AUSTIN, Texas – Integrated teamwork can be uniquely successful in weight-loss clinics, say experts presenting today at the American College of Sports Medicine’s 14th-annual Health & Fitness Summit. It’s important, though, that team members communicate well and have strong clinical skills.
The team approach brings advantages beyond patient outcomes, said Mary E. Sanders, Ph.D., FACSM, RCEP, and Maureen Molini-Blandford, M.P.H., R.D. They point to cost savings and efficiencies allowed by coordinating the work of professionals who are located in one place and communicate regularly. “We can call across the hall for provider support as needed,” said Sanders. “As a team we sit down together, review charts, and discuss the patient’s needs. It’s all about creating an environment of well–informed, compassionate providers who guide people to take charge of their own health. We work from all angles: medicine, exercise, diet, and behavior. If people cannot succeed, we teach them how to prepare for and live well with surgical interventions.”
Molini-Blandford and Sanders are affiliated with the Center for Nutrition and Metabolism (CNM) at the University of Nevada School of Medicine. Their unique approach provides a model for graduate students, medical students and resident physicians to learn clinical skills relating to weight loss. Trained as a Registered Clinical Exercise Physiologist, Sanders said professionals need to go beyond subject-matter expertise and learn how to work successfully with patients.
“My first day at work, they handed me a patient’s chart and pointed me to a little room with a flag showing where I was needed,” she said. “With help from my colleagues I figured out how to work with patients and handle the paperwork.” While registered dietitians share a standardized education that includes clinical skills, she said, many other professionals must separately learn how to work with patients.
Teams at Sanders’ center typically include physicians, registered dietitians, behavior specialists and clinical exercise physiologists. “We spend time interviewing so we understand the patient’s needs, what’s going on in their life and past experiences,” she said. “We set small, individual goals, then we’re there to check and modify as needed. We try to create those positive experiences that make exercise enjoyable.” In comparing notes, team members can share important information that a patient may relate to one team member but not to others.
During the first visit, Dr. Quang Nguyen, a physician on the team, evaluates the patient’s health status and medications to determine the patient needs to be referred back to the primary care physician to address conditions such as unstable angina or if changes in medications that impede weight loss should be made before starting the program. Nguyen ensures the patient is safe to proceed so the team and patient are successful together. During follow-ups, he may adjust medications in response to effects of the meal plan, exercise and/or behaviors that emerge as the patient progresses.
Understanding the expectations of other providers is also important, Nguyen explained. In selecting team members, he looks for “people who know their topic well. Obesity is a touchy subject, so they have to have compassion. Communication is important, and they must stay up to date with literature in their field. The Internet has many blogs and providers need to be able to discuss and debunk these topics with patients.”
Certified health-and-fitness professionals play an important role in creating exercise programs to meet each patient’s needs, according to Sanders. She noted the demonstrated power of physical activity to help prevent and treat chronic diseases such as arthritis, obesity, diabetes, depression and coronary heart disease. However, she noted, even an experienced personal trainer may have to learn new ways of working in a clinical setting. Privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), impose unfamiliar restrictions. For example, HIPAA prohibits mentioning a patient’s name in front of other patients.
Sanders said she enjoys working with those who visit their clinic to learn the integrated team approach: “We’re doing on-the-job training to prepare people to develop these kinds of relationships in their communities or hospitals.” She recalled one patient working with individual providers in the community who had lost weight working with a dietitian, then gained it back after a physician changed her medications. After enjoying success working with CNM faculty, the patient told her “I’m here because of the team.”
The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 35,000 international, national, and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.