Exeter Medical Obesity Service
The Exeter Medical Obesity Service (EMOS) supports people who have experienced difficulties with their weight, often for many years, and who are motivated to learn about what influences weight including long standing behaviours and how to make change based on evidence.
The EMOS team is a dedicated and compassionate group of professionals who will take into account your individual circumstances. The team includes administrators, consultant doctors (endocrinologists), psychologists, physiotherapists, talking health therapists and specialist dietitians.
More on what we do
We offer support in the following areas:
- Medical and dietetic initial assessment which may include onward referral for further psychological assessment if necessary
- Help to understand and explore your relationship with food and weight including patterns of behaviour that can be difficult to change
- Information and guidance about nutrition, feeling well-nourished and looking after your health and wellbeing
- Support to increase your confidence in physical movement and increase your daily activity levels
What to expect at your first appointment?
Your first appointment will be at the Macleod Diabetes and Endocrine Centre at the Royal Devon and Exeter Hospital. You will meet with a consultant doctor and specialist weight management dietitian. You will be asked to complete several questionnaires that help us to understand your experiences. The appointment will cover the following areas;
- Your current eating pattern and your relationship with food
- Your history of dieting, weight loss/gain and your thoughts/feelings about these experiences
- Whether you have any medical symptoms that may require further investigation or treatment - this may include support with your diabetes or referral for a sleep apnoea assessment
- Your wider life circumstances e.g. who you live with, your daily routine, what you enjoy doing
- We will ask you about any previous difficult experiences (such as abuse) that may have affected you during childhood and as an adult
We understand that discussing some topics may be difficult, and you will be able to decide how much you share at your assessment. However, we encourage you to take this opportunity to provide the team with as much knowledge of your individual needs as possible. You are welcome to bring someone with you for support, if you feel comfortable discussing these areas with them present.
Following your initial assessment we will discuss with you, and possibly with other members of the team, what the most suitable pathway of care is for you.
Please be aware that if we think a person has additional needs that we assess as requiring further input, then we will signpost you to more appropriate services. This may mean that we will discharge you from EMOS but you can be re-referred once you have received support for the areas identified.
What is the EMOS Programme?
A personalised pathway that may consist of one or more of the following options:
- A group-based programme consisting of nine sessions over six months - during these sessions you will be supported to learn more about: your relationship with food and weight, what influences your eating and lifestyle, eating in a nourishing way for your health and wellbeing, changing habits and sustainable goal setting
- Individual support from a clinical health psychologist focused on developing a broader understanding of your relationship with food and weight including past experiences.
- 1:1 psychological assessment and therapy with psychological therapists from Talking Health - this is telephone or face-to-face and may focus on anxiety, low mood, eating patterns, binge eating and past experiences of trauma
- Individual physiotherapy from a specialist physiotherapist focused on improving mobility and increasing daily levels of activity
- Referral to local community-based support, such as health and well-being coaches
What happens after EMOS?
Once you have completed your personalised pathway of care within EMOS, you will be offered an individual dietitian review appointment. During this appointment you will be given time to reflect on the changes you have made, any challenges you have experienced and what your hopes are for the future.
You may then be discharged from the service or offered assessment, at your request, for bariatric surgery referral.
Weight Loss Surgery
We appreciate that you might be coming to EMOS as you are hoping for weight loss surgery. Weight loss surgery is a tool that works alongside dietary and psychological change to support weight loss and weight maintenance long term. Therefore preparation, both psychological and dietetic, is required before referral for bariatric surgery is considered and it is normal for this to take a minimum of 12 months and up to two years.
Weight loss surgery has some risks associated with it and these can be explored with the team at a suitable time. For some people it may not be the right time for weight loss surgery and they may need to be referred at a later date or may never be suitable for referral.
When you have completed the EMOS weight management programme you will be supported to explore future options that may be available to you. This may include referral to the Tier 4 weight loss surgery service for assessment for suitability for surgery.
Natalie Chard, Senior Physiotherapist
Dr Tom Fox, Consultant Physician
Esme Deakin, Specialist Dietitian
Dr Anna Disney, Senior Health Psychologist
Isla Gale, Psychological Therapist
Dr Katarina Kos, Consultant Physician and Service Lead
Josie Rodgers, Specialist Dietitian
Fiona Thompson, Specialist Dietitian
Dr Roderick Warren, Consultant Physician
Where to find us
RD&E Wonford, Barrack Rd, Exeter EX2 5DW
Macleod Diabetes and Endocrine Centre (MDEC)
Information for healthcare professionals
Referral to the Exeter Medical Obesity Service can happen if a patient is 18 years old or more and has a BMI of 40 kg/m2 or over, or is are 18 years old or more and was recently diagnosed (within the last five years) with type 2 diabetes, and BMI of 30kg/m2 or over.
Patients with a BMI of 35kg/m2 or over can also be referred to the service, if they have one or more of the following conditions:
- Established (over five years) type 2 diabetes or previous gestational diabetes
- Hyperlipidaemia uncorrected by maximum tolerated doses of statins
- Sleep apnoea
- Gastro-oesophageal reflux disease (GORD) after assessment by a GI surgeon
- Severe osteoarthritis requiring listing for joint replacement
- Intracranial hypertension
- Infertility in which weight is a barrier to therapy
- Non-alcoholic steatohepatitis (NASH)
Due to a greater risk among some ethnic groups of developing diabetes, for patients of South Asian, Chinese, Black African or Caribbean origin, each BMI threshold is lowered by 2.5kg/m2. For example, referral accepted at BMI 32.5 rather than 35 kg/m2.