1
|
Chae K, German J, Kendrick K, Tackett S, O’Rourke P, Gudzune KA, Laudenslager M. What are Internal medicine residents' attitudes toward obesity as a disease, people living with obesity, and obesity treatment? Obes Sci Pract 2024; 10:e748. [PMID: 38562401 PMCID: PMC10984423 DOI: 10.1002/osp4.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Despite the rising prevalence of people living with obesity, physicians are providing suboptimal care to these individuals, which may be a consequence of inadequate education in weight management and negative attitudes toward people living with obesity. Internal Medicine (IM) residency is an ideal setting to address physicians' attitudes toward people living with obesity. However, there is a paucity of recent literature on this topic. This study sought to assess the current attitudes of IM residents toward obesity as a disease, people living with obesity, and obesity treatment. Methods A cross-sectional survey was conducted in 2020 across two IM programs assessing residents' attitudes toward obesity as a disease, people living with obesity, and obesity treatment. RESULTS Among 42 residents who participated in the survey, 64% were women; 31 percent were Post Graduate Year 1, 31% PGY-2, and 38% PGY-3. Mean attitude scores were high on statements regarding obesity as a chronic disease [4.7 (SD 0.4)] and its association with serious medical conditions [4.9 (SD 0.3)]. Residents had overall positive attitudes toward people living with obesity. In contrast, residents felt negatively regarding their level of success in helping patients lose weight [2.0 (SD 0.7)]. CONCLUSIONS While residents recognized obesity as a chronic disease and had positive attitudes toward people living with obesity, their low ratings regarding weight management success suggest that targeted educational efforts are needed to increase obesity treatment self-efficacy.
Collapse
Affiliation(s)
- Kacey Chae
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jashalynn German
- Division of Endocrinology, Diabetes, & MetabolismDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Karla Kendrick
- Winchester Hospital Weight Management CenterBeth Israel Lahey HealthWoburnMassachusettsUSA
| | - Sean Tackett
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Biostatistics, Epidemiology, and Data Management CoreJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paul O’Rourke
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly A. Gudzune
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Marci Laudenslager
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
2
|
Vega-Ramírez L. Exploring the Influence of a Physical Activity and Healthy Eating Program on Childhood Well-Being: A Comparative Study in Primary School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:418. [PMID: 38673329 PMCID: PMC11049796 DOI: 10.3390/ijerph21040418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Childhood is a crucial stage of human development in which the lifestyles children adopt can have a significant impact on their well-being throughout their lives. The aim of this study was to analyze and compare the healthy habits and Body Mass Index (BMI) of students from a primary school that participated in a program to promote physical activity and healthy eating one year earlier with other students from two schools that had not participated in this type of program. We analyzed a sample of 287 Spanish students, aged between 8 and 12 years. A survey of healthy habits was completed, and anthropometric data were taken to determine their Body Mass Index (BMI). The questionnaire data indicated that there are some significant differences (p = ≤ 0.05) in the consumption of some unhealthy foods between the evaluated groups. An amount of 11% of the sample was considered obese and 26% were overweight; no significant differences were found between the groups. This study suggests that the healthy habits strategy implemented by a school improves pupils' habits, especially in reducing the consumption of unhealthy foods. Despite the positive effects, the data indicate that these programs fall short of government recommendations, particularly in areas such as physical activity and certain dietary choices.
Collapse
Affiliation(s)
- Lilyan Vega-Ramírez
- EDUCAPHYS Research Group, Department of General and Specific Didactics, Faculty of Education, University of Alicante, 03690 Alicante, Spain
| |
Collapse
|
3
|
Gabison J, Palazzolo B, Saleh C, Ritchie O, Sheehan K, Othman A, Harper DM, Oshman L. Supporting faculty development for obesity education: A National Survey of United States family medicine residency programme directors. Clin Obes 2024:e12654. [PMID: 38525544 DOI: 10.1111/cob.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/26/2024]
Abstract
Obesity is the most common chronic condition in the United States (US), yet primary care physicians face barriers in providing obesity treatment. This study examines the prevalence of American Board of Obesity Medicine (ABOM) certified obesity specialists on the faculty of US Family Medicine residency training programmes, the preparedness of graduating resident physicians to treat obesity, and residency training programme director preferences for supporting faculty development to improve residency education in obesity management. This cross-sectional on-line survey of programme directors addressed the number of ABOM-certified faculty, perceived graduate preparedness to treat obesity, and priorities to improve faculty expertise and obesity curriculum. Of 672 eligible programme directors, 298 (44%) responded to our survey. Most programmes (76%) had no ABOM-certified faculty. The proportion of programme directors assessing their graduates as prepared to care for patients with obesity has significantly decreased in the last 5 years (2018: 74%, 2022: 58%, p = .016). Residents in programmes with ABOM-certified faculty member were more likely to be assessed as very prepared to provide medical care (18% vs. 7.8% p = .047). A majority (54%) of programme directors identified limited faculty training and expertise as the biggest faculty and resident-level barrier to quality obesity care. This study demonstrates an important trend towards increasing ABOM-certification among Family Medicine residency programme faculty and an urgent need to prioritise faculty development to improve faculty expertise and resident training to address the obesity epidemic.
Collapse
Affiliation(s)
- Jonathan Gabison
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Beatrice Palazzolo
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina Saleh
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivia Ritchie
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kayla Sheehan
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amal Othman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Diane M Harper
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Olson A, Watowicz R, Seeholzer E, Lyons K, Butsch WS, Croniger C. Team-Based Learning Intervention to Improve Obesity Education in Medical School. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11369. [PMID: 38046813 PMCID: PMC10689578 DOI: 10.15766/mep_2374-8265.11369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/25/2023] [Indexed: 12/05/2023]
Abstract
Introduction Obesity is a multifactorial chronic disease and a major contributor to numerous health conditions. Despite the high prevalence, costs, and health effects of obesity, physicians are largely unprepared to treat it. Most medical students and residents lack sufficient training in obesity and obesity management. Methods We evaluated a two-part team-based learning seminar (TBL) on obesity pathogenesis and treatment for first-year medical students at Case Western Reserve University School of Medicine (CWRU SOM). A questionnaire on attitudes toward obesity and self-perceived knowledge of obesity was administered before and after the TBL, utilizing Likert scales. Results Of 183 medical students who attended both TBLs, 155 (85%) completed the baseline questionnaire, and 127 (69%) completed the postintervention questionnaire. Confidence in treating obesity increased significantly from preintervention (M = 2.7, SD = 1.0) to postintervention (M = 3.7, SD = 0.8). The attitude that obesity is caused by poor personal choices decreased significantly from preintervention (M = 2.8, SD = 0.9) to postintervention (M = 2.1, SD = 0.9). Self-perceived knowledge of obesity in all nine areas-epidemiology, energy homeostasis, etiologies, nutrition, physical activity, behavior, pharmacology, surgery, and language-increased significantly. Discussion Despite obesity being one of the most prevalent health concerns, obesity education in medical school is scant. This TBL resulted in improved attitudes toward obesity and self-perceived knowledge of obesity among first-year medical students at CWRU SOM and offers a practical mechanism to introduce more obesity education into undergraduate medical curricula.
Collapse
Affiliation(s)
- Amber Olson
- Third-Year Medical Student, Case Western Reserve University School of Medicine
| | - Rosanna Watowicz
- Assistant Professor, Department of Nutrition, Case Western Reserve University School of Medicine
| | - Eileen Seeholzer
- Medical Director, Adult Weight Loss Surgery and Weight Management Center, MetroHealth System
| | - Katherine Lyons
- Physician, Adult Weight Loss Surgery and Weight Management Center, MetroHealth System
| | - W. Scott Butsch
- Director of Obesity Medicine, Bariatric and Metabolic Institute, Cleveland Clinic
| | - Colleen Croniger
- Associate Professor, Department of Nutrition, Case Western Reserve University School of Medicine
| |
Collapse
|
5
|
Abraham Roshan J, Nagpal TS, Pearce N, Dhaliwal KK, El-Hussein M, Forhan M, Hadjiyanakis S, Hawa R, Kushner RF, Lee-Baggley D, McMillan M, Nutter S, Piccinini-Vallis H, Vallis M, Wharton S, Wiljer D, Sockalingam S. Transforming the landscape of obesity education - The Canadian obesity education competencies. OBESITY PILLARS 2023; 8:100091. [PMID: 38125661 PMCID: PMC10728696 DOI: 10.1016/j.obpill.2023.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
Background With ongoing gaps in obesity education delivery for health professions in Canada and around the world, a transformative shift is needed to address and mitigate weight bias and stigma, and foster evidence-based approaches to obesity assessment and care in the clinical setting. Obesity Canada has created evidence-based obesity competencies for medical education that can guide curriculum development, assessment and evaluation and be applied to health professionals' education programs in Canada and across the world. Methods The Obesity Canada Education Action Team has seventeen members in health professions education and research along with students and patient experts. Through an iterative group consensus process using four guiding principles, key and enabling obesity competencies were created using the 2015 CanMEDS competency framework as its foundation. These principles included the representation of all CanMEDS Roles throughout the competencies, minimizing duplication with the original CanMEDS competencies, ensuring obesity focused content was informed by the 2020 Adult Obesity Clinical Practice Guidelines and the 2019 US Obesity Medication Education Collaborative Competencies, and emphasizing patient-focused language throughout. Results A total of thirteen key competencies and thirty-seven enabling competencies make up the Canadian Obesity Education Competencies (COECs). Conclusion The COECs embed evidence-based approaches to obesity care into one of the most widely used competency-based frameworks in the world, CanMEDS. Crucially, these competencies outline how to address and mitigate the damaging effects of weight bias and stigma in educational and clinical settings. Next steps include the creation of milestones and nested Entrustable Professional Activities, a national report card on obesity education for undergraduate medical education in Canada, and Free Open Access Medication Education content, including podcasts and infographics, for easier adoption into curriculum around the world and across the health professions spectrum.
Collapse
Affiliation(s)
| | - Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Mohamed El-Hussein
- Faculty of Health, Community & Education, School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stasia Hadjiyanakis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert F. Kushner
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Wharton
- University of Toronto, Wharton Medical Clinic, Toronto, Ontario, Canada
| | - David Wiljer
- University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Nagpal TS, Pearce N, Dhaliwal K, Abraham JR. Implementing evidence-based obesity management guidelines requires development of medical competencies: A commentary outlining future directions in obesity education in Canada. OBESITY PILLARS (ONLINE) 2023; 8:100086. [PMID: 38125664 PMCID: PMC10728703 DOI: 10.1016/j.obpill.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023]
Abstract
Background This commentary provides an overview of forthcoming activities by Obesity Canada (OC) to inform obesity competencies in medical education. Competencies in medical education refer to abilities of medical professionals to appropriately provide patients the care they need. A recognized Canadian framework for informing medical competencies is CanMEDs. Additionally, the Obesity Medicine Education Collaborative (OMEC) provides 32 obesity specific medical competencies to be integrated across medical education curriculum. OC released the first globally recognized Adult Obesity Clinical Practice Guideline (CPGs) in 2020 inclusive of 80 recommendations. Referring to the CanMEDs and OMEC competencies, OC is developing medical education competencies for caring for patients who have obesity in line with the recent CPGs that can be applied to health professions education programs around the world. Methods Activities being completed by OC's Education Action Team include a scoping review to summarize Canadian obesity medical education interventions or programs. Next, with expert consensus a competency set is being developed by utilizing the CanMEDs Framework, OMEC and the CPGs. Following this, OC will initially survey undergraduate medical programs across the country and determine to what degree they are meeting the competencies in content delivery. These findings will lead to a national report card outlining the current state of obesity medical education in Canada within undergraduate medical education. Results To date, OC has completed the scoping review and the competency set. The Education Action Team is in the process of developing the survey tools to assess the current delivery of obesity medical education in Canada. Conclusion The evidenced-based report card will support advocacy to refine and enhance future educational initiatives with the overall goal of improving patient care for individuals living with obesity. The process being applied in Canada may also be applicable and modified for other regions to assess and better obesity medical education.
Collapse
Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | - Khushmol Dhaliwal
- Department of Family Medicine Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Joseph Roshan Abraham
- Department of Family Medicine Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Srivastava G. Diagnostic challenge: A pediatric patient with severe obesity and complications of imminent death. OBESITY PILLARS (ONLINE) 2023; 7:100077. [PMID: 37990678 PMCID: PMC10661896 DOI: 10.1016/j.obpill.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 11/23/2023]
Abstract
Background A 15-year-old patient suffering from severe obesity (400 pounds, BMI 71.6 kg/m2) with a clinical phenotype suggestive of syndromic obesity was hospitalized for severe heart failure and cardiogenic shock. The hospital admission prompted a palliative care and heart transplant consultation given end-stage-disease and poor prognosis. It further necessitated a pediatric inpatient obesity consult, which was complicated by several significant hurdles including lack of insurance coverage, FDA approvals, availability of medications, and inadequate knowledge among the medical community. Methods Innovative treatment, proactive, persistent advocacy, anti-obesity medication combination strategies modeled after diabetes and hypertension treatment algorithms, and latest evidence in obesity management were utilized to effectively and expeditiously overcome major challenges to care and the medical emergency. Results The patient was stabilized and ultimately discharged home, after -25.2% weight loss over 4 months (weight down to 299 pounds, BMI 49.9 kg/m2) through collaborative medical obesity intervention. Conclusion The typical delay in care sought by patients suffering from obesity, often due to stigma and lack of disease awareness, results in missed opportunities to prevent serious obesity-related complications. Skilled specialist expertise, fund of obesity-specific knowledge, and constant advocacy can be crucial in surmounting regulatory barriers to obesity care and in generating successful weight loss outcomes.
Collapse
Affiliation(s)
- Gitanjali Srivastava
- Vanderbilt University School of Medicine, Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Nashville, TN, USA
- Department of Surgery, Vanderbilt University School of Medicine, United States
- Department of Pediatrics, Vanderbilt University School of Medicine, United States
- Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, United States
| |
Collapse
|
8
|
Phillips E, Traina A, Smolarz BG. A Survey of Obesity Education and Training in United States Pharmacy Schools. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100109. [PMID: 37597919 DOI: 10.1016/j.ajpe.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 03/17/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To assess how obesity is addressed in Doctor of Pharmacy (PharmD) schools and colleges, identify the extent to which core obesity competencies are covered in the curricula, and identify opportunities for expanding obesity management training. METHODS An online survey was conducted with PharmD program leaders in the United States. Respondents answered questions regarding obesity education in their pharmacy school curricula. Data were analyzed in aggregate, using descriptive statistics. RESULTS We collected responses from 75 of 150 (50%) PharmD programs. One-third (32%) of respondents thought their graduating students were very prepared to discuss obesity pharmacotherapy (anti-obesity medication) options with patients. A total of 45% reported obesity pharmacological treatment was covered to a great extent. Few respondents (19%) were very familiar with anti-obesity medications; 21% thought their students were similarly familiar. No programs covered weight stigma and discrimination to a great extent. Most respondents (88%) believed obesity education was fairly/very important to include in PharmD curricula, and 96% thought it was similarly appropriate to include. But 72% indicated that expanding obesity education was not a priority/low priority. Lack of room in the curricula was cited as the greatest barrier, with 60% of PharmD programs reporting this to be a large barrier. CONCLUSION Pharmacists, as medication experts, are key members of the care team. However, obesity management/pharmacotherapy is not emphasized in most pharmacy schools. Therefore, pharmacists are not well-prepared to provide counseling on medications for obesity. Leveraging guidance on core obesity competencies and available resources could help expand obesity education in pharmacy schools.
Collapse
Affiliation(s)
- Elizabeth Phillips
- St. John Fisher University, Wegmans School of Pharmacy, Rochester, NY, USA
| | | | | |
Collapse
|
9
|
Schumacher LM, Ard J, Sarwer DB. Promise and unrealized potential: 10 years of the American Medical Association classifying obesity as a disease. Front Public Health 2023; 11:1205880. [PMID: 37521999 PMCID: PMC10375286 DOI: 10.3389/fpubh.2023.1205880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In June 2013, the American Medical Association (AMA), one of the most influential healthcare organizations in the United States, voted to recognize obesity as a disease. Many who supported this change believed that recognition by AMA of obesity as a disease would serve as a tipping point that would increase access to care, accelerate training and research on the prevention and treatment of obesity, and reduce weight stigma. On the 10-year anniversary of this vote, this perspective piece outlines key advances made, as well as unrealized potential, in improving the obesity public health landscape since the AMA's classification of obesity as a disease. Methods We draw on the empirical literature, as well as our experiences as clinical psychologists, a physician, and public health researchers specializing in obesity, to provide an overview of major advances and continued challenges in improving access to obesity treatment, accelerating prevention and training, and reducing weight stigma. We also outline important next steps to advance these goals. Results While several notable advancements have occurred, significant work remains to create equitable access to evidence-based treatments, bring research and training on obesity on par with its prevalence, and reduce the pervasiveness and harm of weight stigma. Conclusion The past decade has witnessed some advances with respect to access to care and attention, yet there is unrealized potential that awaits attention. Truly conceptualizing and treating obesity as a chronic disease requires a major paradigm shift.
Collapse
Affiliation(s)
- Leah M. Schumacher
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, United States
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jamy Ard
- Department of General Surgery, Atrium Health Wake Forest Baptist, Weight Management Center, Winston-Salem, NC, United States
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - David B. Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, United States
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| |
Collapse
|
10
|
Olson A, Stanford FC, Butsch WS. Obesity in the USMLE Step 1 examination: A call to action. Int J Obes (Lond) 2023:10.1038/s41366-023-01308-2. [PMID: 37031285 PMCID: PMC10082342 DOI: 10.1038/s41366-023-01308-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Amber Olson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Fatima Cody Stanford
- MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
11
|
Essel KD, Fotang J, Deyton L, Cotter EW. Discovering the Roots: A Qualitative Analysis of Medical Students Exploring Their Unconscious Obesity Bias. TEACHING AND LEARNING IN MEDICINE 2023; 35:143-156. [PMID: 35236208 DOI: 10.1080/10401334.2022.2041421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Phenomenon: Bias against individuals with obesity in medical settings has negative implications for patients, including stigmatization, poor health outcomes, and reduced healthcare utilization. This study explored reflections of medical students when confronted with their own implicit obesity bias.Approach: A group of 188 pre-clinical second-year medical students from George Washington University School of Medicine and Health Sciences completed the Weight Implicit Association Test (IAT) in 2020 and were instructed to write a reflective response based on their results. Participants reflected upon their preferences ("fat" vs. "thin") and described the factors that influenced their perceptions of obesity. Inductive coding techniques were used to generate themes from medical students' responses using Dedoose Version 8.3.35 (SocioCultural Research Consultants LLC, Los Angeles, California).Findings: Regarding IAT results, 7% of medical students preferred "fat over thin," 14% had no preference, and 78% preferred "thin over fat." Reflection themes highlighted medical students' difficulty accepting IAT results, perspectives on the origins of obesity in individuals, personal and family challenges with obesity and body image, medical training's perceived influence on bias, reservations about discussing obesity with patients, and desires to change current and future practices.Insights: Many medical students expressed a desire to provide optimal care for patients of all weight classes despite demonstrating a strong unconscious bias against individuals with obesity on the IAT. Medical school should provide targeted opportunities to acknowledge and mitigate obesity bias by expanding on medical students' pre-established and often harmful understandings of obesity and highlighting the complexities of this disease. Such training would better equip medical students to facilitate successful interactions with patients as future physicians.
Collapse
Affiliation(s)
- Kofi D Essel
- Pediatrics, General & Community Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jenny Fotang
- Department of Psychology, American University, Washington, DC, USA
| | - Lawrence Deyton
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | |
Collapse
|
12
|
Crowley N. Person-First Treatment Strategies: Weight Bias and Impact on Mental Health of People Living with Obesity. Prim Care 2023; 50:89-101. [PMID: 36822731 DOI: 10.1016/j.pop.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stigma and bias surrounding body weight is both explicit and implicit, but the most concerning impact on individuals is internalized stigma which is correlated with poor physical and mental health. Strategies to combat this public health concern include increasing awareness, education around the complex disease of obesity, proper use of communication and language surrounding weight, health, and treatment approaches, addressing equipment and practices in the clinical environment, and larger, systemic approaches to policy. Addressing stigma for a condition impacting the majority of our population is critical for the best health and well-being of our patients and ourselves.
Collapse
|
13
|
Grunvald E, Wei J, Lin T, Yang K, Tu XM, Lunde O, Ross E, Cheng J, DeConde J, Farber N. Exploring the Effect of Adding an Interactive Lecture to a Standardized Patient Curriculum on the Attitudes of Third-Year Medical Students About Patients With Obesity: A Quasi-Experimental Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231207683. [PMID: 37854280 PMCID: PMC10580723 DOI: 10.1177/23821205231207683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Anti-obesity bias is pervasive among medical professionals, students, and trainees. Stigmatization of patients leads to suboptimal care and clinical outcomes. Educational strategies in medical training are needed to reverse these attitudes. The aim of this study was to evaluate the effect of an innovative didactic intervention and a standardized patient (SP) exercise on attitudes towards patients with obesity among medical students. METHODS In 2016, a quasi-experimental study design was used at a US medical school. The class was divided into 2 groups according to a pre-determined protocol based on their clinical schedule, one assessed after exposure to a SP group and the other after exposure to the SP and an interactive lecture (IL + SP group) with real patients. The Attitudes about Treating Patients with Obesity and The Perceived Causes of Obesity questionnaires measured changes in several domains. A generalized estimating equations model was used to estimate the effect of the interventions both within and between groups. RESULTS Both groups showed improvements in negative and positive attitudes, although the reduction in scores for the negative attitude domain did not reach statistical significance in the IL + SP group (for the SP group, P = .01 and < .001, respectively; for the IL + SP group, P = .15 and .01, respectively). For perceived causes of obesity, there were no statistically significant changes for pre-post survey measures within each group, except for the physiologic causes domain in the SP group (P = .03). The addition of an IL to a SP curriculum did not result in any changes for any domain in between-group analyses. CONCLUSIONS Although adding a novel intervention utilizing real patients to a SP curriculum failed to show an additional educational benefit, our study showed that it is possible to influence attitudes of medical students regarding patients with obesity.
Collapse
Affiliation(s)
- Eduardo Grunvald
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jennie Wei
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Tuo Lin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Kun Yang
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Xin M Tu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Ottar Lunde
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Evelyn Ross
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Fox Chase Cancer Center, Temple University, Philadelphia, PA, USA
| | - Jessica Cheng
- University of California San Diego School of Medicine, La Jolla, CA, USA
- Elica Health Centers, West Sacramento, CA, USA
| | - Jennifer DeConde
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Neil Farber
- University of California San Diego School of Medicine, La Jolla, CA, USA
| |
Collapse
|
14
|
Johnson S, Gupta S, Mackey E, McCarron K, Fischer L, Panton D, Essel K. "We Feel Like We Are in It Alone": A Mixed-Methods Study of Pediatric Primary Care Barriers for Weight Management. Child Obes 2023; 19:3-12. [PMID: 35275705 DOI: 10.1089/chi.2021.0274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sheryl Johnson
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Simran Gupta
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Eleanor Mackey
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
| | - Kristy McCarron
- Young Men's Christian Association of Metropolitan DC, Washington, DC, USA
| | | | | | - Kofi Essel
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Children's National Hospital, Washington, DC, USA
| |
Collapse
|
15
|
Faro JM, D'Addario A, King AM, Mazor KM, Pbert L, Sadasivam RS, Geller AC, Murphy EA, Ockene JK. Video-based communication assessment for weight management counseling training in medical residents: a mixed methods study. BMC MEDICAL EDUCATION 2022; 22:899. [PMID: 36578064 PMCID: PMC9795434 DOI: 10.1186/s12909-022-03984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents. METHODS This study was a mixed methods pilot conducted in 3 phases. First, we created five vignettes based on our prior data and expert feedback, then administered the vignettes via the VCA to Internal Medicine categorical residents (n = 16) from a University Medical School. Analog patients rated responses and also provided comments. We created individualized feedback reports which residents were able to view on the VCA. Lastly, we conducted debriefing interviews with the residents (n = 11) to obtain their feedback on the vignettes and personalized feedback. Interviews were transcribed, and we used thematic analysis to generate and apply codes, followed by identifying themes. RESULTS Descriptive statistics were calculated and learning points were created for the individualized feedback reports. In VCA debriefing interviews with residents, five themes emerged: 1) Overall the VCA was easy to use, helpful and more engaging than traditional learning and assessment modes, 2) Patient scenarios were similar to those encountered in the clinic, including diversity, health literacy and different stages of change, 3) The knowledge, skills, and reminders from the VCA can be transferred to practice, 4) Feedback reports were helpful, to the point and informative, including the exemplar response of how to best respond to the scenario, and 5) The VCA provide alternatives and practice scenarios to real-life patient situations when they aren't always accessible. CONCLUSIONS We demonstrated the feasibility and acceptability of the VCA, a technology delivered platform, for delivering WMC to residents. The VCA exposed residents to diverse patient experiences and provided potential opportunities to tailor providers responses to sociological and cultural factors in WMC scenarios. Future work will examine the effect of the VCA on WMC in actual clinical practice.
Collapse
Affiliation(s)
- Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA.
| | | | - Ann M King
- National Board of Medical Examiners, Philadelphia, USA
| | - Kathleen M Mazor
- Meyers Health Care Institute, University of Massachusetts Medical School, 385 Grove St, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard University, 677 Huntington Ave, Cambridge, MA, USA
| | - Elizabeth A Murphy
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave. North, Worcester, MA, USA
| | - Judith K Ockene
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation St, Worcester, MA, 01605, USA
| |
Collapse
|
16
|
Wharton S, Macklin D, Morin MP, Blavignac J, Menzies S, Garofalo L, Francisco MA, Thomas C, Barakat M. The i-ACT™ in Obesity educational intervention: a pilot study on improving Canadian family physician care in obesity medicine. BMC PRIMARY CARE 2022; 23:101. [PMID: 35501830 PMCID: PMC9059350 DOI: 10.1186/s12875-022-01715-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/18/2022] [Indexed: 11/23/2022]
Abstract
Background Obesity is a chronic problem in Canada and although the Canadian Medical Association recognizes obesity as a disease, health care professionals (HCPs) are not necessarily proactively managing it as one. This study aimed to assess current obesity management knowledge and practices of Canadian family physicians (FPs) and evaluate the feasibility of an online self-directed learning platform, i-ACT™ in Obesity, in delivering learning and changing practice intentions to advance obesity management. Methods i-ACT™ in Obesity is an online self-directed learning program designed by Canadian obesity medicine experts to provide individualized learning curricula to participants. One hundred FPs, with an interest in weight management and managing patients with obesity, were recruited across Canada to participate in a pilot study. FP education was delivered in a stepwise manner. Each participant completed a practice profile assessment to determine knowledge gaps and educational needs. Learners then watched didactic videos across disciplines on topics assigned to their curriculum by the program algorithm based on the relative difference between indicated and desired current knowledge. FPs also completed 10 retrospective patient assessments to assess clinical management practices and planned behaviour change. Feasibility, acceptability, and satisfaction of the learning program were assessed to formulate the rationale for a more widespread deployment in the future. Survey responses and related data were analyzed using comparative measures and descriptive statistics. Results The program was piloted by ninety-one Canadian FPs, where 900 patients were assessed. FPs showed distinct differences between their current and desired levels of comfort in a variety of obesity-related topics. Participation was associated with an intention to use more obesity treatment interventions moving forward. The program received an overall satisfaction rating of 8.6 out of 10 and 100% of the evaluators indicated that they would recommend it to their colleagues. Conclusion The program was overall well received and successfully changed obesity management intentions among participating FPs, thus setting the stage for a larger more comprehensive study to examine the efficacy of i-ACT™ in Obesity in addressing knowledge gaps and advancing evidence-based, guidelines-aligned approach to obesity treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01715-w.
Collapse
|
17
|
Cameron NA, Kushner RF. Development of a telehealth obesity OSCE and reliable checklist for assessment of resident physicians: a pilot study. BMC MEDICAL EDUCATION 2022; 22:630. [PMID: 35986272 PMCID: PMC9389479 DOI: 10.1186/s12909-022-03672-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obesity is a major public health problem, yet residents undergo little formal training and assessment in obesity-related care. Given the recent growth of telehealth, physicians must further learn to apply these skills using a virtual platform. Therefore, we aimed to develop an objective structured clinical examination (OSCE) with reliable checklists to assess resident ability to take a patient-centered obesity-focused history that was feasible over telehealth based on published obesity competencies for medical education. METHODS We developed a 15-minute telehealth OSCE to simulate an obesity-related encounter for residents modified from a script used to assess medical student obesity competencies. We designed three checklists to assess resident skills in history taking, communication and professionalism during the obesity-related encounter. Resident performance was assessed as the percentage of obesity-related history taking questions asked during the encounter and as the mean communication and professionalism scores on a scale of 1 through 5 with 1 representing unacceptable/offensive behavior and 5 representing excellent skills. Encounters and assessments were completed by two commissioned actors (standardized patients) and 26 internal medicine residents over a secure online platform. We assessed the reliability of each checklist by calculating the percent agreement between standardized patients and the kappa (κ) statistic on each checklist overall and by each checklist item. RESULTS Overall agreement between standardized patients on the history taking, communication and professionalism checklists were 83.2% (κ = 0.63), 99.5% (κ = 0.72) and 97.8% (κ =0.44), respectively. On average, residents asked 64.8% of questions on the history taking checklist and scored 3.8 and 3.9 out of 5 on the communication and professionalism checklists, respectively. CONCLUSIONS Results from this pilot study suggest that our telehealth obesity OSCE and checklists are moderately reliable for assessing key obesity competencies among residents on a virtual platform. Integrating obesity OSCEs and other educational interventions into residency curricula are needed to improve resident ability to take an obesity-focused history.
Collapse
Affiliation(s)
- Natalie A Cameron
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA
| | - Robert F Kushner
- Department of Medicine, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, USA.
- Departments of Medicine and Medical Education, Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 645 North Michigan Avenue, Suite 530, Chicago, USA.
| |
Collapse
|
18
|
Capehorn MS, Hinchliffe N, Cook D, Hill A, O’Kane M, Tahrani AA, Vincent A, Williams S, Feenie J. Recommendations from a Working Group on Obesity Care Competencies for Healthcare Education in the UK: A Report by the Steering Committee. Adv Ther 2022; 39:3019-3030. [PMID: 35451741 PMCID: PMC9027014 DOI: 10.1007/s12325-022-02108-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/01/2022] [Indexed: 01/20/2023]
Abstract
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.
Collapse
|
19
|
There Is an Inverse Correlation between Basic Motor Skills and Overweight in Schoolchildren Aged 8 to 12. CHILDREN 2021; 8:children8121198. [PMID: 34943394 PMCID: PMC8700602 DOI: 10.3390/children8121198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
In the last three decades, childhood obesity has become a 21st century epidemic, a product of social development. The purpose of this study was to analyze the repercussions that overweight and obesity have for the basic motor skills of a group of children in primary school, as well as their interrelations. We analyzed a sample of 287 students from Spain, aged between 8 and 12 years. Anthropometric data were taken to determine their Body Mass Index (BMI). A scale of assessment of basic motor skills was used to evaluate their motor skills. The BMI data revealed that 11% of this sample was considered obese, and 26% was overweight. Children showed higher competence in locomotor skills than in object control and turn and rolling skills, for which motor competence levels were lower. Likewise, there was an inverse relationship between BMI and basic motor skills; children with obesity had the lowest levels of motor skills, and there was a significant difference regarding non-obese children (p ≤ 0.05). These results showed that overweight and obese children have lower basic motor skills, which can lead to the abandonment of physical activity and the preference for other activities that reinforce a sedentary lifestyle.
Collapse
|
20
|
Attitudes, Perceptions, and Practices in Managing Obesity Among Endocrinologists. Endocr Pract 2021; 28:179-184. [PMID: 34748965 DOI: 10.1016/j.eprac.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Obesity is globally recognized as a critically important disease by professional medical organizations in addition to the World Health Organization and American Medical Association, but the health care systems, medical teams, and the public have been slow to embrace this concept. METHODS American Association of Clinical Endocrinology (AACE) staff drafted the survey, and two endocrinologists independently reviewed the survey questions and modified the survey instrument. The survey included inquiries related to practice and patient demographics, awareness of obesity, treatment of obesity, barriers to improving obesity outcomes, digital health, cognitive behavioral therapy, lifestyle medicine, anti-obesity medications, weight stigma, and social determinants of health. The survey was emailed to 493 endocrinologists, with 305 completing the study (62%). RESULTS Ninety-eight percent of the responders agree that obesity is a disease, while 2% neither agree nor disagree. 53% of respondents are familiar with the term "adiposity-based chronic disease." 13% of the respondents are certified by the American Board of Obesity Medicine (ABOM). 57% of the respondents use published obesity guidelines as a resource for treating patients with obesity. Most endocrinologists recommend dietary and lifestyle changes, but fewer prescribe anti-obesity medication (AOM) or recommend bariatric surgery. ABOM-certified endocrinologists are more likely to use a multidisciplinary approach. CONCLUSION Self-reported knowledge and practices in the management of obesity highlight the importance of a multimodal approach to obesity and foster collaboration among healthcare professionals. It is necessary to raise awareness about obesity among clinicians, identify knowledge gaps and create educational tools to address those gaps.
Collapse
|
21
|
Yarlagadda S, Townsend MJ, Palad CJ, Stanford FC. Coverage of obesity and obesity disparities on American Board of Medical Specialties (ABMS) examinations. J Natl Med Assoc 2021; 113:486-492. [PMID: 33875239 PMCID: PMC8521551 DOI: 10.1016/j.jnma.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/15/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
Obesity is a widespread disease which adversely impacts all organ systems and disproportionately affects African Americans and other minority groups. Physicians across medical specialties must possess current knowledge of obesity as an important, distinct disease with biological and social causes. Coverage of obesity on board certification examinations, which influence standards in medical knowledge and practice in each specialty, has not previously been examined. The member boards of the American Board of Medical Specialties offer a content outline or "blueprint" detailing material tested. We parsed the 24 available general certification exam blueprints for mentions of obesity and related keywords. We categorized blueprints into three tiers: mention of obesity (Tier 1), mention of related terminology but not obesity (Tier 2), and no mention of obesity or related terminology (Tier 3). We analyzed mentions of obesity and related terms by blueprint word count and procedural versus non-procedural specialties. Six (25.0%) of 24 board exam blueprints mentioned obesity (Tier 1), fifteen (62.5%) mentioned related terminology only (Tier 2), and three (12.5%) mentioned neither obesity nor related terminology (Tier 3). There was no significant difference in obesity-related mentions between procedural and non-procedural specialties (X2, p = .50). None of the blueprints included racial/ethnic disparities related to obesity. Word count was not significantly correlated with mentions of obesity in linear regression (p = .42). The absence of any mention of obesity on most content outlines and of racial/ethnic disparities on all content outlines indicates need for increased coverage of the diagnosis, prevention, and treatment of obesity across all board examinations.
Collapse
Affiliation(s)
- Siddharth Yarlagadda
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, MGH Weight Center, Department of Medicine- Neuroendocrine Division, Department of Pediatrics- Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA.
| |
Collapse
|
22
|
Pendharkar JA, Frisard CF, Geller AC, Pbert L, Crawford S, Guck TP, Stadler DD, Ockene J. Weight management counseling experiences of first year medical students before starting medical school and their self-perceived impact on treating patients with obesity. Prev Med Rep 2021; 23:101411. [PMID: 34150473 PMCID: PMC8193141 DOI: 10.1016/j.pmedr.2021.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Physicians can play a vital role in counseling patients on overweight and obesity. This secondary analysis examined whether experiences in patient care specific to weight management before starting medical school were associated with students' intentions and confidence to provide weight management counseling (WMC) to patients who have overweight or obesity, and perceived impact as future physicians on patients' motivation to manage weight. First-year medical students (n = 1305) in the entering class of 2020 at eight medical schools nationwide completed questions relating to their prior experiences in patient care and WMC using the 5As. Also assessed were their intentions to treat patients with overweight or obesity, and confidence in counseling patients to help manage their weight. Over half the students (58.3%) who completed the survey had prior experience in patient care and nearly half (47.4%) began medical school with prior WMC experiences. Prior experiences correlated positively with higher confidence in performing WMC and students' intentions to treat patients with overweight or obesity. Given the relatively high rates of exposure to some type of weight management or lifestyle counseling among students before enrolling in medical school, the curriculum could build on established student interest and experience by offering treatment strategies including counseling for patients with overweight and obesity. By making prior experiences advantageous for admission, medical schools could gravitate towards admitting students who have brief but valuable insights about weight management in health care, thus increasing the possibility of filling important gaps.
Collapse
Affiliation(s)
- Jyothi A. Pendharkar
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine F. Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Cambridge, MA, USA
| | - Lori Pbert
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sybil Crawford
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Judith Ockene
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
23
|
Orjuela-Grimm M, Butsch WS, Bhatt-Carreño S, Smolarz BG, Rao G. Benchmarking of provider competencies and current training for prevention and management of obesity among family medicine residency programs: a cross-sectional survey. BMC FAMILY PRACTICE 2021; 22:132. [PMID: 34167487 PMCID: PMC8229273 DOI: 10.1186/s12875-021-01484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
Background U.S. physicians lack training in caring for patients with obesity. For family medicine, the newly developed Obesity Medicine Education Collaborative (OMEC) competencies provide an opportunity to compare current training with widely accepted standards. We aimed to evaluate the current state of obesity training in family medicine residency programs. Methods We conducted a study consisting of a cross-sectional survey of U.S. family medicine residency program leaders. A total of 735 directors (including associate/assistant directors) from 472 family medicine residency programs identified from the American Academy of Family Physicians public directory were invited via postal mail to complete an online survey in 2018. Results Seventy-seven program leaders completed surveys (16% response rate). Sixty-four percent of programs offered training on prevention of obesity and 83% provided training on management of patients with obesity; however, 39% of programs surveyed reported not teaching an approach to obesity management that integrates clinical and community systems as partners, or doing so very little. Topics such as behavioral aspects of obesity (52%), physical activity (44%), and nutritional aspects of obesity (36%) were the most widely covered (to a great extent) by residency programs. In contrast, very few programs extensively covered pharmacological treatment of obesity (10%) and weight stigma and discrimination (14%). Most respondents perceived obesity-related training as very important; 65% of the respondents indicated that expanding obesity education was a high or medium priority for their programs. Lack of room in the curriculum and lack of faculty expertise were reported as the greatest barriers to obesity education during residency. Only 21% of the respondents perceived their residents as very prepared to manage patients with obesity at the end of the residency training. Conclusion Family medicine residency programs are currently incorporating recommended teaching to address OMEC competencies to a variable degree, with some topic areas moderately well represented and others poorly represented such as pharmacotherapy and weight stigma. Very few program directors report their family medicine residents are adequately prepared to manage patients with obesity at the completion of their training. The OMEC competencies could serve as a basis for systematic obesity training in family medicine residency programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01484-y.
Collapse
Affiliation(s)
- Manuela Orjuela-Grimm
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - W Scott Butsch
- Departments of Surgery and Internal Medicine and Geriatrics, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Silvia Bhatt-Carreño
- Departments of Epidemiology and Pediatrics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Goutham Rao
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
24
|
Dupuis L, Kay D, Pasarica M, Topping D, Gonzalez C, Wasserstrom S. Lifestyle Medicine at the University of Central Florida College of Medicine. Am J Lifestyle Med 2021. [DOI: 10.1177/15598276211011055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
From 2009 to present-day, the University of Central Florida College of Medicine has progressively incorporated lifestyle medicine into its curriculum thanks to a variety of student and faculty-led efforts. These efforts include extracurricular learning opportunities through a student-run Lifestyle Medicine Interest Group, curriculum-based didactics through University of Central Florida faculty members’ integration of lifestyle medicine in preexisting sessions, and clinical experiences for students provided by a American Board for Lifestyle Medicine certified practitioner.
Collapse
Affiliation(s)
- Léonie Dupuis
- University of Central Florida College of Medicine, Orlando, Florida
| | - Denise Kay
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Daniel Topping
- University of Central Florida College of Medicine, Orlando, Florida
| | - Carla Gonzalez
- University of Central Florida College of Medicine, Orlando, Florida
| | - Sharon Wasserstrom
- University of Central Florida College of Medicine, Orlando, Florida
- UCF Health, Orlando, Florida
| |
Collapse
|
25
|
Lessans S, Vega X, Foley B, Bossan A, Baker A, McElroy M, Crouse E, Pasarica M. A patient-centredness improvement study for efficacy of behaviour change for healthy lifestyle and weight loss in a student-run free clinic. Fam Pract 2021; 38:38-42. [PMID: 32667977 DOI: 10.1093/fampra/cmaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary care is the ideal place to implement behaviour change interventions for weight management. However, most primary care physicians are not managing patient weight as a standard of care due to lack of knowledge, skills and reimbursement. Generating more physicians who are familiar and comfortable with providing weight management is essential in leveraging a global change. In our university free clinic, medical students provide healthy lifestyle counselling using shared decision making to each patient at every clinic visit. OBJECTIVE Improve the efficacy of behaviour change interventions via increased patient responsiveness and adherence. METHODS The needs assessment demonstrated a subpar patient response rate to check-ins regarding behavioural change goals. In the first and second interventions, check-in message structure and contact schedule were varied to maximize patient responsiveness and goal achievement. RESULTS In the needs assessment, 58% of patients responded to follow-ups and 58% of patients accomplished their goal. The first intervention cycle resulted in an improvement of responsiveness to 70% and accomplishment of goals to 59%. The second intervention cycle resulted in an improvement of responsiveness to 78% and accomplishment of goals to 74%. CONCLUSIONS Messages that were frequent, unique, succinct and delivered within 4 weeks after the clinic visit resulted in the highest response rate and goal attainment. Other primary care clinics can use these interventions to increase patient completion of implemented behaviour changes for a healthier lifestyle.
Collapse
Affiliation(s)
- Spencer Lessans
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Xamil Vega
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Brandon Foley
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Alexia Bossan
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Alexandra Baker
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Mitchell McElroy
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Eloisa Crouse
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Magdalena Pasarica
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA
| |
Collapse
|
26
|
Abstract
Diabetes remission-the occurrence of durable normoglycemia without antidiabetic medications-has been demonstrated in some patients with type 2 diabetes who have achieved and sustained weight loss through lifestyle intervention or metabolic and bariatric surgery. Although this pursuit would represent a paradigm shift in our diabetes chronic care model, could diabetes remission become a routine treatment strategy in patients with type 2 diabetes? This article reviews the mechanisms by which weight loss can drive improvements in insulin sensitivity and β-cell function sufficient to normalize glycemia, treatment approaches that provide evidence for diabetes remission, and avenues for developing the research and discovery that will be required to make diabetes remission possible as part of the routine medical management of type 2 diabetes.
Collapse
Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center, Baton Rouge, LA
| |
Collapse
|
27
|
Berry EM. The Obesity Pandemic-Whose Responsibility? No Blame, No Shame, Not More of the Same. Front Nutr 2020; 7:2. [PMID: 32118024 PMCID: PMC7025495 DOI: 10.3389/fnut.2020.00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Elliot M Berry
- Braun School of Public Health, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
28
|
Butsch WS, Kushner RF, Alford S, Smolarz BG. 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. BMC MEDICAL EDUCATION 2020; 20:23. [PMID: 31992274 PMCID: PMC6988262 DOI: 10.1186/s12909-020-1925-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/03/2020] [Indexed: 05/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- W Scott Butsch
- Bariatric and Metabolic Institute at Cleveland Clinic, Cleveland, OH, USA
| | | | - Susan Alford
- Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ, 08536, USA
| | - B Gabriel Smolarz
- Novo Nordisk Inc, 800 Scudders Mill Rd, Plainsboro Township, NJ, 08536, USA.
| |
Collapse
|
29
|
Butsch WS, Robison K, Sharma R, Knecht J, Smolarz BG. Medicine Residents are Unprepared to Effectively Treat Patients with Obesity: Results from a U.S. Internal Medicine Residency Survey. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520973206. [PMID: 33283047 PMCID: PMC7691912 DOI: 10.1177/2382120520973206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND In an obesity epidemic, physicians are unprepared to treat patients with obesity. The objective of this study was to understand how obesity is currently addressed in United States (U.S.) Internal Medicine (IM) residency programs and benchmark the degree to which curricula incorporate topics pertaining to the recently developed Obesity Medicine Education Collaborative (OMEC) competencies. METHODS Invitations to complete an online survey were sent via postal mail to U.S IM residency programs in 2018. Descriptive analyzes were performed. RESULTS Directors/associate directors from 81 IM residencies completed the online survey out of 501 programs (16.2%). Although obesity was an intentional educational objective for most programs (66.7%), only 2.5% of respondents believed their residents are "very prepared" to manage obesity. Formal rotation opportunities in obesity are limited, and at best, only one-third (34.6%) of programs reported any one of the core obesity competencies are covered to "a great extent." Many programs reported psychosocial components of obesity (40.7%), weight stigma (44.4%), etiological aspects of obesity (64.2%) and pharmacological treatment of obesity (43.2%) were covered to "very little extent" or "not at all." Lack of room in the curriculum and lack of faculty expertise are the greatest barriers to integrating obesity education; only 39.5% of residency programs have discussed incorporating or expanding formal obesity education. CONCLUSIONS Our study found the current obesity curricula within U.S. IM residency programs do not adequately cover important aspects that address the growing obesity epidemic, suggesting that obesity education is not enough of a priority for IM residency programs to formalize and implement within their curricula.
Collapse
Affiliation(s)
- W Scott Butsch
- Bariatric and Metabolic Institute,
Cleveland Clinic, Cleveland, OH, USA
| | | | - Ranita Sharma
- Rutgers Robert Wood Johnson Medical
School, Department of Medicine, Brunswick, NJ, USA
| | | | | |
Collapse
|
30
|
Dietz WH. The Obesity (Under) Treatment Conundrum. Obesity (Silver Spring) 2019; 27:1928-1929. [PMID: 31696629 DOI: 10.1002/oby.22641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022]
Affiliation(s)
- William H Dietz
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| |
Collapse
|
31
|
Garvey WT. Core Principles, Treatment Standards, and Provider Competencies for the Care of Patients with Obesity. Obesity (Silver Spring) 2019; 27:1045-1047. [PMID: 31231959 DOI: 10.1002/oby.22538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022]
Affiliation(s)
- W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham Veteran's Affairs Medical Center, Birmingham, Alabama, USA
| |
Collapse
|