Centers of Therapeutic Excellence (COTE)

Certification and Accreditation Standards


COTE certification and accreditation standards have been developed by the American Association of Bariatric Counselor’s Centers of Therapeutic Excellence Standards Committee. This document provides guidance to centers/providers world-wide, who are eligible to apply for certification/accreditation and to become recognized as a Centers of Therapeutic Excellence (COTE) in the treatment of obesities. AABC reserves the right to amend these standards at any time, giving reasonable notice to all COTE centers.

The American Association of Bariatric Counselors (AABC) recognizes Centers of Therapeutic Excellence as those healthcare centers that can satisfy these requisite standards. A Center of Therapeutic Excellence is a specialty health facility that uses current evidence-based best practices and responsibly provides comprehensive and compassionate therapeutic care for all bariatric patients

The COTE initiative can ensure that research driven therapeutic bariatric care is provided for obese individuals world-wide. Specialized professionals who dedicate their competencies to patient-centered care that addresses individual needs and clinical interventions for patients with obesity and diabesity. A COTE will employ specialized professionals and other qualified ancillary staff, including AABC Certified Bariatric Counselors, to ensure measures of empirical care and treatment.

Hospitals with bariatric departments, mental health centers, physicians with bariatric practices, clinical nutrition centers and other health professional bariatric practices that can satisfy COTE standards, are eligible candidates for certification and accreditation as Centers of Therapeutic Excellence

Through this document the American Association of Bariatric Counselors is issuing Certification Standards for all Centers of Therapeutic Excellence, which will include: program requirements, service descriptions, staff qualifications, eligibility requirements and performance standards.


            Globesity is a pandemic of the 21st century. Just thirty years ago, the World Health Organizationhad its focus on malnutrition. Today the world is faced with the pandemic of obesity/diabesity, and many other associated non-communicable diseases/disorders. The pandemic originated in the US and spread to Europe and then to other affluent nations, before, remarkably it penetrated even the world’s poorest countries. The globosity pandemic continues to outweigh and allude all our efforts to combat it. Today, it is rare to find a family that has not been affected by this pandemic.

A large body of contemporary research and interventions that addresses the full spectrum of obesities and metabolic disorders have emerged into bariatric science.Bariatric science is a science whose time has come. Bariatric science embodies the research, diagnosis, treatment and prevention of obesities and its related biopsychological diseases/disorders. The pandemics emergent global need for multi-disciplinary bariatric science trained professionals fostered the development of the American Association of Bariatric Counselors education and certification program.  Now Centers of Therapeutic Excellence, staffed with Board Certified Bariatric Specialists, will further advance the very best practices in bariatric therapeutic care and advance the COTE global mission.


  1. Administration& Commitment:
  • Centers seeking COTE Accreditation must provide a letter from facility leadership demonstrating the center’s current and continuous administrative commitment to the COTE-Accredited center. The letter must cover the following points:
    • A high-level description of the treatment program provided at the center
    • Quality improvement initiatives, bariatric patient care, implemented in the most recent 12 months
    • Ongoing development and support from leadership for the bariatric treatment program
    • Financial resources currently allocated and future resources to be invested in the Center.
  • The applicant agrees to provide AABC/COTE vetting team with all the information needed for the process of accreditation & arranges for the cooperation of all members of staff.
  • COTE administrationswill adhere to the established mission, goals and all required standards.
  • COTE professional health care providers have appropriate credentials, licensure commensurate with their disciplines.
  • COTE have minimum of (1) Board Certified Bariatric Counselor/Educator on staff or have an eligible staff member that is or will be enrolled in the AABC Board Certification Program. ( Staff member enrollment in Certification Program can be included the initial COTE application)
  • COTE will have a process in place to ensure that key staff positions are filled in a timely manner.
  • COTE must be in good standing and compliance with their applicable regulatory agencies
  • COTE will comply with HIPAA privacy laws. Non-US COTE will comply with their HIPPA equivalent patient data protection laws
  • COTE will ensure an appropriate process for client documentation and record maintenance that is accessible to all providers within their Center of Therapeutic Excellence.
  • COTE have procedures in place for dispute resolution for both patients and staff

Measure: Adherence to mission, goals and standards. Established process for documenting and sharing of medical records. Compliance with patient data protection laws. In good standing with appropriate regulatory agencies. Establish standards for staffing levels. Dispute resolution procedure.

  1. Experience and Education:
  • COTE multidisciplinary providers are credentialed in their areas of practice.
  • COTE will keep current records of professional staff’s CVs, licensure .certification/registration.
  • COTE will invest in staff continuing professional education and training related to bariatric science.
  • COTE will keep current records of their professional staff’s completion of continuing professional education.
  • COTE has handicap access and appropriate sized furniture, bathroom facilities and medical equipment, i.e. scales, gowns, exam tables, pressure cups etc.
  • COTE willing agree to participate in collaborative sharing of data to aid researchers and clinicians ability to further the improvement of empirical bariatric science.
  • COTE will provide( for all staff) on-going obesity stigma-reduction training to reduce weight bias that will  help remove barriers that interfere with treatment and  a quality healthcare experience

Measure:  Profession staff’scredentials on-file, Continuing Profession Education, Research collaboration, Stigma reduction training, Equipment and infrastructure appropriate for obese patients.

  1. Staffing Levels: manner or provide coverage to help ensure continuity of care.
  • COTE will ensure appropriate staffing levels are reached and maintained to provide appropriate services.
  • COTE will appoint and maintain a COTE program coordinator position.

Measure: Program coordinator

  1. Program Coordinator:
  • COTE coordinators are, responsible for maintaining accurate  patient data entry and collection system as well as the ability to share this data with centers healthcare professionals
  • COTE coordinator will schedule and facilitate quality assurance activities and conducting data-driven annual satisfaction survey.
  • COTE coordinator will identify and address challenges and opportunities that can improve their centers ability to provide best practices in bariatric therapeutic care.
  • COTE coordinator will schedule and facilitate regular in-service peer group activities with focus on cases and methods and overall patient care.
  • COTE coordinator will schedule and facilitate regular in-service obesity stigma reduction activities for all staff.
  • COTE coordinator will adhere to other responsibilities as determined by the Center of Therapeutic Excellence Standards Committee

Measure: Written COTE coordinator job description on file.

  1. Policies and procedures:
  • COTE will have online published. policies and procedures manual
  • COTE policies and procedures to include client rights, confidentiality guidelines, patient and staff grievances, nondiscriminatory policies, appropriate consent forms, shared data collection and quality improvement guidelines.
  • COTE will have establish mechanisms for tracking referrals, intakes, outcomes and attrition

Measure: Online policy and procedure manual. Policies and procedures to include, patient/client rights, confidentiality, grievances informed consent, shared data collection and quality improvement guidelines

  1. Safety &InfrastructureStandards:
  • COTE have handicap access and appropriate sized furniture, bathroom facilities and medical equipment, i.e. scales, gowns, exam tables, pressure cups , specific to the treatment needs of the patients they serve
  • COTE will comply with all State, Federal, OSHA, and specific municipality safety standards.Non-US COTE will comply with their equivalent required safety standards.
  • COTE has established emergency protocols for health and safety-related incidents.
  • COTE are welcoming, comfortable and free from anticipated hazards.
  • COTE will provide accommodations and safety measures specific to the needs of people of the populations they serve.
  • COTE maintain patient records in accordance with established clinical documentation requirements of licensing and accreditation bodies and adheres to the most current standards of patient confidentiality. Adhere to standards relating to the privacy and security of all Personal Health Information.

Measure: Compliance with all appropriate regulatory agencies. Amenities and accommodations that secure safety and patient wellbeing.  Process in place to assure the safety and confidentiality of patient records (paper and electronic).

  1. Treatment Standards:
  • COTE standards of care will follow guidelines and protocols that experts would agree are best practices of care and treatment.
  • COTE recognize that obesities are chronic lifelong conditions and utilize interventions that  reflect a chronic care management model
  • COTE treatments will provide care that reflects the specific and unique needs of the individual.
  • COTE health professionals conceptualize that frequentweight gain lapses/relapse are not human failings but rather an integral part of chronic  obesity care management
  • COTE have comprehensive relapse prevention and relapse resolution modalities
  • COTE mental health professionals will employ evidencebased counseling techniques to facilitate behavioral change, cognitive change and psychosocial wellbeing..
  • COTE health professionals will take into consideration the circumstances, needs, and preferences of the individual prior to developing an obesity treatment plan.
  • COTE health professionals usepatient/clientcenteredcommunication and employ language and strategies that prevents discrimination toward individuals with obesity.
  • COTE will recognize and emphasize psychosocial and behavioral improvements as significant achievements and not merely weight-reduction..
  • COTE when appropriate, will be able identify and refer to appropriateallied obesity-sensitive consultative professionals to aid with co-morbid conditions.
  • COTE health professionalswill be knowledgeable about long‐term, psychosocial, nutritional and medical needs of patients/clients who have had bariatric surgery and provide care consistent with established best practices
  • COTE when appropriate, healthcare professionals will discuss and/or prescribe obesity medicationsapproved by the US Food and Drug Administration for weight management
  • COTE healthcare professionals will, if possible,minimize the use of medications that may promote weight gain and preferentially consider those that are weight neutral or associated with weight loss for patients/ clients with body weight concerns..
  • COTE will network with community health centers and professionals and share their centers missions, goals and expertise.
  • COTE will notrecommend, or refer patients/ clients to obesity treatments for which the potential risks and costs outweigh the expected health benefits for a given individual.
  • Measure: Best practice in bariatric care, appropriate consultative professionals, chronic care obesity management, medication management, healthcare community networking
  1. Patient Education Standards:
  • COTE healthcare staff will provide ongoing contemporary, engaging education related to the needs of bariatric patients/clients..
  • COTE will have resources for the development of patient and staff education materials (Nutrition mental health, physical health, behavioral health etc).
  • COTE will provide both pre and post-surgery education for patients/clients seeking weight-loss surgery
  • COTE will provide viable options for patients not requiring weight loss surgery.
  • COTE will have organized a supervised support group or an allied, support group resource(s) sensitive to the needs of bariatric patients/clients.
  • COTE will offer information orientations for potential patients/clients regarding available therapy options, surgical and non-surgical.

Measure: Establish patient education manual. Established support group. Access to ongoing education and support with a Registered Dietitian/Nutritionist. Have established process to provide education on surgical options for management of obesity and diabesity.

  1. Patient Consent for Services:
  • COTE will have all appropriatelegal consent forms included in patient/client records.
  • COTE healthcare professionals and allied staff will explain all terms and conditions of informed consent forms.
  • COTE will obtain patient’s signature on the appropriate consent forms
  • COTE will request patients to consent to release personal health information to all professionals that may provide therapy within the COTE facility
  • COTE will inform clients/patients of their rights and responsibilities as a participant in the program

Measure: Appropriate legal consent forms, provide explanations of informed consent forms. Request patients consent to sharing personal health information with profession within COTE facility. Inform patient/clients of right and responsibilities. 

  1. Quality Improvement Standards
  • COTE will adhere to all accreditation standards that support quality improvement and that lead to patient/client satisfaction and successful outcomes..
  • COTE will maintain a Continuous Quality Improvementprogram to monitor the care provided and identify opportunities to improve patient care and services.
  • COTE will conduct annual patient satisfaction survey
  • COTE quality improvement data and patient satisfaction data will be made available when necessary; consistent with patient privacy and confidentiality standards.
  • COTE will schedule professionalstaff meetings to discuss all aspects of patient care.
  • COTE will comply with HIPPA requirements for sharing information.

Measure: Written policies on CQI in place, Maintain meeting minutes of multidisciplinary care team meeting. Develop and annual written summary and analysis of recent the program’s patient satisfaction survey.