Physician Training in Obesity Management is Long OverdueTuesday, October 15, 2013
Unfortunately, not much has changed.
This sorry state of affairs is now discussed by James Colbert and Sushrut Jangi in a Perspectives piece in the New England Journal of Medicine.
As the Colbert and Jangi note,
“Physicians-in-training frequently fail to recognize obesity, are unfamiliar with treatment options, and spend relatively little clinic time treating obesity.”
As I have previously suggested, all physicians-in-training need a rigorous background in the biological and pathophysiological foundations of obesity.
“Once trainees have achieved a solid foundation in the science of obesity, these fundamentals must be applied clinically through mastery of behavioral medicine.”
“Finally, successful management of obesity requires that students learn to function as members of interdisciplinary care teams that include physicians, nurses, medical assistants, social workers, nutritionists, and behavioralists; the earlier such collaborative models are introduced into medical education, the more likely they will be to successfully replace the antiquated model of the solo physician and patient.”
While Colbert and Jangi note the importance of educating physicians in nutrition and motivational interviewing, I would take that this is far too “nutrition-centric” a view of what is needed.
Although, more education in nutrition and physical activity during physician training could certainly not hurt, we need to ultimately move beyond the age-old “eat-less-move-more” paradigm of obesity management. Not only, has this approach failed our patients, it also fails to acknowledge the complex physiology and psychology of obesity.
Thus, I would suggest that even the most knowledgeable “nutrition doctor” will more often than not end up treating the “symptoms” and not the “root cause” of obesity.
So, while I am all for teaching medical students the basics of obesity management (indeed, I would go as far as to fail any trainee, who does not know the fundamentals of energy physiology and the neuroscience of ingestive behaviour), propagating a “lifestyle” approach to obesity management will do little more than reinforce the notion that obesity is simply a matter of motivation and choice.
Health professionals, who still believe that obesity can be conquered simply by teaching and motivating people to eat healthy, are sadly part of the problem rather than part of the solution.
Colbert JA, & Jangi S (2013). Training Physicians to Manage Obesity – Back to the Drawing Board. The New England journal of medicine, 369 (15), 1389-1391 PMID: 24106932