Setting Up An Obesity Program: Staffing

Once we have identified the appropriate medical or surgical leadership for our program, we turn to the issue of staffing. 

Obviously, we need appropriate administrative support staff to man the front desk and take care of scheduling, record keeping, stocking and all of the other secretarial tasks that are so essential to running a smooth clinic. Obviously, they need not only be good at their work but also have undergone sensitivity training and generally work towards creating a welcoming, supportive, and empathic atmosphere for patients. 

That said, the models for obesity programs vary widely. Whilst everyone probably agrees that most patients will need both dietary and psychological support, whether or not these can be directly integrated into the clinic or will be provided outside the clinic (but in close collaboration) may depend on the local circumstances and funding models. In our clinic in Edmonton, we are fortunate to have both dietitians and clinical psychologists as an integral part of our clinic. In addition, we have registered nurses, who take on the important role of “case managers” and guide the patients through the whole process. From time to time, we have also had occupational therapists, physiotherapists and exercise physiologists as valued partners in our team, but for various reasons, these have not become a fixed feature of our program. 

Irrespective of the discipline, in my experience most dietitians, psychologists, nurses or other allied health professionals (similar to most doctors) have generally not had specific training in obesity management prior to joining the program. Thus, while they bring important generic tools of their trade to the team, learning to work with patients presenting with obesity, according to the prevailing “philosophy” of the clinic, generally demands a steep learning curve. 

This is of particular relevance when patients need to be supported in medical and/or surgical treatments for obesity. Thus, for example, patients undergoing bariatric surgery have very specific psychological and nutritional challenges to deal with that may go well beyond the expertise of a psychologist or dietitian who has not worked in this setting before. Fortunately, there are now an increasing number of educational resources offered to allied health professionals entering this field. 

One such example is the Certified Bariatric Educator program offered by Obesity Canada, which is open to all licensed allied health professionals (this program is currently being updated to line up with the new Canadian Clinical Practice Guidelines and should be relaunched shortly). 

Given the complexity of the field, I am not surprised to have seen a broad range of allied health professionals work in obesity programs – physician assistants, social workers, recreational therapists, pharmacists and even unlicensed “health coaches” (often with bachelor degrees in health-sciences or related fields). All of these models can work, as long as the overall concepts and ability to work in a team are sound. 

Importantly, as the field is in rapid flux, ability to train and retrain, adopt new concepts as they emerge, revise and reframe approaches and expectations is the rule rather than the exception. This is where networking and sharing experience with colleagues working in other obesity centres is most helpful. 

@DrSharma
Berlin, D