June 25, 2019 03:42 pm Sheri Porter – A look at CDC statistics for 2015-2016 show that 39.8 percent of U.S. adults -- some 93.3 million people -- were affected by obesity, and since that time, the number has continued to surge. As America's collective girth swells, so, too, does the list of associated chronic conditions, including diabetes, coronary artery disease and hypertension, and the costs associated with treating them.
The enormity of the problem makes new research findings on obesity education in family medicine clerkships in U.S. and Canadian medical schools all the more compelling.
An article describing that research was published in the May 27 issue of BMC Medical Education.
"Despite obesity having a substantial effect on patient care in all disciplines in medicine … it seems physicians' and medical students' education about obesity is often limited and inadequate, and historically has been received from sources outside of their formal medical school education," wrote the authors. "These educational gaps may leave physicians underprepared to address the needs of this substantial and growing portion of their patient population."
The researchers noted that family medicine clerkship directors determine which educational topics will be covered in their programs. However, in preparation for their study, the authors found little existing data on the quantity and content of obesity education or on the factors that persuade clerkship directors to include obesity content in their programs.
Identifying those factors served as the impetus for this research and ultimately "may help inform future decisions around obesity education in family medicine clerkships and medical school curricula in general," they wrote.
Between June and August 2017, researchers distributed an electronic survey to 125 U.S. and 16 Canadian family medicine clerkship directors. The overall survey response rate was 71.2%, with 99 of 139 clerkship directors responding.
The survey asked 45 questions -- 18 of which were general questions about each respondent's medical school and clerkship program. An additional six queries were related to obesity, and in most cases, participants were offered multiple choice responses and the opportunity to choose more than one answer.
For instance, one question asked, "Which of the following obesity topics are taught during your family medicine clerkship? Choose all that apply."
Clerkship directors also were asked about methods used to teach those topics, barriers to obesity education, future plans related to obesity curriculum and, for those who were in clinical practice, the percentage of their own patients who had obesity.
Directors' attitudes about the importance of obesity education were assessed using a 5-point Likert scale.
The researchers found that the top three obesity-related topics covered during family medicine clerkships were comorbid conditions associated with obesity, diet for weight loss and exercise for weight loss.
Specific percentages for clinical topics covered were
Despite the fact that more than one-third of the U.S. population is affected by obesity, "this survey showed family medicine clerkships are not consistently including many obesity topics" other than the top three, wrote the authors.
Additionally, "Only 10% of CDs endorsed teaching about obesity bias," said authors, despite results of a 2013 survey(insights.ovid.com) that showed "nearly 40% of medical students surveyed had an anti-fat bias," and two-thirds of those students were unaware of their bias, said researchers.
Regarding barriers to including obesity topics in the curriculum, 89% of clerkship directors said they were limited by time constraints. However, the authors found no correlation between longer clerkships -- those scheduled for six weeks or more -- and the number of obesity topics covered.
"Our results show that lengthening a family medicine clerkship will not necessarily improve the amount of obesity education, but CD attitude was shown to affect the number of obesity-related topics covered," the authors wrote.
Furthermore, the survey showed that despite shortfalls in this area of training, most clerkship directors were not planning any significant curriculum changes in the next three years.
Lead author Harlan Holman, M.D., has practiced family medicine for 14 years and currently sees patients at Spectrum Health Family Medicine Residency Center in Grand Rapids, Mich. He's also served as the family medicine clerkship director at the Michigan State University College of Human Medicine in East Lansing, Mich., for the past four years.
Holman told AAFP News that as clerkship director, he oversees curriculum development for seven satellite campuses and was interested early on in developing more curriculum around the all-too-common problem of obesity.
"I started wondering what other people were doing across the country -- such as interactive culinary medicine electives -- and that was how the idea for this research project grew," he said.
"In the past, we've talked a lot about the consequences of obesity, and more recently, we've begun to think of obesity itself as a disease, and that's changed how we approach this broad topic," said Holman. "Now is a critical time to identify the key areas students need exposure to during their outpatient experience in medical school."
For him, it was eye-opening to see that most clerkship directors identified lack of time as the primary barrier to teaching obesity topics, only to discover that even those clerkships with additional weeks of training cited time constraints.
"It was really all about attitude. The clerkship directors who thought it was important content put the obesity topics into their clerkships. Too many clerkship directors were just not prioritizing this issue," said Holman.
And even though most programs did teach the obesity basics of diet, exercise and comorbidities, "I was a little surprised at the lack of some of the other more advanced topics, like obesity bias, cultural aspects and medications for obesity," he said.
Holman's key takeaway message for family physician colleagues is this: "When you're pressed for time, both in teaching students and in working with your patients, don't forget to think about obesity as an independent topic that is related to a host of other problems, and don't be afraid to talk about it with your patients.
"I think that because of our obesity bias, sometimes we just want to kind of hide the topic under a shelf."
Holman added that family physicians are unique in their ability to tie multiple health issues together in a nonjudgmental way to help patients understand and begin to deal with their obesity.
He praised family physician preceptors who voluntarily teach medical students one-on-one every day in clinical practices around the country -- augmenting the education students receive in medical school.
Those brief conversations with students on obesity-related educational topics -- for instance, how psychiatric medications can cause obesity -- can go a long way toward showing students family medicine's holistic view of obesity, said Holman.
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