Setting Up an Obesity Program: Importance of Having a Diagnostic and Consultant Network

Irrespective of what services you can integrate into your obesity clinic, there will always be issues that require consultation with other specialists or require diagnostic procedures outside your clinic. Or, as I learnt early in my medical practice, the two most important skills of being a good doctor are knowing when to consult a colleague and knowing who to consult. 

Areas in which any obesity clinic will most likely need regular consult services include psychiatry, sleep medicine, gastrointestinal medicine and hepatology, thrombosis, uro-gynaecology, respiratory medicine, cardiology, orthopaedic surgery, plastic surgery and a few others. Common diagnostic requirements will include ultrasounds, cardiac testing, CTs, MRIs, etc. 

In all cases, you will find colleagues who are happy to see patients with obesity and those who are not. You will also find that certain diagnostic procedures have technical or weight limitations for patients with obesity.

Ideally you would be able to identify at least one colleague in each of these disciplines who will welcome patients with obesity into their clinics and are willing to work closely with you in helping your patients deal with these issues. 

Be aware that it may take time for colleagues to recognise and adapt to the special needs of this population. Not everyone is comfortable practicing bariatric psychiatry, bariatric cardiology, or bariatric plastic surgery. Over time, hopefully, these colleagues will come to appreciate the issues specific to patients with obesity. 

A good source of determining whether or not your patients with obesity are welcomed and well treated are your patients themselves. Sometimes patients will complain about a specific consultant or practice and in my experience it is often worthwhile bringing this to their attention, as they may be unaware of how their attitude or statements are being received. Sometimes the complaints may not be about the colleagues themselves but rather about their clinic personnel or even just about the ambience and infrastructure.  Many colleagues will thank you for this feedback and many will change their practice. In cases where patients continue to complain, you may be better off looking for a new consultant for that specific issue. 

One important reason for having competent consultants at hand is, because patients presenting at an obesity centre may often have problems that need to be dealt with before you can have any hope of helping them manage their obesity. This includes patients with unmanaged or uncontrolled psychiatric issues like depression, anxiety, or ADHD, unmanaged sleep apnea, chronic pain, unmanaged reflux disease, and many more, where these conditions can be significant barriers to obesity management. 

Thus, as you set up your obesity centre be prepared to proactively create and cultivate your own network of consultants, without which you will find managing obesity even more challenging than it already is. 

@DrSharma
Berlin, D