1.Long-Term and Multidisciplinary Care for Sustained Outcomes: Similar to cancer treatment, maintaining the effectiveness of bariatric surgery requires long-term and consistent follow-up. This approach transitions weight loss treatment from a single method to a multidisciplinary, multimodal cycle of long-term care. Core team members provide patient care based on their specific responsibilities.

2.The Crucial Role of Care Managers: Care managers play a vital role in the team by acting as a communication bridge between primary physicians, dietitians, and patients. As the frontline point of contact, care managers are the most trusted individuals for weight loss patients. In addition to using phone calls and text messages, care managers utilize messaging apps to track patients. They schedule follow-ups and consultations and promptly report patient conditions to physicians and dietitians. This ensures immediate understanding of patient needs, builds trust, and lays a solid foundation for maintaining long-term success after bariatric surgery.

3.Core Care Team Meetings: Every three months, the team conducts case discussions for special patients, particularly those who experience weight loss failure six months after surgery despite escalated care. These discussions include an evaluation of the surgical process, preoperative psychiatric assessments, dietitian analyses of dietary records, recommendations on medications from physicians, and reviews of behavioral motivation and exercise plans. The team collaboratively formulates tailored treatment strategies for each patient.

4.Biannual Multidisciplinary Meetings: Twice a year, multidisciplinary meetings are held to address challenging cases, including patients who fail to achieve weight loss despite core team care, those with short-term complications like leaks, long-term gastrointestinal issues, or poorly controlled diabetes and hypertension. These discussions involve specialists from psychiatry, gastroenterology, endocrinology, and other integrative care teams. Additionally, research topics and progress related to weight loss are also discussed during these meetings.