Clinical obesity services sorely lacking: report

The lack of clinical obesity services in public hospitals means only a small fraction of the one million Australians with severe obesity can access treatment, a national audit of services has found.

Specialist obesity services in Australia are limited to a few teaching hospitals in major centres that only have capacity to offer treatment to about 2000 patients a year, according to the first national review of services across all states.

A survey of clinicians at 15 obesity services in public hospitals across all states and territories found that the composition of services varied widely and many lacked the key staff and structural components needed for a multidisciplinary team approach (MDT).

Only about half the current services had a multidisciplinary team (47%), an exercise physiologist/physiotherapist (53%) and a bariatric surgeon (53%), while only a third had pharmacotherapy resources.

Patient access to obesity services was limited by strict entry criteria (eg BMI >40 kg/m2 and complications), out of pocket costs, long waiting times and geographical distance.

The dire state of service availability prompted the consortium of endocrinologists and obesity treatment clinicians to publish a position statement calling for more resources, better infrastructure and development of clinical pathways to allow more people to access obesity services.

The report authors, including endocrinologist Professor Gary Wittert from the University of Adelaide and Foundation Director of the Boden Institute of Obesity Professor Ian Caterson, noted that there are more than one million Australians with severe obesity (BMI >40 or >35 with at least one complication). However, almost 90% of bariatric surgery services are currently performed in private hospitals.

With the increasing rates of obesity, public services will need to expand substantially to provide equitable and timely treatment for people with severe obesity, they said.

“Even if there was a 10-fold increase in services tomorrow, it would take more than 25 years to treat at least 1 million people potentially eligible for specialist obesity services including bariatric surgery,” they wrote.

The six key recommendations in the position statement relate to:

  1. Staffing with a physician led MDT
  2. Physical infrastructure including group rooms and adequately sized fittings
  3. Access enabled by state-wide frameworks for public hospitals
  4. Education and training for healthcare professionals in specialist obesity management
  5. An electronic database to capture clinical data and for information sharing
  6. Research funding to explore ways to improve specialist obesity services

The report is published in Clinical Obesity.

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