Clinical Obesity Services in Public Hospitals in Australia: a position statement based on expert consensus

Abstract

We aimed to describe the current state of specialist obesity services for adults with clinically severe obesity in public hospitals in Australia, and to analyse the gap in resources based on expert consensus. We conducted two surveys to collect information about current and required specialist obesity services and resources using open-ended questionnaires. Organizational level data were sought from clinician expert representatives of specialist obesity services across Australia in 2017. Fifteen of 16 representatives of current services in New South Wales (n = 8), Queensland (n = 1), Victoria (n = 2), South Australia (n = 3), and the Australian Capital Territory (n = 1) provided data. The composition of services varied substantially between hospitals, and patient access to services and effective treatments were limited by strict entry criteria (e.g. body mass index 40 kg/m or higher with specific complication/s), prolonged wait times, geographical location (major cities only) and out-of-pocket costs. Of these services, 47% had a multidisciplinary team (MDT), 53% had an exercise physiologist/physiotherapist, 53% had a bariatric surgeon and 33% had pharmacotherapy resources. Key gaps included staffing components of the MDT (psychologist, exercise physiologist/physiotherapist) and access to publicly funded weight loss pharmacotherapy and bariatric surgery. There was consensus on the need for significant improvements in staff, physical infrastructure, access to services, education/training in obesity medicine and targeted research funding. Based on the small number of existing, often under-resourced specialist obesity services that are located only in a few major cities, the vast majority of Australians with clinically severe obesity cannot access the specialist evidence based treatments needed.

Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: Results from the Canberra Obesity Management Service

“…This was in large part due to the referred patients not meeting the COMS eligibility criteria, with a range of referrals received for non‐adults, for those with a BMI below the severe obesity range and/or for those without obesity‐related comorbidities. Prolonged wait times are known to impact attendance, and therefore, the duration between referral and initial medical review observed in our study is likely to have further contributed to the reduced number of patients attending initial medical review.…”

“…Recent data from Australia indicate that the prevalence of obesity has increased from 19% in 1995 to 28% in 2014‐2015 . In an effort to address this obesity epidemic, several Australian state and territory Health Departments have introduced publicly funded specialist obesity services …”

“…Australia is a geographically, socioeconomically and culturally diverse nation with the provision of specialist obesity services varying by locality and multidisciplinary treatment types . Patient engagement and outcomes are often context driven and dependent on access to services and individual patient factors .…”

“…COMS is the only Australian Capital Territory (ACT)‐based, public‐funded obesity service and is a participant in the Clinical Obesity Services in Public Hospitals (COSiPH). COMS provided ACT‐specific service and resource data and contributed to the COSiPH expert consensus position statement in early 2018 …”

Standard baseline data collections in obesity management clinics: A Delphi study with recommendations from an expert panel

“…In Australia, these services have arisen ad hoc and include services in both the public and private health sector. Specialist obesity services in public hospitals in Australia have been described in detail by the Clinical Obesity Services in Public Hospitals (COSiPH) collaborators, including variations in the composition of services, limitation of access to obesity services by geography, disease severity and cost and inadequate resourcing of clinics, including both staff and infrastructure, along with recommendations for improvements . One of the recommendations put forth by the panel of experts in the COSiPH Working Group was a systematic capturing of minimum and standardized clinical data for ongoing monitoring and evaluation within services and to promote collaboration between services, such as information sharing for quality assurance as well as data linkage for future research purposes.…”