• In our hospitals there are few ‘joined up’ services for people who are overweight or obese; there is a need to develop and integrate weight management services with those healthcare services that manage the complications and conditions which arise from obesity such as coronary heart disease (CHD), diabetes, arthritis, sleep disorders and gynaecological disorders.

• Multidisciplinary teams have a proven track record in cancer care to promote quality by providing integrated services for patients, and we recommend that this model is translated to obesity. 

1 All members of the multidisciplinary team (MDT) should be trained and experienced in motivational interviewing and incorporate these techniques into their clinical practice.

2 Since type 2 diabetes is common among the overweight and obese population, and management of obesity may directly affect diabetes prevention and management, integration with diabetes services is recommended.

3 Adoption of the Edmonton Obesity Staging System (EOSS) will allow better 'phenotyping' of the individual patient and facilitate audit and outcomes review and research.

4 The primary care team has an important role in signposting to relevant services which are known to be effective. Many patients may contemplate commercial programmes, or increasingly such services maybe providers of care within the NHS, and request advice from the primary care team. It is vital to ensure that patients attend services most suited to them.

5 The specialist MDT needs expertise in multiple obesity-related disorders. The MDT should include specialist consultant physicians, consultant surgeons, dietitians, nurses, psychologists and psychiatrists and exercise/physical activity professionals.

6 A particular issue amongst patients with extreme obesity is the increased prevalence of psychiatricdisorders, including eating disorders, anxiety and depression. Thus, close collaboration with primary care and mental health services is required to assist patients with significant psychological trauma or psychiatric illness.

7 A growing number of patients within primary care will have had bariatric surgery (sometimes performed outside the UK), and links with the (hospital-based) medico-surgical MDT are essential.8 Adequate administrative support to ensure that patients move smoothly through the MDT assessment is essential.