Chronic Care Models for Obesity Management

Because of the high prevalence of obesity, a major challenge for national health services worldwide is to elaborate effective, efficacious, and sustainable models for assistance and rehabilitation of the complicated obese patient. Two main chronic care models for obesity management have so far been described: the British “Triple tier model for weight management”, and more recently the Italian “Hub and Spoke model for obesity management”. The triple tier model was primarily designed for increasing efficacy for weight management in primary care; emphasis is put on weight control rather than on disease management. The hub and spoke model describes a service network with different but integrated levels of care, with the patient at the center. It identifies highly specialized hospitals (hub) for diagnosis and treatment of morbid obesity and of its complications, patients being referred to and from peripheral centers (spokes), for initiation/continuation of their treatment and rehabilitation program. Regardless of the model chosen, the development of clinical pathways for obesity—from primary care to rehabilitation—for morbid and complicated obesity requires first of all an appropriate organizational, structural, and educational setting. They should clearly define the multidisciplinary integration between different levels of care and between professionals, identifying roles, and responsibilities. Obese patients should be guaranteed to be cared for in hospitals meeting defined standards for accommodation, patients’ handling, equipment by trained medical, and nursing personnel. Telemedicine has the potential to further improve chronic care management of the obese patients, both for weight management and management of the complications.