Multidisciplinary care: A team-centered, patient-focused approach to obesity management

Obesity is a complex disease with multifactorial etiology. Multidisciplinary care is an optimal way to support patients with short-term success, long-term weight loss maintenance, and the prevention of obesity-related complications.

In the United States, 41.9% of the population is affected by obesity. With a wide range of associated physical and mental complications like diabetes, hypertension, depression and anxiety, obesity must be treated by an interdisciplinary team working together to create a comprehensive, patient-focused plan.

What is multidisciplinary care?

A multidisciplinary approach involves a team of health care professionals who leverage their expertise and collaborate to provide high-quality patient care. For example, in a Bariatric Center of Excellence, that team could include a bariatric surgeon, obesity medicine specialist, registered dietician, psychiatrist or psychotherapist, and a nonmedical team including an insurance coordinator, bariatric coordinator, nursing staff and office staff.

Studies show that patients receive higher quality care when a group of medical experts works together. Maximizing the skillset of multiple providers complements and enhances the overall quality of care when managing a multifaceted condition like obesity.

How can providers implement a multidisciplinary approach?

The first step is diagnosing the patient’s etiologies. Obesity presents differently in each patient depending on his or her comorbidities and health factors, so creating a baseline understanding of the patient’s underlying conditions is crucial in knowing how to move forward with treatment.

When working with multiple health care professionals, sharing an accurate and in-depth patient health history is paramount to delivering the highest quality care. For example, when treating a patient with an eating disorder, collaboration between the dietitian, psychiatrist/psychotherapist and obesity management specialist is beneficial in determining the etiology, which leads to a well-developed treatment plan.

For providers and practices that want to lay the foundation for successful multidisciplinary care, there are several steps to take:

1. People-first language: The entire team, from doctors to front-office staff, should be trained in people first language (PFL). PFL puts the person before the condition, so using a phrase like “person with obesity” instead of “obese person.” Patients with obesity often face weight bias, so professionals must use empathetic language in all conversations with them.
2. Bariatric furniture: The clinic should have bariatric patient-specific accommodations like chairs, doorways, elevators, bioimpedance weighing scales, blood pressure cuffs and gowns.
3. Forms and consents: Ensure the office has all necessary forms regarding procedures and consents (for example, if the office is dispensing controlled substances, know the state rules regarding dispensing).
4. Hospital credentials: Verify the office is properly credentialed for bariatric surgery with the hospital.
5. Center of Excellence protocols and policies: If the office is pursuing a Bariatric Center of Excellence designation, access the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for protocols and policies.

What are the benefits of multidisciplinary care?

Multidisciplinary care has wide-ranging benefits for both the patient and the health care team. Creating a patient-first, integrated treatment plan can lead to a more efficient, effective process for everyone involved.

Potential patient benefits include:

• access to a comprehensive roster of medical experts who are well-versed in the patient’s medical history;
• quicker diagnosis and treatment timeline due to real-time collaboration between providers;
• improved outcomes due to a multidisciplinary approach of physicians and providers offering their expertise on the patient’s condition; and
• better patient satisfaction.

Health care professionals also see the benefits, including:

• improved communication and collaboration amongst care teams and providers;
• more efficient treatment process and timeline;
• deeper relationships between physicians, providers and staff; and
• reduction of redundancies or lag-time during the treatment process.

Here is an excellent illustration of how this care strategy would function for a patient preparing for bariatric surgery. Instead of navigating multiple providers and treatment protocols, the patient can benefit from a “one-stop-shop” process:

1. The patient meets with the bariatric coordinator to understand insurance requirements.
2. The coordinator works with the insurance company for approval and pre-authorization.
3. The patient meets with an obesity medicine specialist for an accurate history and diagnosis, which will then inform the care plan.
4. The team engages with a dietitian to optimize nutrition plans and learn about pre- and post-bariatric surgery nutrition requirements.
5. A psychiatrist engages with the patient to provide guidance and expertise on the mental and emotional aspects of bariatric surgery (this step is often mandated by insurance).
6. A bariatric surgeon educates the patient on the pros and cons of the procedure and formulates a therapeutic plan.
7. The entire team works with the patient for short- and long-term success and prevention of complications.

While multidisciplinary care has many benefits, it doesn’t come without challenges. To avoid communication roadblocks or overlap, it’s important to clearly define each provider’s role on the team early in the process.

Understanding how and when people on the team will communicate with the patient is crucial for the long-term success of a multidisciplinary approach and will help mitigate confusion or duplication throughout the duration of treatment.

Resources to get started

The Obesity Medicine Association (OMA) has resources and networking opportunities to help providers enhance and evolve their practices. As the largest clinical obesity organization in the U.S., OMA is composed of more than 4,000 physicians, nurse practitioners, physician assistants and other health care providers dedicated to preventing, treating and reversing the disease of obesity. To learn more, join OMA and access a wide range of resources.

Reference:

• Bryan S, et al. National Health and Nutrition Examination Survey 2017–March 2020 prepandemic data files — development of files and prevalence estimates for selected health outcomes. National Health Statistic Reports. Number 158. 2021;doi:10.15620/cdc:106273.