Educating Administrators

While we’re on the topic of harnessing the enthusiastic support from administrators for an obesity program, it is important to consider that administrators, like most people, have little experience in thinking of obesity as a chronic disease nor fully appreciate the complexity of its causes or the need for multi-modal treatment pathways.

While, given the clear unmet need,  one may well succeed in convincing administrators of the need for setting up an obesity program, they may not be thinking beyond “educational” interventions focussed on promoting “healthy lifestyles”.  In fact, their idea of an obesity program may be limited to providing dietary or exercise counselling, whether to individuals or groups, in the hope that this will be enough to help patients reduce their weight. 

At the other end of the spectrum, administrators may be gung ho about bariatric surgery (perhaps hoping for a new income stream), little recognising that such a program requires far more than simply hiring surgeons and giving them sufficient OR time. They may in fact be surprised that such a program involves medical management, psychologists, dietitians, and nurses, not to mention the considerable space and infrastructure required for intake, pre-surgical assessment and management as well as extended follow-up. In addition, there is almost never consideration or plan for post-surgical abdominoplasties or body contouring surgery. 

Lately, with the increasing availability of effective anti-obesity medications, the boundaries between “medical” and “surgical” programs is fast eroding, as these medications, and thus medical management, is proving to be an integral part of pre- and post-surgical care. Thus, today, obesity programs must plan to integrate both conservative medical as well as pre- and post-surgical management of patients (even if the actual surgery may be performed elsewhere).

Thus, a key step in gaining administrative support for setting up an obesity program, is ensuring that they fully understand the nature of obesity and the complex needs of these patients, so that they plan for the provision of what is required. Simply hiring a dietitian and an exercise specialist does not constitute an obesity program, nor does simply performing a few bariatric surgeries on anyone willing to pay for them. 

Berlin, D