Are We Overemphasising the Need For Multidisciplinary Obesity Management?Monday, August 16, 2021
Obesity is a heterogeneous complex chronic disease that generally requires patients to make changes to their lifestyles and perhaps deal with various psychological aspects of their mental health.
But so is diabetes, hypertension, coronary artery disease, chronic lung disease, or, for that matter, almost any chronic disease that is routinely managed in clinical practice.
Obviously, if you have a team of allied health specialists including dietitians, exercise physiologists, behavioural psychologists, occupational therapists, health educators, etc. you could probably do a much better job of managing patients with any of these diseases, than if your were sitting in your office by yourself with no more than 5-8 minutes to dedicate to each patient.
And yet, that is exactly how doctors routinely manage the vast majority of patients presenting with these diseases in their real-world practices.
And to be fair, most docs do a fairly reasonable job of managing these diseases without having the luxury of working in extended multidisciplinary health teams with support from an army of allied health practitioners.
So, why when it comes to obesity, do we suddenly expect them to harness all these resources in order to provide even the most basic obesity care?
Why, for example, do we think that it is more important to have a dietitian on my team for managing obesity, than say for managing a patient with diabetes or hypertension or dyslipidemia? Why is it more important to have an exercise specialist on my obesity team, than for my patients with coronary artery disease or heart failure? In fact, why is it more important to have a psychologist on my team for managing obesity, than it is for managing my patients with depression or anxiety disorder?
Obviously, patients with any of these conditions would likely benefit from being managed by a multidisciplinary team of experts, but somehow, we manage to provide acceptable care even without all this support.
Why, in obesity care, do we often take the “all or nothing” approach? Frankly, I cannot recall the number of times I have heard colleagues tell me that the most important reason they cannot offer obesity treatments, is because they simply do not have the allied health resources they need.
And they justify this attitude towards managing obesity, by highlighting the importance that is generally given to multidisciplinary management in obesity guidelines.
In fact, reading these guidelines with their emphasis on lifestyle and behavioral interventions, it is easy to see why most doctors would simply conclude that treating this condition without extensive allied health support would just be a waste of time.
Allow me to go on the record that I firmly believe that any doctor who can do a decent job of managing diabetes, or hypertension, or heart failure, or rheumatoid arthritis, or chronic kidney disease, without the luxury of extensive allied health support, can probably also do a pretty decent job of helping their patients with obesity better manage their disease – if only they knew what they were doing!
Because, in contrast to having learnt all about managing patients with diabetes, or hypertension, or heart failure, or rheumatoid arthritis, or chronic kidney disease in medical school and residency, most doctors have never learnt to manage patients with obesity (beyond telling them to go lose weight).
Naturally, this makes them wish for an allied health team that they hope knows more about managing obesity than they do (which, sadly, they often don’t).
As long as we keep pretending that obesity is so complex that it takes an army of allied health practitioners with hours and hours of time on their hands to manage obesity, we should not expect to see doctors take much interest in obesity management.
Rather, we need to make obesity management as manageable as managing any other chronic disease, if we truly hope to insert obesity management into routine family practice.