Administrative Support: Buy-In and Enthusiasm

Now that I have discussed some of the “Big Picture” barriers that need to be considered when thinking about setting up an obesity program, it is time to take a deeper dive into the challenge of harnessing administrative enthusiasm and support.

Obviously, for folks in the private sector, who are their own bosses and can pretty much do whatever they want, this topic is not of relevance. However, for those of us working in health systems, public or private, where funders, governing boards, administrators, business managers, and accountants have their say in what services are to be delivered, obesity programs are not an easy sell. 

Although everyone is by now aware of the rising prevalence of obesity and its impact on health, most administrators (like most people) have little understanding of the complexity of the field. Indeed, many still don’t consider obesity a chronic disease or see the need for programs that go beyond providing some education and encouragement to eat a healthier diet and to be more physically active. Given that there is always a shortage of funding in health systems, weighing investments into this new area of medicine against investments in other, more established disease areas (all of which have their demands), is anything but straightforward. 

One approach to getting interest from administrators may require making a case for obesity care that either promises a new revenue stream or cost-savings in other areas. However, in my experience, neither attractive revenue streams nor significant savings within the health system are easily demonstrable, especially over shorter time frames (e.g. 3-5 years). This is because setting up and running a high-quality and effective obesity program will require significant up-front investments in space and ongoing expenditures in personnel, with little immediate return on investment other than hopefully improving the health of patients living with obesity. Thus, trying to “sell” obesity programs to administrators using financial arguments is generally a difficult prospect. 

There are of course exceptions. Thus, for example, in public systems, when governments make separate streams of targeted funding available for obesity programs, hospital administrators may sense an additional source of revenue. For e.g. a few years ago, when the Ontario Ministry of Health announced a separate funding envelope for creating bariatric surgical programs, several hospitals in Ontario (almost overnight) developed a keen interest in setting up such programs. Indeed, even in the private sector, bariatric surgery programs, in contrast to medical programs, can open new profitable revenue streams, which may explain the proliferation of private surgical programs at least in some jurisdictions. 

Rather than presenting obesity programs as a new “profit centre”, I have had some success with administrators, when I got them to buy into the human cost of obesity and recognise that these patients need medical care in their own right, similar to patients presenting with any other health problem. Once I can get administrators to appreciate the unmet need presented by this patient population, I have, on occasion, sensed a more supportive attitude to the notion of setting up an obesity program. Indeed, I have even seen administrators become enthusiastic champions for setting up obesity programs, not because they anticipate additional revenue or cost-savings, but simply because they are convinced that this underserved patient populations needs access to such services. 

There is absolutely no doubt that having enthusiastic administrative support goes a long way in easing the path to setting up an obesity program – in contrast, without at least some level of administrative buy-in, setting up a viable program is virtually impossible and will probably not prove rewarding professionally or otherwise. 

Thus, as a first step for anyone considering setting up an obesity program, it is essential to gauge high-level administrative interest and support for such an endeavour before investing too much time and effort in an enterprise that may lead nowhere. 

Berlin, D