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Low priority of obesity education leads to lack of medical students' preparedness to effectively treat patients with obesity: Results from the U.S. medical school obesity education curriculum benchmark study


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Background: Physicians are currently unprepared to treat patients with obesity, which is of great concern given the obesity epidemic in the United States. This study sought to evaluate the current status of obesity education among U.S. medical schools, benchmarking the degree to which medical school curricula address competencies proposed by the Obesity Medicine Education Collaborative (OMEC). Methods: Invitations to complete an online survey were sent via postal mail to 141 U.S. medical schools compiled from Association of American Medical Colleges. Medical school deans and curriculum staff knowledgeable about their medical school curriculum completed online surveys in the summer of 2018. Descriptive analyses were performed. Results: Forty of 141 medical schools responded (28.4%) and completed the survey. Only 10.0% of respondents believe their students were "very prepared" to manage patients with obesity and one-third reported that their medical school had no obesity education program in place and no plans to develop one. Half of the medical schools surveyed reported that expanding obesity education was a low priority or not a priority. An average of 10 h was reported as dedicated to obesity education, but less than 40% of schools reported that any obesity-related topic was well covered (i.e., to a "great extent"). Medical students received an adequate education (defined as covered to at least "some extent") on the topics of biology, physiology, epidemiology of obesity, obesity-related comorbidities, and evidence-based behavior change models to assess patient readiness for counseling (range: 79.5 to 94.9%). However, in approximately 30% of the schools surveyed, there was little or no education in nutrition and behavioral obesity interventions, on appropriate communication with patients with obesity, or pharmacotherapy. Lack of room in the curriculum was reported as the greatest barrier to incorporating obesity education. Conclusions: Currently, U.S. medical schools are not adequately preparing their students to manage patients with obesity. Despite the obesity epidemic and high cost burden, medical schools are not prioritizing obesity in their curricula.
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R E S E A R C H A R T I C L E Open Access
Low priority of obesity education leads to
lack of medical studentspreparedness to
effectively treat patients with obesity:
results from the U.S. medical school obesity
education curriculum benchmark study
W. Scott Butsch
, Robert F. Kushner
, Susan Alford
and B. Gabriel Smolarz
Background: Physicians are currently unprepared to treat patients with obesity, which is of great concern given
the obesity epidemic in the United States. This study sought to evaluate the current status of obesity education
among U.S. medical schools, benchmarking the degree to which medical school curricula address competencies
proposed by the Obesity Medicine Education Collaborative (OMEC).
Methods: Invitations to complete an online survey were sent via postal mail to 141 U.S. medical schools compiled
from Association of American Medical Colleges. Medical school deans and curriculum staff knowledgeable about
their medical school curriculum completed online surveys in the summer of 2018. Descriptive analyses were
Results: Forty of 141 medical schools responded (28.4%) and completed the survey. Only 10.0% of respondents
believe their students were very preparedto manage patients with obesity and one-third reported that their
medical school had no obesity education program in place and no plans to develop one. Half of the medical
schools surveyed reported that expanding obesity education was a low priority or not a priority. An average of 10 h
was reported as dedicated to obesity education, but less than 40% of schools reported that any obesity-related
topic was well covered (i.e., to a great extent). Medical students received an adequate education (defined as
covered to at least some extent) on the topics of biology, physiology, epidemiology of obesity, obesity-related
comorbidities, and evidence-based behavior change models to assess patient readiness for counseling (range: 79.5
to 94.9%). However, in approximately 30% of the schools surveyed, there was little or no education in nutrition and
behavioral obesity interventions, on appropriate communication with patients with obesity, or pharmacotherapy.
Lack of room in the curriculum was reported as the greatest barrier to incorporating obesity education.
Conclusions: Currently, U.S. medical schools are not adequately preparing their students to manage patients with
obesity. Despite the obesity epidemic and high cost burden, medical schools are not prioritizing obesity in their
Keywords: Obesity, Medical school curricula, Obesity education, Medical student, Medical school education
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* Correspondence:
Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ 08536,
Full list of author information is available at the end of the article
Butsch et al. BMC Medical Education (2020) 20:23
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Obesity is a major public health threat and leading cause
of morbidity and mortality in the United States today
[1]. The prevalence of obesity is nearly 40% in U.S.
adults, with higher rates among certain minority groups
[2]. Despite the health and economic impact of obesity
on individuals and society [3,4], medical students re-
main inadequately trained in obesity and obesity man-
agement. A recent survey of medical students found that
understanding genetic and biological factors related to
obesity correlated with better counseling skills for pa-
tients with obesity [5]. This underscores the need to
educate medical students on the disease of obesity to re-
duce bias and improve patient care.
Little progress has been made to incorporate obesity
education into undergraduate medical curricula despite
studies describing insufficient medical student training in
obesity counseling and medical management of obesity [6
8]. In addition, the 2007 Association of American Medical
Colleges (AAMC) call to action report, which con-
cluded that medical education must assure that future
physicians will be better prepared to provide respectful, ef-
fective care of overweight and obese patientsand that
education on preventing and treating obesity should be in-
cluded in medical school curricula, has not led to any
meaningful change in medical education and training [9].
Several studies have uncovered the paucity of nutrition
education, an essential component of comprehensive obes-
ity education, in U.S. medical schools [10,11]. A recent
survey on nutrition education reported students receive an
average of 19 h of nutrition education over the course of
medical school, most within the pre-clinical years, falling
short of the recommended 25-h minimum [11]. In
addition, a recent study found a limited number of refer-
ences to obesity in the United States Medical Licensing Ex-
aminations (USMLE). The USMLE focuses on weight-
related complications of obesity such as type 2 diabetes ra-
ther than the disease of obesity itself [12].
To date, there is no literature describing the state of
obesity education in undergraduate medical education.
The aim of this study is to report how obesity is cur-
rently addressed in the curricula of U.S. allopathic med-
ical schools and provide a benchmark from which we
can assess progress toward as well as understand barriers
to implementing core competencies in obesity.
Between July and September 2018, we sent invitations to
medical school curriculum deans and administrators at
141 accredited allopathic U.S. medical schools identified
from the AAMC membership list to request their volun-
tary participation in this cross-sectional study consisting
of an online survey [13].
Survey participation was limited to allopathic medical
schools in the U.S., excluding Puerto Rico. Responses were
restricted to one representative per medical school to en-
sure consistent data and equal representation of each insti-
tution. Online searches identified a total of 552 potential
respondents within the qualifying medical schools using
their title as an indicator of curriculum knowledge, e.g.,
Dean of Medical Education. Potential respondents received
a postal mailing with a letter identifying the study sponsor
(Novo Nordisk) and key collaborators (Drs. Scott Butsch
and Robert Kushner), study objectives, participation re-
quirements, and a modest prepaid incentive of $50 in the
form of a check. At least one follow-up telephone call, fax
or email was used to remind non-responders to participate.
To participate, respondents had to confirm a current role
in undergraduate medical education and knowledge of
their four-year curriculum.
The survey instrument was comprised of 33 questions
addressing the structure, format, content, and method of
education; it included multiple choice, scalar, and nu-
meric text questions. Using a 4-point Likert scale (great
extent,some extent,very little,not at all), respon-
dents were asked about coverage of topics related to the
core obesity competencies established by the Obesity
Medicine Education Collaborative (OMEC) [14]. We
also asked respondents about their expectations regard-
ing future incorporation of obesity into the curriculum
and perceived importance of obesity education. The
complete survey is available [see Additional file 1].
Statistical analysis
We performed descriptive statistical analysis (means, fre-
quencies) using SPSS Statistics for Windows 15.0.1
(SPSS, Chicago, Illinois) and Stata/IC 14/1. Data are pre-
sented as number and percentage for categorical vari-
ables, and continuous data expressed as the mean ±
standard deviation (SD) unless otherwise specified.
Characteristics of respondents
Forty medical schools (28.4% of U.S. medical schools)
responded and completed the survey. These schools
(Table 1) are representative of the universe of medical
schools in the U.S. [15] in terms of geographic regions
(current distribution: Northeast-28.4%, Midwest-24.1%,
South-34.8% and West-12.8%) and public and private
(60 and 40%, respectively) funding source. Median time
to complete the survey was 9 min. Respondents had nearly
20 years of experience in undergraduate medical education
and 75.0% of them were medical school deans of educa-
tion. More than three-quarters of the respondents were
very familiarwith the four-year curriculum and all ex-
cept two reported teaching medical students. See Table 1
for sample characteristics.
Butsch et al. BMC Medical Education (2020) 20:23 Page 2 of 6
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Structure of curriculum
Only 7.5% of medical schools reported offering obesity as a
standalone course while 60.0% integrated a few elements of
obesity education into a broader clinical nutrition or pre-
ventative medicine course. Some medical schools (20.0%)
used virtual learning systems, e.g., Nutrition in Medicine
modules, to provide obesity education. Although only 17.5%
of medical schools reported teaching obesity in an outpatient
clinical medicine rotation, nearly half (47.5%) reported offer-
ing elective shadowing opportunities with non-medical pro-
viders such as dietitians and psychologists who treat obesity.
Content of curriculum
A mean of ten hours of specific obesity education was
taught across the four-year curriculum, however less than
40% of schools reported covering any topic related to core
obesity competencies to a great extent. Core competen-
cies on basic obesity pathophysiology and the physical
examination of a patient with obesity were each covered to
avery littleextent or not at allin 15.0% of medical
schools. Coverage of non-judgmental communication and
use of respectful language with patients who have obesity
was covered to a very littleextent or notatallin more
than one-quarter of the medical schools. Very few schools
thoroughly covered core strategies to develop a comprehen-
sive obesity management care plan such as nutrition inter-
ventions, physical activity, behavioral interventions, and
pharmacological treatments. Policies and public health ini-
tiatives pertaining to obesity were the least covered, with
64.9% of respondents reporting little to no coverage at all
(Fig. 1). Schools which reported having an obesity education
program currently in place were more likely than those
without a program to report most of the core obesity com-
petencies were covered to some extentor a great extent.
Preparation of medical students to manage obesity
On a 4-point scale ranging from not at all preparedto
very prepared, only 10.0% of respondents reported that
their graduating medical students are very preparedto
manage patients with obesity; a majority (62.5%) re-
ported that their students are only somewhat prepared.
Priority to incorporate obesity education in curriculum
Expanding obesity education was a low priority or not a
priority for 50.0% of those surveyed and nearly half of
these schools reported having no obesity education pro-
gram in place and no plans to develop one. Just over one-
third of medical schools reported having an obesity educa-
tion program in place; of those without a program, only
half reported having active discussions on how to incorp-
orate obesity or develop an obesity education program. Of
the one-third of medical schools considering incorporat-
ing or expanding obesity education, most (76.9%) ex-
pected to implement their plans within the next 2 years.
Respondents who stated that expanding obesity education
is not a priority or is a low priority for their school were
less likely to have a program in place or plans to develop
one compared to schools in which obesity education is a
higher priority (Fig. 2).
Lack of room in the curriculum was the most com-
monly reported barrier to integrating obesity education
into the curriculum half of respondents (50.0%) re-
ported it as a large barrierand one-third reported it as a
moderate barrier.Lack of faculty expertise was reported
to be a largeor moderatebarrier for 27.5% of surveyed
medical schools. Lack of student interest was least likely to
be cited as a barrier. See Fig. 3.
Table 1 Characteristics of 2018 Medical School Curriculum
Benchmark Online Survey Respondents (n= 40)
Title/Role n(%)
Dean of medical education/curriculum 30 (75.0)
Administrator 4 (10.0)
Course/Curriculum coordinator 2 (5.0)
Curriculum director 2 (5.0)
Other 2 (5.0)
Academic Experience (years) mean ± SD
Time at current institution 15.3 ± 11.0
Time in current role 6.6 ± 4.4
Time involved in undergraduate medical
19.7 ± 10.3
Role in Undergraduate Education
Actively teach medical students 38 (95.0)
Teach a course to medical students 25 (62.5)
Give lectures to medical students 33 (82.5)
Participate as a tutor to medical students 9 (22.5)
Participate as a preceptor in clinic to medical
16 (40.0)
Other 12 (30.0)
Funding Source n(%)
Public 25 (62.5)
Private 15 (37.5)
Region n(%)
Northeast 9 (22.5)
Midwest 12 (30.0)
South 14 (35.0)
West 5 (12.5)
SD Standard deviation
Percentages may not sum to 100% due to rounding
Multi-select response options
Butsch et al. BMC Medical Education (2020) 20:23 Page 3 of 6
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This is the first study to comprehensively assess the state
of obesity education in undergraduate medical education
in the United States. This Medical School Curriculum
Benchmark Study survey revealed inconsistent and inad-
equate obesity education in U.S. allopathic medical
schools resulting in medical students being ill-prepared to
manage patients with obesity. Despite the recognition of
obesity as a disease by the American Medical Association
(AMA) in 2013 and rising prevalence rates of the disease
[16,17], none of the core obesity competencies were well-
covered by more than four in ten medical schools
surveyed. The survey revealed that in approximately one-
quarter to one-third of the medical schools surveyed, there
was little to no coverage of rudimentary treatments for
obesity, i.e., nutrition, behavioral, and physical activity
These data underline not only the limited coverage of
obesity education, but also the lack of prioritization to de-
velop future curricula in obesity. An overcrowded curricu-
lum was reported as the major barrier to implementing
obesity education in this study; however, external barriers,
e.g., poor faculty knowledge about obesity, lack of stan-
dardized testing on obesity, and overall negative attitudes
about the disease of obesity, are possible reasons why
obesity education is not prioritized. Nutrition education,
Fig. 1 Coverage of Obesity Core Competencies. 2018 Medical School Curriculum Benchmark Online Survey Respondents (n= 40). Note: Some
competencies have been shortened for presentation. Responses of Some extentand I dont knownot shown
Fig. 2 Development of Obesity Curriculum by Stated Priority Level. 2018 Medical School Curriculum Benchmark Online Survey
Respondents (n= 40)
Butsch et al. BMC Medical Education (2020) 20:23 Page 4 of 6
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one facet of obesity education, is similarly underprioritized
in undergraduate medical education. In a recent study of
medical student perspectives on why nutrition education
is inadequate in medical school, the perception that nutri-
tional care is not the responsibility of doctors was sug-
gested as a barrier [18]. Although our study did not obtain
this information, the role of weight bias and the belief that
obesity is the result of a voluntary lifestyle choice, and not
a biologic disease, may influence decisions and opportun-
ities of inclusion in medical school curricula.
To address the paucity of obesity education in U.S. med-
ical schools, two recent educational initiatives included the
development of core competencies in obesity in health care
professional schools. First, the Provider Training and Edu-
cation Workgroup, part of an activity associated with the
Roundtable on Obesity Solutions at the National Acad-
emies, developed ten high-level provider competencies for
the prevention and management of obesity for health care
professional schools [19]. Secondly, OMEC, which is spear-
headed by the Obesity Medicine Association, The Obesity
Society, and the American Society of Metabolic and Bariat-
ric Surgery, developed 32 obesity-related competencies and
associated benchmarks across the six core domains of the
Accreditation Council for Graduate Medical Education
(ACGME). These obesity-related competencies were devel-
oped for medical undergraduate and postgraduate training
programs to assess learners within a training program [14].
Competencies from both initiatives are the first step to
evaluating obesity knowledge of health care professionals
and developing a structure for standards of care.
There are several limitations to our study including a
response rate of approximately 30%; however, this is
not unexpected given the target audience of medical
school program leaders who have great demands on
their time. To minimize response bias (i.e., inaccurate
responses) in our survey, the instrument was designed
in collaboration with a survey expert to design opti-
mal questions; however, the survey was not validated,
and response bias is possible. Non-responder bias, in
which certain types of respondents are less likely to
respond (for example, schools without a strong obes-
ity program in place), is also a possibility, and could
have skewed the results toward a more favorable out-
look of obesity education in U.S. medical schools. We
believe that positive skewing is unlikely given the
findings of low prioritization of obesity education re-
ported by the respondents. Some of the reported data
are subjective, including extent that the obesity com-
petencies are covered, student preparedness, and the
prioritization of obesity education.
The design of this research places a greater import-
ance on the number of institutions represented rather
than the homogeneity of respondents. It is important
to have homogeneity of the respondents, and we be-
lieve the deans of education and curriculum leaders
were the most appropriate respondents. In our study,
nearly all respondents taught medical students and
more than 75% were very knowledgeable of their curricu-
lum; however, we were unable to control for the influence
of respondentsvaried roles and professional experience on
their responses. Additionally, due to the difficulty of true
random sampling, this research is limited by the extent to
which our sample of 40 schools represents the true popula-
tion of U.S. allopathic medical schools. Development of the
list of contacts was dependent on publicly available infor-
mation, and therefore, the number of contacts identified at
each institution varied. However, our survey sample closely
aligned to the composition of the current medical schools
in the U.S. with regards to regional distribution and source
of funding (public/private). Thus, we believe the sample we
obtained represents the population in question (U.S. allo-
pathic medical schools).
Fig. 3 Barriers to Implementing/Expanding Obesity Education in Medical School. 2018 Medical School Curriculum Benchmark Online Survey
Respondents (n= 40)
Butsch et al. BMC Medical Education (2020) 20:23 Page 5 of 6
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Obesity is a major public health crisis which is clearly
not being prioritized within the context of medical
school education. Our study highlights the need for U.S.
medical school administrators to change their priorities
and recognize the urgency to develop curricula that com-
prehensively address the disease of obesity. Administrators
should take advantage of resources provided by organiza-
tions such as OMEC and incorporate obesity education
into their curricula so that graduating medical students
will be more knowledgeable and prepared to address the
challenges of caring for and managing the nearly 100 mil-
lion people with obesity in the U.S. today.
Supplementary information
Supplementary information accompanies this paper at
Additional file 1. Medical School Curriculum Benchmark Survey;
Description of data: Survey conducted among medical school directors.
AAMC: Association of American Medical Colleges; ACGME: Accreditation
Council for Graduate Medical Education; AMA: American Medical Association;
OMEC: Obesity Medicine Education Collaborative; U.S.: United States;
USMLE: United States Medical Licensing Examinations
The authors would like to thank Megan Winters for her early efforts in this
survey and Rebecca Hahn of KJT Group, Inc. for medical writing assistance
and support. The authors also would like to thank Eric Campbell, PhD for his
assistance with the survey instrument.
WSB, SA, BGS designed the study and developed the study materials. All
authors provided input into the data analyses, contributed to writing the
manuscript, and read and approved the final manuscript.
Novo Nordisk Inc. financed the development of the study design, third-party
blinded data collection, analysis, and interpretation of data as well as writing
support of the manuscript. Both Dr. Smolarz and Dr. Alford, employees of
Novo Nordisk, co-designed the study, interpreted the data, and generated re-
ported conclusions.
Availability of data and materials
The datasets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.
Ethics approval and consent to participate
Ethical approval has been waived (exempted) by Western Institutional
Review Board, July 18, 2018, reference number 11095554-1. Prior to
completing surveys, respondents provided informed consent electronically.
Consent for publication
Not applicable.
Competing interests
Dr. Butsch is a health consultant for Novo Nordisk Inc. and on an advisory
board for Rhythm Pharmaceuticals, Inc.; Dr. Kushner is on the advisory board
for Novo Nordisk and WW, and is a clinical researcher for Novo Nordisk; Dr.
Alford is an employee of Novo Nordisk and owns stock in Novo Nordisk.; Dr.
Smolarz is an employee of Novo Nordisk and owns stock in Novo Nordisk.
Author details
Bariatric and Metabolic Institute at Cleveland Clinic, Cleveland, OH, USA.
Northwestern University, Chicago, IL, USA.
Novo Nordisk Inc, 800 Scudders
Mill Rd, Plainsboro Township, NJ 08536, USA.
Received: 21 October 2019 Accepted: 3 January 2020
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... One study highlighted the need for guidelines and curricula that address obesity in depth. Universities, hospitals and organisations involved in the care of patients with obesity can incorporate competencies to better prepare staff and HCPs for the challenges related to obesity care [31]. The current undergraduate and professional training lacks adequate teaching on the causes of obesity and the impact on patient lives. ...
... Training aimed at promoting the use of patient-first language and increasing awareness of the bias and stigma that patients often experience from HCPs can help strengthen the patient-HCP relationship and improve patient outcomes. Furthermore, greater education about the aetiology of obesity as well as evidence of appropriate and effective interventions is an ongoing process and therefore continual professional development that utilises standardised competencies can bridge the gaps in information to produce highly trained HCPs [31]. This list of obesity care competencies aims to provide an initial framework to improve education for HCPs and therefore to improve patient care in obesity. ...
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Introduction: Obesity significantly increases the risk of developing (or worsening) more than 200 chronic diseases, and it is also a risk factor for severe COVID-19. With the rising prevalence of obesity in the UK, there is a need to develop obesity care competencies that apply to healthcare professionals (HCPs) at all levels of the health service, to increase the capacity for contemporary, evidence-based treatment that is effective, compassionate, and avoids stigmatising patients. Methods: A UK Obesity Care Competencies Working Group consisting of experts by profession and experts by experience was created to provide a framework of obesity care competencies for HCPs involved in specialist obesity care (tiers 2-4 in the UK). The framework was adapted from a set of competencies recently published by the USA-based Obesity Medicine Education Collaborative (OMEC) and was intended to be adaptable to nurses and allied health professionals, as well as physicians, owing to the multidisciplinary team approach used in healthcare in the UK. Results: The UK Obesity Care Competencies Working Group developed a set of 29 competencies, divided into five focal areas, namely obesity knowledge, patient care and procedural skills, practice-based learning and improvement, professionalism and interpersonal communication skills, and systems-based practice. The working group recommends that the obesity care competencies are targeted at HCPs training as specialists. The competencies could be imported into existing training programmes to help standardise obesity-related medical education and could also be used to direct a new General Practitioner with Extended Role (GPwER) qualification. Conclusion: This list of obesity care competencies aims to provide an initial framework to improve education for HCPs and therefore to improve patient care in obesity. The acceptance and integration of these competencies into the healthcare system should provide a stepping stone toward addressing trends in health inequality.
... Obesity is a challenging disease for many physicians. The reasons are many, but it is known physicians generally have little training or confidence in counseling patients about obesity and nutrition (Devries et al., 2019;Butsch et al., 2020). Further, obesity treatments are often not covered by insurance (Jannah et al., 2018), despite public support for obesity care (Woolford et al., 2013). ...
Medicine is having a reckoning with systemic racism. While some continue to believe medicine is apolitical and grounded purely in science, history and research reveal that medicine is inseparable from underlying systems, laws, and policies. Obesity is a useful case study. Weight loss trials have shown the immense difficulty in achieving and sustaining weight loss without addressing overlying systems. Barriers are double for Black, Indigenous, and People of Color (BIPOC) with obesity, who must contend with multiple layers of oppressive systems. Increasingly, illness is not a matter of bad luck, but is a function of oppressive structures. COVID-19 likely originates in a deteriorating environment, we have an increasing global burden of disease from oppressive sales of food, sugar, alcohol, guns, nicotine, and other harmful products, and social inequality and resource hoarding are at a peak. Medicine can and must participate in redefining these systems. In doing so, it must center the experiences of BIPOC and push change that alleviates power disparities.
... The prevalence of adult obesity in the United States (US) now exceeds 40%, and patients with obesity are at higher risk for various diseases including type 2 diabetes, cardiovascular disease, cancers, and the novel coronavirus disease (COVID-19), among others [1][2][3][4][5]. Yet, key facets of obesity medicine such as the basic disease pathophysiology, prevention methodologies, and best practices for working with patients with obesity may be underrepresented within the medical school curriculum [6][7][8]. This is further evident in board certification exams, the majority of which only mention related terminology and not obesity itself [9]. ...
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Background/Objectives Obesity is a pressing health concern within the United States (US). Obesity medicine “diplomates” receive specialized training, yet it is unclear if their accessibility and availability adequately serves the need. The purpose of this research was to understand how accessibility has evolved over time and assess the practicality of serving an estimated patient population with the current distribution and quantity of diplomates. Methods Population-weighted Census tracts in US counties were mapped to the nearest facility on a road network with at least one diplomate who specialized in adult (including geriatric) care between 2011 and 2019. The median travel time for all Census tracts within a county represented the primary geographic access measure. Availability was assessed by estimating the number of diplomates per 100 000 patients with obesity and the number of facilities able to serve assigned patients under three clinical guidelines. Results Of the 3371 diplomates certified since 2019, 3036 were included. The median travel time (weighted for county population) fell from 28.5 min [IQR: 13.7, 68.1] in 2011 to 9.95 min [IQR: 7.49, 18.1] in 2019. There were distinct intra- and inter-year travel time variations by race, ethnicity, education, median household income, rurality, and Census region (all P < 0.001). The median number of diplomates per 100 000 with obesity grew from 1 [IQR: 0.39, 1.59] in 2011 to 5 [IQR: 2.74, 11.4] in 2019. In 2019, an estimated 1.7% of facilities could meet the recommended number of visits for all mapped patients with obesity, up from 0% in 2011. Conclusions Diplomate geographic access and availability have improved over time, yet there is still not a high enough supply to serve the potential patient demand. Future studies should quantify patient-level associations between travel time and health outcomes, including whether the number of available diplomates impacts utilization.
... While the most current research reveals obesity is not recognised as a priority in medicine [49], nursing [50] and physiotherapy education [51], inclusion of a formal obesity curriculum at entry and graduate level, that is co-designed with patients living with obesity, who have first-hand experience of healthcare weight bias and stigmatisation, should now be part of contemporary health and social care education. Moreover, in addition to training the next generation of HCPs, introduction of education resources for current HCPs, focusing on the complexity of obesity, the impact of weight stigma, environmental barriers and communication coaching, used alongside a 'zero weight discrimination in healthcare' policy, may be the first steps towards dispelling these negative attitudes [52]. ...
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Background Current data indicates 70% of adults with obesity report experiencing bias and stigmatisation when engaging with healthcare. Most studies to date, have focused on weight bias from a healthcare professional’s perspective. Few have explored weight bias from the perspective of the individual living with obesity and no study has conducted this research in the Irish context. Aims This study explored, the lived-in experience of individuals afflicted with obesity, when interacting with the Irish healthcare system. It examined whether participants encountered weight bias and stigma, if so, how it may have impacted them and gathered their suggestions on how it could be best addressed. Methods Employing a phenomenological approach, purposive sampling and semi-structured interviews were conducted with 15 individuals living with class II (BMI 35.0–39.9) or III obesity (BMI ≥ 40kg/m ² ) who reported regular and consistent engagement with the Irish healthcare system. Predominant emergent themes were categorised using the interview domains; (1) experiences of obesity bias and stigma, (2) impact of this bias and stigma and (3) suggested avenues to reduce bias and stigma. Findings Participants reported experiencing high levels of weight bias and stigmatisation. Relating to experiences, three themes were identified; interpersonal communication, focus of care and physical environment. In terms of its impact, there were two emergent themes; negativity towards future healthcare and escalation of unhealthy behaviours. Suggested avenues to eliminate bias and stigma included the introduction of a timely and clear clinical pathway for obesity management and a focus on HCPs education in relation to obesity causes and complexity. Conclusions Outside of specialist obesity tertiary care, weight bias and stigmatisation is commonly reported in the Irish healthcare system. It is a significant issue for those living with obesity, detrimental to their physiological and psychological health. A concerted effort by HCPs across clinical, research and educational levels is required to alleviate its harmful effects.
The prevalence of obesity now exceeds the prevalence of undernutrition worldwide. Furthermore, the medical complications of obesity, such as diabetes, cardiovascular disease, and cancer, will soon begin to swamp medical care systems throughout the world, and some countries have already begun preparations. In 2017, a Provider Training and Education workgroup was convened by an Innovation Collaborative of the Roundtable on Obesity Solutions at the US National Academy of Medicine to develop competencies necessary for obesity care. The obesity care competencies described above are designed for a variety of health care professionals. A separate but related set of competencies was developed by The Obesity Medicine Education Collaborative designed for clinicians (specifically prescribers) for whom a more detailed knowledge of obesity and its pathophysiology is required to medically manage obesity. The lack of inclusion of obesity in medical licensure exams is another barrier to the incorporation of obesity in medical education.
Obesity is a chronic disease with increasing prevalence. It affects quality of life and renders those affected at increased risk of mortality. For people living with obesity, weight loss is one of the most important strategies to improve health outcomes and prevent or reverse obesity-related complications. In line with newly released clinical practice guidelines, weight loss targets for people living with obesity should be defined individually based on their clinical profile, and progress measured in the context of improvements in health outcomes, rather than weight loss alone. We outline current treatment options for clinically meaningful weight loss and briefly discuss pharmacological agents and devices under development. Numerous studies have shown that weight loss of ≥5% results in significant improvements in cardiometabolic risk factors associated with obesity; this degree of weight loss is also required for the approval of novel anti-obesity medications by the US Food and Drug Administration. However, some obesity-related comorbidities and complications, such as non-alcoholic steatohepatitis, obstructive sleep apnea, gastroesophageal reflux disease and remission of type 2 diabetes, require a greater magnitude of weight loss to achieve clinically meaningful improvements. In this review, we assessed the available literature describing the effect of categorical weight losses of ≥5%, ≥10%, and ≥15% on obesity-related comorbidities and complications, and challenge the concept of clinically meaningful weight loss to go beyond percentage change in total body weight. We discuss weight-loss interventions including lifestyle interventions and therapeutic options including devices, and pharmacological and surgical approaches as assessed from the available literature.
Background: Obesity is a chronic multifactorial disease affecting approximately one in five youth. Many pediatric clinical strategies focus on behavioral change/lifestyle modification efforts, but are limited by their intensity and muted by their inability to address the sociocultural contexts of obesity. The primary objective of the study was to explore primary care pediatric clinicians' current barriers/management practices of patients with obesity. Methods: A mixed-methods study was conducted by distributing an electronic survey to pediatric providers in Washington, DC, and its surrounding metropolitan area. Three focus groups were conducted with a subgroup of these primary care clinicians to further explore their responses. Results: Pediatric clinicians (n = 81) completed the survey out of 380 invitations sent, and 20 took part in 3 focus groups, ranging in size between 4 and 8 clinicians. Over 90% of clinicians felt comfortable advising patients. However, 52% lacked confidence in addressing obesity and over 80% indicated that time constraint is a barrier to care and emphasized the need for more training in obesity management. Six themes emerged regarding clinician barriers to addressing obesity, including (1) limited time, (2) clinician perceived familial resistance, (3) challenges with racial and ethnic concordance, (4) perceived environmental barriers, (5) limited knowledge of community resources, and (6) inadequate collaborative support. Conclusions: Clinicians have difficulty implementing obesity management strategies into their everyday practice due to a variety of barriers. This study emphasized the need for better implementation strategies, tools, and collaboration with community stakeholders for clinicians to engage weight management more effectively.
Training experiences where residents provide Spanish-language concordant care (SLCC) have not been widely described despite their increasing need and prevalence in graduate medical education. In this qualitative study, we enrolled nonnative Spanish-speaking residents (n = 21) within SLCC training clinics from 3 geographically unique programs. Participants completed semistructured interviews focused on their overall SLCC training experience. Major themes identified included (1) high levels of satisfaction in their SLCC experience, (2) concern about ongoing language barriers, (3) demonstration of high levels of cultural humility in caring for patients with limited English proficiency, and (4) identification of several valuable programmatic and clinical resources. Based on these findings, we conclude that SLCC training experiences are of significant value to trainees in becoming pediatricians able to promote health equity. Themes identified could help inform how graduate medical education programs utilize SLCC to grow health-equity based efforts to deliver more effective and compassionate care to our linguistically diverse populations.
Obesity is a treatable chronic disease. Primary care providers play an essential role in diagnosis, treatment, and comprehensive care of patients with obesity. In recent years, treatment approaches have rapidly evolved, increasing effective and safe therapies. In this review, we provide practical information on the care of patients with obesity with a focus on antiobesity pharmacotherapy within the context of currently available therapeutic modalities such as intensive lifestyle interventions and bariatric surgery.
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Background Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person’s control. We evaluated whether medical school students’ beliefs about obesity correlate with ability to effectively counsel patients with obesity. Methods Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity. We surveyed these students to evaluate their beliefs about the causes of obesity and their attitudes towards people with obesity. We analyzed correlations between student beliefs, negative obesity attitudes, and OSCE performance. Results The response rate was 60.7% (n = 71). When asked to rate the importance of individual factors, students rated controllable factors such as unhealthy diet, physical inactivity, and overeating as more important than genetics or biological factors (p < 0.01). Believing obesity is caused by uncontrollable factors was negatively correlated with obesity bias (r = − 0.447; p < 0.0001). Believing that obesity is caused by factors within a person’s control was negatively correlated with counseling skills (r = − 0.235; p < 0.05). Conclusions Attribution of obesity to external factors correlated with greater ability to counsel patients with obesity, suggesting that educating providers on the biological causes of obesity could help reduce bias and improve provider care.
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Background: The provision of nutrition care by doctors is important in promoting healthy dietary habits, and such interventions can lead to reductions in disease morbidity, mortality, and medical costs. However, medical students and doctors report inadequate nutrition education and preparedness during their training at school. Previous studies investigating the inadequacy of nutrition education have not sufficiently evaluated the perspectives of students. In this study, students' perspectives on doctors' role in nutrition care, perceived barriers, and strategies to improve nutrition educational experiences are explored. Methods: A total of 23 undergraduate clinical level medical students at the 5th to final year in the School of Medicine and Health Sciences of the University for Development Studies in Ghana were purposefully selected to participate in semi-structured individual interviews. Students expressed their opinions and experiences regarding the inadequacy of nutrition education in the curriculum. Each interview was audio-recorded and later transcribed verbatim. Using the constant comparison method, key themes were identified from the data and analysis was done simultaneously with data collection. Results: Students opined that doctors have an important role to play in providing nutrition care to their patients. However, they felt their nutrition education was inadequate due to lack of priority for nutrition education, lack of faculty to provide nutrition education, poor application of nutrition science to clinical practice and poor collaboration with nutrition professionals. Students opined that their nutrition educational experiences will be improved if the following strategies were implemented: adoption of innovative teaching and learning strategies, early and comprehensive incorporation of nutrition as a theme throughout the curriculum, increasing awareness on the importance of nutrition education, reviewing and revision of the curriculum to incorporate nutrition, and involving nutrition/dietician specialists in medical education. Conclusion: Though students considered nutrition care as an important role for doctors they felt incapacitated by non-prioritisation of nutrition education, lack of faculty for teaching of nutrition education, poor application of nutrition science and poor collaboration with nutrition professionals. Incorporation of nutrition as a theme in medical education, improving collaboration, advocacy and creating enabling environments for nutrition education could address some of the barriers to nutrition education.
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Background: Recent trends in obesity show that over two-thirds of US adults are considered at least overweight (body mass index, BMI≥25 kg/m(2)) and of those, about one-third are categorized as obese (BMI≥30 kg/m(2)). Physicians can address the health impacts of obesity; yet research has suggested that physicians-in-training frequently fail to recognize obesity, are not properly educated regarding treatment options, and spend relatively little clinic time treating obesity. Medical school is a unique opportunity to address this area of need so that the doctors of tomorrow are prepared to treat obesity appropriately. Objectives: The objective of this study was to determine perceptions of where clinical training for medical students on the topic of obesity and its treatment should improve and expand so that we could address the needs identified in a computerized clinical simulation. Methods: We conducted a literature review, as well as a needs analysis with medical school students (N=17) and faculty (N=12). Literature review provided an overview of the current state of the field. Students provided input on their current needs, learning preferences, and opinions. Faculty provided feedback on current training and their perceptions of future needs. Results: Most students were familiar with obesity medicine from various courses where obesity medicine was a subtopic, most frequently in Biochemistry or Nutrition, Endocrinology, and Wellness courses. Student knowledge about basic skills, such as measuring waist circumference, varied widely. About half of the students did not feel knowledgeable about recommending weight loss treatments. Most students did not feel prepared to provide interventions for patients in various categories of overweight/obesity, patients with psychosocial issues, obesity-related comorbidities, or failed weight loss attempts. However, most students did feel that it was their role as health professionals to provide these interventions. Faculty rated the following topics as most important to supplement the curriculum: patient-centered treatment of weight, bringing up the topic of weight, discussing weight and well-being, discussing the relationship between weight and comorbidities, and physician role with overweight or obese patients. Conclusions: A review of the literature as well as surveyed medical students and faculty identified a need for supplementation of the current obesity medicine curriculum in medical schools. Specific needed topics and skills were identified.
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Objective: Obesity is a worldwide problem that has been linked to serious medical issues. Obesity-related conditions drain healthcare expenditures globally, and in particular in the U.S. This article suggests methods to forecast future costs associated with obesity-related healthcare in the next two decades. Methods: An Auto Regressive Integrated Moving Average (ARIMA) time series analysis was implemented to model the data published by the Center for Disease Control and Prevention. Results: The findings suggest that the proportion of individuals in the population defined as overweight will decline slowly in the next 20 years. However, the proportion of the population considered obese will increase substantially and could represent as much as 45% of the entire population by 2035. The proportion of morbidly obese will also increase considerably. These trends are likely to impact the actual costs of healthcare considerably. Conclusions: Policy makers in the healthcare sector should be aware of this trend and prepare to deal with increasing numbers of medical problems related to obesity. Concrete recommendations for policy makers are put forward in the discussion as well as avenues for future research.
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Purpose . To assess the state of nutrition education at US medical schools and compare it with recommended instructional targets. Method . We surveyed all 133 US medical schools with a four-year curriculum about the extent and type of required nutrition education during the 2012/13 academic year. Results . Responses came from 121 institutions (91% response rate). Most US medical schools (86/121, 71%) fail to provide the recommended minimum 25 hours of nutrition education; 43 (36%) provide less than half that much. Nutrition instruction is still largely confined to preclinical courses, with an average of 14.3 hours occurring in this context. Less than half of all schools report teaching any nutrition in clinical practice; practice accounts for an average of only 4.7 hours overall. Seven of the 8 schools reporting at least 40 hours of nutrition instruction provided integrated courses together with clinical practice sessions. Conclusions . Many US medical schools still fail to prepare future physicians for everyday nutrition challenges in clinical practice. It cannot be a realistic expectation for physicians to effectively address obesity, diabetes, metabolic syndrome, hospital malnutrition, and many other conditions as long as they are not taught during medical school and residency training how to recognize and treat the nutritional root causes.
Objective: Obesity Medicine Education Collaborative (OMEC) was formed to develop obesity-focused competencies and benchmarks that can be used by undergraduate and graduate medical education program directors. This article describes the developmental process used to create the competencies. Methods: Fifteen professional organizations with an interest in obesity collaborated to form OMEC. Using the six Core Competencies of the Accreditation Council for Graduate Medical Education as domains and as a guiding framework, a total of 36 group members collaborated by in-person meetings, email exchange, and conference calls. An iterative process was used by each working subgroup to develop the competencies and assessment benchmarks. The initial work was subsequently externally reviewed by 19 professional organizations. Results: Thirty-two competencies were developed across the six domains. Each competency contains five descriptive measurement benchmarks for evaluator rating. Conclusions: This set of OMEC obesity-focused competencies is the first evaluation tool developed to be used within undergraduate and graduate medical training programs for both formative and summative assessments. Routine and more robust assessment is expected to increase the competence of health care providers to assess, prevent, and treat obesity. In addition to dissemination, the competencies and benchmarks will need to undergo evaluation for further validity and practicality.
Objective: The aim of this work is to develop a practical, tangible, measurable, and simple standard of care for the treatment of adult obesity that provides guidance for both clinical providers and community settings. Methods: Three roundtables with relevant stakeholder groups were convened by the STOP Obesity Alliance at The George Washington University to develop the proposed standard of care. Results: The proposed standard of care for adult obesity treatment proposes practices for the spectrum of clinical, community, and digitally based entities and for clinical providers. Coverage and payment policy standards are also provided. Conclusions: These standards are intended to augment published guidelines developed for obesity care providers and can also be viewed as the first step to define an optimal benefit package.
Obesity is associated with serious health risks. Monitoring obesity prevalence is relevant for public health programs that focus on reducing or preventing obesity. Between 2003–2004 and 2013–2014, there were no significant changes in childhood obesity prevalence, but adults showed an increasing trend. This report provides the most recent national estimates from 2015–2016 on obesity prevalence by sex, age, and race and Hispanic origin, and overall estimates from 1999–2000 through 2015–2016.
Approach: Examination items that included obesity-related keywords were identified by National Board of Medical Examiners (NBME) staff. A panel of 6 content experts evaluated all items and coded obesity-relevant items using the American Board of Obesity Medicine (ABOM) test outline rubric into 4 domains and 107 subdomains. Findings: There were 802 multiple-choice items containing obesity-related keywords identified by NBME, of which 289 (36%) were identified as being relevant to obesity and were coded into appropriate domains and subdomains. Among the individual domains, the Diagnosis & Evaluation domain comprised most of the items (174) for all 3 Step examinations. Fifty-eight percent of items were represented by 4 of 17 organ systems, and 80% of coded items were represented by 6 ABOM subdomains. The majority of obesity-coded items pertained to the diagnosis and management of obesity-related comorbid conditions rather than addressing the prevention, diagnosis, or management of obesity itself. Insights. The most important concepts of obesity prevention and treatment were not represented on the Step exams. Exam items primarily addressed the diagnosis and treatment of obesity-related comorbid conditions instead of obesity itself. The expert review panel identified numerous important obesity-related topics that were insufficiently addressed or entirely absent from the examinations. The reviewers recommend that the areas identified for improvement may promote a more balanced testing of knowledge in obesity.
Obesity is the second leading cause of preventable death in the United States. However, physicians feel poorly trained to address the obesity epidemic. This article examines effective training methods for overweight and obesity intervention in undergraduate medical education. Using indexing terms related to overweight, obesity, and medical student education, we conducted a literature searched PubMed PsycINFO, Cochrane, and ERIC for relevant articles in English. References from articles identified were also reviewed to located additional articles. We included all studies that incorporated process or outcome evaluations of obesity educational interventions for U.S. medical students. Of an initial 168 citations, 40 abstracts were retrieved; 11 studies were found to be pertinent to medical student obesity education, but only 5 included intervention and evaluation elements. Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified participants (e.g., year of medical students), interventions, evaluations, and results. These 5 studies successfully used a variety of teaching methods including hands on training, didactic lectures, role-playing, and standardized patient interaction to increase medical students' knowledge, attitudes, and skills regarding overweight and obesity intervention. Two studies addressed medical student bias toward overweight and obese patients. No studies addressed health disparities in the epidemiology and bias of obesity. Despite the commonly cited "obesity epidemic," there are very few published studies that report the effectiveness of medical school obesity educational programs. Gaps still exist within undergraduate medical education including specific training that addresses obesity and long-term studies showing that such training is retained.