The Assessment and Management of Obesity and Self maintenance (AMOS) Clinic Evaluation

Individualised multidisciplinary multi-intervention assessment and treatment of obesity management. The focus was to provide the person living with obesity and type 2 diabetes support to enable informed, individualised strategies to support sustained weight loss. On attending the AMOS Clinic (intervention) at the Diabetes Centre at the Tasmanian Health Service the participant will be offered the following: 1. A 30-minute face-to-face pre-assessment by a Credentialled Diabetes Educator ( a nurse specialising in diabetes with 5-years’ experience as a health professional) including: a. Physical measurements (BMI, BP, girth, weight) and HbA1c. b. Universal screening for depression, anxiety, sleep apnoea, cardiovascular to support planned assessment and care: • Psychometric scales (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7), Health Survey Short Form (SF-36v2), Assessment of Quality of Life (AQoL) and Work Productivity and Activity Impairment (WPAI) • Epworth Sleepiness Scale • Absolute cardiovascular risk • Edmonton Obesity Staging 2. A 45-mintue face-to-face pre-assessment by a senior physiotherapist with a minimum 3-years’ experience as a health professional including: a. Assessment for physical functioning performed b. Completion of McCaffery Pain Assessment scale 3. Two to four weeks later participants are then seen in the AMOS clinic by the dietitian for 30-minutes and nurse practitioner for 30-minutes face-to-face at baseline, six and 12-weeks and then three-monthly for assessment and management, and the physiotherapist at baseline and six weeks and 6-monthly for development of an exercise prescription and assessment. a. According to dietitian assessment participant seen 1:1 for a 60-mintue face-to-face consultation or booked into a 90-minute group program involving maximum of four participants facilitated by a psychologist and dietitian with focus on identification of barriers to weight loss and healthy eating. b. Nurse practitioner assessment includes: i. a review of participants obesity and diabetes management. ii. screening for metabolic pathology (HbA1c, lipids, vitamin B12 and folates, TFTs, LFTs, ACR, eGFR and leptin, ketones and vitamin D. c. Physiotherapist face-to-face assessment at the clinic includes: i. Completion of McCaffery Pain assessment scale ii. Completion of a full physical functioning and balance assessment [6-minute walk test (6MWT), Timed Up and Go (TUG), 30-second Chair Stand test (30s-CST), falls risk] iii. Exercise prescription included a home exercise program of low to moderate intensity dependent on cardiac function and medical clearance including walking, hydrotherapy, resistance and strengthening exercises with resistance band to be performed 5 times per week. iv. Assessment was completed by reassessing markers from point (ii) and adherence measured by verbal confirmation at each consultation with the following scale: - Sedentary (no planned activity) - Less than 120 minutes/week (minimal) - Up to 150 minutes/week (moderate) - Greater than 150 minutes/week (recommended) d. Treatment plan devised in partnership with participant, nurse practitioner and dietitian and includes: i. Agreed weight loss goals. ii. Referral as relevant to: o Other health professional/specialist (sleep apnoea or pain management assessment if applicable) o Community Based Weight /Pain management programs (Stanford – Get The Most Out Of Life program and Overcoming Pain And Living Well program [OPAL]). o When a moderate or high score is confirmed on psychometric scales (PHQ-9 and GAD-7) the participant is triaged and offered an appointment with the psychologist. iii. Resistant or balance training. iv. Medicines alteration and/or titration in alignment with caloric intake reduction. v. Behaviours Modification and Self-Maintenance awareness 4. Participants will also receive a 10-minute phone call at weeks 2, 4, 8 and 10 by a credentialled diabetes educator allocated to the clinic to confirm instructions were understood, assess medication side effects and progress. 5. Initiation of Orlistat if BMI > 35 and < 2% weight loss after 3 months. 6. Referral for bariatric assessment if deemed suitable and after 12 months failed treatment and <5% weight loss.