by the approximately normal distribution of responses (Table 2). In the future, it will be possible to extend the scale to capture how the service may be delivered addressing both facilitators and barriers.

Pharmacists in our study were perceived to be trustworthy, accessible and generally well‐liked. The main issues highlighted were about perceived lack of appropriate training, lack of time, and/or no private consultation rooms to provide a weight management service. These barriers have been previously noted in a study of consumer views by Krska and Morecroft, who found that respondents were unwilling to use pharmacy as a source of public health advice owing to lack of privacy and space. ²⁶ It may be important to consider that not all pharmacies are suited to provide a pharmacist‐led weight management service and only those which have dedicated time and separate counselling areas should be considered.

The perceived view of pharmacists’ lack of expertise may be resolved by providing pharmacists with training to deliver such services. ²² In an evaluation of pharmacy‐based weight management services by Blenkinsopp et al. ²⁷ , the authors found a persistent theme that community pharmacists are less confident about the effectiveness of their advice when counselling obese patients. Lack of expertise was identified to be a barrier associated with less confidence in achieving positive outcomes and therefore reduced frequency in counselling obese patients. ²⁸ In addition, creating awareness among patients about pharmacists’ ability was perceived as most important in overcoming barriers. ²⁸ This indicates that upskilling and training pharmacists is a crucial requirement to deliver a weight management service. Furthermore, development of professional qualifications and accreditation processes ¹⁴ may provide pharmacists greater confidence in their ability as well as in reassuring consumers.

Participants proposed that a pharmacy‐based weight management service should take a multi‐disciplinary approach. Consumers’ recognized weight loss and maintenance requires a holistic approach and possibly incorporates various healthcare professionals such as general practitioners, dieticians and exercise physiologists. Pharmacists need to be willing to collaborate and engage in a multi‐disciplinary team, the effectiveness of which has already been shown with one weight management service called The Lifestyle Challenge Programme (USA). ²⁹ This programme was co‐directed by a pharmacist and involved a physician specializing in nutrition, a behavioural psychologist, a dietician and an exercise physiologist. ²⁹

Consumers suggested pharmacists should provide advice regularly, monitor progress and provide motivational support. A survey of Australian patients’ views on the role of general practitioners in weight management also found that patients considered regular review to be useful and they would be willing to attend for follow‐up care. ³⁰ In addition, motivational interviewing and goal‐oriented counselling made a positive contribution to one Australian rural community pharmacy‐delivered weight management service, which produced significant weight reductions and positive behavioural changes in nutrition and exercise. ³¹ It is envisaged that the design of a pharmacy‐based weight management service in the future should incorporate these elements to best meet consumers’ needs.

A recent systematic review by Gordon et al. ³² comprising 10 studies showed that community pharmacy‐based weight management interventions can produce modest weight loss from baseline; however, the authors found it difficult to draw conclusions on how to improve interventions as the studies were so variable. They concluded there is insufficient evidence for the effectiveness and cost‐effectiveness of pharmacy‐based weight management initiatives to support investment in their provision. ³² It remains to be established whether a model of weight management in pharmacy is clinically effective, financially viable or meets consumers’ needs. Any future service provision must consider these elements in its design and evaluation.

A limitation of the current study was that general demographics of the consumers participating in the study were unknown. This information could have allowed for correlations to be made.

Conclusion

Determining consumer perceptions of the pharmacist’s potential role in weight management is crucial to identify present and future needs. Australian consumers recognized that pharmacists could play a beneficial role because of their trustworthiness and accessibility. However, they did not consider pharmacists to be experts in the domain or that they have had the appropriate training and therefore were not willing to pay for specific pharmacy‐based services. If the perceived barriers presented in this study such as the perceptions of conflict of interest, lack of specialized training and dedicated consultation areas could be addressed, community pharmacies could serve as a viable setting in primary care for the management of obesity.

Sources of funding

This research received no specific grant from any funding agency in the public, commercial or not‐for‐profit sectors.

Conflicts of interest

The Author(s) declare(s) that they have no conflicts of interest to disclose.