IntroductionObesity is a condition wherein the body exhibits an excess accumulation of

IntroductionObesity, is a condition wherein the body exhibits an excess accumulation of body fat. It has evolved into a chronic, debilitating health problem worldwide. Most widely affected are first-world countries such as the United States and Australia. Data gathered has shown that An estimated 55%-to 60% of adult Americans are overweight. (Mcqueen M.A., 2009). Australian statistics show that the prevalence of obesity has more than doubled from the years 1980-2000, with no regard to age differences as it is observed in 67.5% of men, 52.1% of women and 19%-23% of children and adolescents who are obese or overweight. (Proietto & Baur, 2004). The aetiology of obesity has been influenced by the increased intake and availability of high energy and processed foods coupled with an environment wherein everything can be reached electronically thus encouraging a decrease in regular physical activity. Body mass index, more commonly known as BMI, is the main determinant of obesity measurement.. This is computed as weight in kilos divided by the square of height in meters. ( Proietto, J & Bauer, L.,2004) Serious health concerns are associated with obesity as it has several comorbidities. These are chronic system diseases such as diabetes, cancer, cardiovascular disorders, lipid disorder, and psychological disorders. Obesity has been shown to significantly affect life span and health span, shortening life expectancy by 2-10years.(Foster, Sanchez-Collins & Cheskin, 2017) Obesity treatment is centered on proper nutrition and an increase in physical activity to promote weight loss in a manner that promotes intensive lifestyle intervention. Management of obesity in individuals involves a 2 step process of weight loss and weight maintenance strategy (Proietto & Baur, 2004). Weight loss is achieved by decreasing the amount of food intake while increasing energy spent on physical exercise thus establishing a negative energy balance. Weight maintenance strategy is significantly harder to achieve as it involves lifestyle changes which should be followed lifelong and medical pharmacotherapy. If results aren’t achieved by these, bariatric surgery will be the next step.A Multidisciplinary team approach is recommended for optimal treatment results. Members of the team, including specialists are aware of each others unique roles and have effective communication channels. A Multidisciplinary team can consist of a physician, a nurse, a dietician, an exercise physiologist and a psychologist. (Foster, Sanchez-Collins & Cheskin, 2017)The nature of each discipline in conducting intensive lifestyle intervention was based in conjunction with the Chronic Care Delivery Model which identify 5 main factors: Long-term commitment, Patient-centered care, Multidisciplinary team, evidence-based and protocol-driven care. (Coleman, Austin, Brach & Wagner, 2009) Long term commitment encompasses a lifestyle that can be maintained and is flexible in accommodating changes in behavior; requires that the health care provider can influence and motivate and establish connections for the patient to both clinic and community programs. Patient Centered Care makes the patient the center of its universe, and encourages the patients to achieve goals, develop skills and self-management. Treatment of Obesity as a lifelong illness requires changes in lifestyle and behavior that can be maintained by the individual while some patients will also require pharmacotherapy or bariatric surgery. In order to achieve this, different professional services that are focused on patient-centered care are desirable. This can be achieved by teamwork within the healthcare industry. In the Australian setup, Enhanced Primary Care, now known as Chronic Disease Management is a program meant for GP’s to arrange allied health care for clients with chronic conditions, needing multidisciplinary team care. These services are meant to identify, prevent and treat chronic, debilitating ailments. The different health care disciplines work as a team and provide a range of services ranging from diagnostic, therapeutic, technical, each specialised as to their own expertise which is critical to other health professionals and patients they serve. ( Everitt, 2020)Multidisciplinary obesity clinics must work together to achieve specific and defined goals. This will involve the members of the multidisciplinary teams are in contact with each other, understand each others roles, and move towards specific targets. Integrated care is defined as a means to improve access, quality, and continuity of services in a more efficient way, especially for people with complex needs (Leutz, 1999)Role of GP: The General Practitioner functions as a gatekeeper for patients’ health concerns. According to (Grol et al., 2018), GPs develop relationships with patients over time by being the first point-of-contact for a variety of patient problems. They instigate the initial diagnosis and advise or prescribe treatment for patient concerns as well as care plans for chronic conditions. General practice provides care continuous acute and chronic medical care while keeping in perspective, the patient’s social circumstances, beliefs, and values.According to Jansen, Desbrow & Ball, 2015, obesity management by GP’s consists of referrals and delegations to secondary health providers. Inasmuch as GP’s are tasked to be involved in all aspects of patient care, physical activity and exercise advice are often not given much emphasis as part of therapy for illness whether acute or chronic. Gp’s are guided by the 5 A’s of Weight Management, Ask and Assess, Advise, Assist and Arrange, in which they “ Establish a therapeutic relationship, communicate and provide care in a way that is person centred, culturally sensitive, non-directive and non-judgemental.”(Mazza, McCarthy, Carey, Turner & Harris, 2019) “ Arrange,” involves referral to specialists such as exercise physiologists or weight management clinics. Although a study revealed that GP’s more often “Ask and Assess” and are less likely to “ Assist” and “ Arrange.” (Sturgiss, Haesler, Elmitt, van Weel & Douglas, 2017) when those last two steps are more likely to create changes in a patients’ habits. This shows the need for GP’s to be given extra support in patient management of obesity. Need for Allied Healthcare:Role of Exercise Physiologist:McQueen, MD states that the process of assessment before an obese patient enters an exercise program begins with a thorough history and physical examination to identify comorbid conditions such as metabolic illness, arthritic symptoms, cardiovascular disease, among others, that can impede improvement. Aside from comorbidities, mental and psychosocial barriers are also taken into consideration. Patients with arthritis may need gentler weight-bearing exercises, and side effects of medications must be taken into consideration. Accredited exercise physiologists are degree-qualified professionals who design and conduct exercise programs. Their services are claimable under Medicare and most health insurance providers. They are distinguished from Physiotherapists who deal with more acute conditions. In Australia, a program called, “ Exercise is Medicine,” promotes exercise as part of the prevention, treatment and management of several chronic conditions. This program consists of exercise management conducted by accredited exercise professionals. They encourage GP’s and nurses to include an exercise assessment as part of their patient interaction. They also offer free education and CPD points to encourage healthcare referrals. As obese individuals commonly harbor muscle and joint pains, making movements difficult and can create injuries. AEP’s can prescribe the correct type of exercise and monitor the individual exercise needs such improvement in motion and flexibility and limitations to decrease risk of injury. Role of Dietician: In the paper by Bleich, Bandara, Bennett, Cooper & Gudzune, 2014, dieticians were identified by both physician and non- physician health professionals to be the most qualified professional group to help obese patients lose or maintain weight. Nutrition professionals make use of evidence-based procedures in weight management such as portion control and calorie tracking [2013 American Heart Association/The Obesity Society guidelines], goal setting, self-monitoring strategies. Their biggest hurdle was patient non-adherence and lack of motivation or willpower. According to the National Health and Medical Research guidelines on managing obesity,7 section 5, patients with a high glycemic index need to be well-versed in knowing which foods contain fat and are high in carbohydrates. Reducing food intake to 2500kJ or 600 calories would lead to a weight loss of 0.6/week. In this regards, the skill of a dietician is required.(Proietto & Baur, 2004)Perceived Benefits of Integration for the ClientThe benefits of having different health care disciplines working in collaboration in the treatment of obesity are numerous. Generally, it has been recorded that there is an improvement in allocation of resources thus creating a more cost effective therapy. Patients are supported to be able to achieve a high level of compliance with various treatment forms such as medication taking, exercise and eating the recommended diet thus improving the outcome of their therapy. The existence of interdisciplinary teams reflect the higher levels of specialisation of collaborating healthcare disciplines. Challenges that may AriseGoal setting must be realistic to begin with. Proietto & Baur, 2004 point out that patients may not be satisfied with a weight loss of 5%-10% which from a medical standpoint is already beneficial. It must be explained to them that this will be easier to achieve and maintain long term. Of great importance as well, is that patients are cooperative and have a mindset to lose weight. Summary:Obesity is becoming a worldwide global epidemic. Its various comorbidities create challenges for an already complex aetiology and treatment. Various studies promote the effectivity of having multiple disciplines such as the General Practitioner, Dietician and Exercise Physiologist collaborating with together and with other healthcare to be able to address the patients’ healthcare needs from various perspectives. At the same time, maintaining the the values of patient-centredness, utilisation of evidence-based protocols and collaboration between healthcare professionals. Assessing obesity and treating it with all strategies available is now a clinical standard of care.( Wyatt, 2013). Healthcare providers must establish effective ways to communicate, collaborate and report to be able to provide successful chronic healthcare that is consistent and lifelong for patients with obesity.

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