Health Professionals Are Poorly Prepared To Address Obesity

“…health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity.“

This quote, taken from the paper by William Dietz and colleagues included in the 2015 Lancet series on obesity, pretty sums up the dire state of affairs when it comes to health professionals’ ability to help people living with obesity.

While governments around the world continue to dither on prevention measures, and even if these were implemented, would take decades to substantially reduce global obesity rates (a halting in progression would already be widely considered a major success), health care systems the world around are challenged with an enormous clinical burden that will require innovative treatment and care-delivery strategies are needed.

Well, not all that innovative – after all, the very same health care systems are well versed with providing ample care for scores of other chronic diseases – obesity is just not one of them.

As Dietz points out,

“Existing shortcomings of current health-service delivery include poor teamwork, a mismatch of competencies to the needs of patients and populations, episodic rather than continuous care, and hyperspecialisation.”

In fact we don’t even know if health professionals are actually being trained for this at all,

“A scarcity of information exists for undergraduate medical education in obesity, and even less information is available for nursing and allied health professional students.”

Despite various high-sounding recommendations,

“Overall, the level of implementation of health professional education in obesity at all levels appears inadequate in several countries….The Royal Australian College of General Practitioners is the only specialist training college to include obesity in the prescribed curriculum.”

In Canada we are still licensing family physicians without any requirement to have spend even a single day in a bariatric centre. The recently released Canadian Obesity Practice Guidelines, endorsed by the Canadian College of Family Physicians, provide virtually no guidance to family doctors apart from the rather strong recommendation (based on virtually non-existent evidence) to record BMIs on all patients.

According to Dietz,

“Commonly identified areas for additional training in the care of adults with obesity include motivational interviewing, the comanagement of bariatric surgery patients, and nutrition and exercise counselling.”

Clearly, the emerging role of pharmacotherapy will add a further dimension to the need for health professional education.

None of this will happen without also addressing the stigma and bias against people presenting with excess weight continue to face in their dealing with health professionals. More on this in tomorrow’s post.

@DrSharma
Edmonton, AB