How to provide semaglutide for ethical weight-loss

Taking time to understand a patient’s weight loss goals and checking their medical history to ensure there are no underlying problems that may need onward referral are both key elements of an ethical weight-management service, says Deborah Evans, Superintendent Pharmacist and Clinic Director at Remedi Health.

“At Remedi Health we take a full clinical history and we take time to question and listen to an individual’s weight issues – what they’ve tried before, what’s worked – and their understanding of how this particular medication might work for them. We check that there are no contraindications and that they are not on any medicines that might be an issue. We may also undertake further diagnostic testing to see whether there are any other underlying reasons for gaining or not being able to lose weight, for example, hormonal issues such as low thyroid [function] or if they’re going through the menopause”, explains Ms Evans. Checks for high blood pressure and pre-diabetes/diabetes are also made, in case an onward referral is required.

Once again Ms Evans emphasises that weight loss with semaglutide is not a quick fix and should be the result of an informed decision by the patient. “We use behavioural techniques to support them in whatever change they want to [make] and make sure that this is part of a broader health and well-being approach so that they can adopt these practices in the long term.  We will always explain the benefits, risks and side effects. At the end of the day this is a joint decision. It’s very person-centred and they need to decide that this is something that they want to embark on. It’s not cheap – it’s an expensive treatment – and it could make them feel really quite unwell to start off with. People describe feeling nauseous [and] having headaches as they titrate up their medicine. One of my clients [has] experienced quite a significant amount of reflux and discomfort which means she can’t eat after four o’clock in the afternoon – so it is important to recognize that it can take a while to get to a therapeutic dose and that you have to potentially go through some side effects before you get to somewhere that your body’s comfortable with”, she says.

In addition, practical details are important, such as training people in the administration technique and agreeing a regular follow-up schedule.  “We’ll also check with them about how frequently they want to come in and be weighed and to talk about progress – how they overcome some of the barriers. A lot of clients will talk about how this makes them more accountable to their program and supports weight loss going forward”, says Ms Evans.

The NICE technology appraisal for semaglutide recommends that the drug should be used (at NHS expense) within a specialist weight management service providing multidisciplinary management of overweight. Remedi Health is able to offer a range of support services to “support an individual across the board”.  “What’s important, I think, is to understand where my competence ends and somebody else needs to begin. So, we can make referrals to their GP or to other private practitioners including an endocrinologist who works with us”, she adds.

Clinical governance

When a community pharmacy offers a weight management service, including the supply of semaglutide, it is important to ensure that appropriate safeguards are in place. This is especially important when the medicine has not been available for long and long-term safety data are lacking. “We need to make sure that we’re safeguarding our patients and making sure that everything that we do is appropriately documented and supported with evidence.”, says Ms Evans. For prescribing pharmacists this means that they must be working within their field of competence and are able to provide evidence of the training undertaken, she explains. “We also need to engage our patient in the decision regarding prescribing so that they’re fully informed of risks and benefits and that’s particularly important …… because if it’s Ozempic that we’re providing, it is off-label”, she adds. In addition, detailed records of batch numbers and expiry dates need to be kept.

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