Bariatric Times

APR 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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12 The Medical Student Notebook Bariatric Times • April 2017 MEDICAL STUDENT T his column is written by medical students and is dedicated to reviewing the science behind obesity and bariatric surgery. Notebook The A Call for Comprehensive Obesity Training for All Physicians by CHRISTOPHER MURRAY Bariatric Times. 2017;14(4):12–14. O besity-linked chronic diseases, including heart disease, stroke, and type 2 diabetes (T2DM), account for 7 out of 10 deaths in the United States today. 1 Moreover, the management of obesity and related chronic diseases contributes an estimated 75 percent of the over $2 trillion spent on healthcare in the United States each year. 2 Alarmingly, obesity and linked chronic diseases are on the rise, especially among children. Today, over 34 percent of adults and 17 percent of children in the United States have obesity. 3,4 T2DM prevalence has also increased; 9.3 percent of Americans have T2DM compared with one percent 50 years ago. 5,6 One in three children born after 2000 are expected to develop diabetes in their lifetime. 7 It is no surprise that some epidemiologists predict, "America's children will be the first in the nation's history to live shorter lives than their parents." 8 These trends are global. In the developing world, rates of obesity and linked diseases are increasing faster than in the United States. In China, childhood overweight and obesity increased six-fold from 2 to 12 percent between 1980 and 2015. 9 An estimated half of all humans with diabetes now live in China or India. 10 Diseases traditionally associated with wealth and the Western diet have become the greatest killers of the poor in the developing world. 1 1 Despite the increasing prevalence of obesity, many physicians lack an understanding of the proven treatments for obesity, namely lifestyle modification, pharmacotherapy, and bariatric surgery. Medical education is largely to blame. More than half of graduating medical students rate their nutrition knowledge as inadequate, and only 14 percent of internal medicine residents feel qualified to offer nutrition counseling to patients. 12,13 This is unsurprising considering United States medical schools offer, on average, 19.6 hours of nutrition education over the course of a four- year medical degree, accounting for less than one percent of total lecture hours. 12 Moreover, a survey of physicians in primary care practices affiliated with Massachusetts General Hospital found that the majority of providers do not fully understand the indications, risks, and benefits of bariatric surgery. 14 Medical training at all levels must change to better prepare physicians to tackle obesity. This change should be pursued both at individual institutions and nationally. Medical schools and residency programs should take the initiative to incorporate more obesity content into their training programs. Likewise, policy makers and advocates should leverage national accountability mechanisms and funding conditions to ensure healthcare professionals are all competent in obesity treatment and prevention. Weaving obesity education into medical training should be viewed as a creative opportunity for medical educators. Offering traditional lectures on topics relevant to obesity, such as nutrition, exercise, stress management, and bariatric surgery, are a possible effective approach. For resource-limited institutions, the University of North Carolina offers the free, online, lecture-based curriculum "Nutrition in Medicine: Evidence-based Clinical Nutrition Education for Medical Students, Residents, Fellows, and Other Physicians" available at http://nutritioninmedicine.org/. 15 Alternatively, training institutions could pursue more innovative approaches to obesity education by modeling, for example, Tulane University's culinary medicine program, which provides hands-on training for medical students through culinary medicine classes in the form of electives and seminars as well as continuing education for the healthcare and foodservice Daniel B. Jones, MD, MS, FASMBS Professor of Surgery, Harvard Medical School Vice Chair, Beth Israel Deaconess Medical Center Boston, Massachusetts ABSTRACT Obesity and related chronic diseases account for an increasingly large portion of the disease burden in the United States and around the world. However, physicians are often not adequately trained in obesity treatment and prevention. Medical education at all levels must change to better prepare physicians to tackle obesity. On an institution level, medical schools and residency programs must take the initiative to weave obesity training into their education programs. On the national level, policy makers and advocates must leverage national accountability mechanisms and funding conditions to ensure all healthcare professionals are competent in obesity treatment and prevention. Failing to implement these changes could have serious public health and economic consequences. KEYWORDS Obesity, bariatric surgery, education, training, healthcare COLUMN EDITOR FEATURED STUDENT Christopher Murray Medical Student, Harvard Medical School Boston, Massachusetts More than half of graduating medical students rate their nutrition knowledge as inadequate, and only 14 percent of internal medicine residents feel qualified to offer nutrition counseling to patients. 1 2,13

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