AAMC Reporter: July 2007

Study: Medical Schools Should Incorporate Obesity into Curricula

Related Resources Curing 'Couch Potatoes': Doctors Play Key Role in Promoting Exercise—Reporter, Feb. 2006 Obesity Takes Center Stage in Health Debate—Reporter, July 2004 AAMC Medical School Objectives Project (MSOP) MSOP is designed to help the the medical education community reach general consensus on the skills, attitudes, and knowledge that graduating medical students should possess.

A new report is calling for a change in the way tomorrow's doctors think about and treat overweight and obese patients.

"Contemporary Issues in Medicine: The Prevention and Treatment of Overweight and Obesity, the 8th Report of the Medical School Objectives Project," was commissioned by the AAMC and included input from a national panel of experts on obesity and obesity education.

"Obesity is arguably the greatest health threat we face in this country, and unarguably the least controlled," said David L. Katz, M.D., M.P.H., a report panelist as well as co-founder and medical studies director at the Yale-Griffin Prevention Research Center in Connecticut. "The mandate to reverse trends in obesity couldn't be clearer."

It is well known that obesity causes medical problems including heart disease, diabetes, and certain cancers—and that these problems are becoming more prevalent in more Americans as obesity rates rise. Data published in the Journal of the American Medical Association in 2006 showed that in 2004, more than 66 percent of American adults aged 20 years or older were overweight or obese—an increase of more than 150 percent since the early 1970s. The prevalence of overweight children and adolescents has doubled in the past 20 years.

"Overweight and obesity are among the most threatening modifiable health risks, so preparing the future medical community is critical," said Rika Maeshiro, M.D., M.P.H., a report co-author and assistant vice president for public health and prevention in the AAMC's Division of Medical Education.

"Overweight and obesity are risk factors for so many chronic illnesses and premature mortality. The universal importance of weight management should be emphasized more greatly in physician education."

The panelists call for a multidisciplinary approach to obesity study and education, including more programs in basic science, medicine, and population health education, as well as more collaboration among these branches. The report also calls for a change in the way doctors view obese patients.

"One of the barriers is that physicians don't feel there is much they can do about obesity," Maeshiro said. "We need to have more resources available, including access to multiprofessional, intensive programs.We need clinicians to know they can make a difference. Today's lifestyle can lead to unhealthy weight gain, and physicians should have a better appreciation for that.

Traditionally, we have perhaps not been as good at focusing on behavioral changes. Clinical people also need to be more active in the broader public health or population health perspectives on these issues." The report did state, however, that there is a dearth of evidence supporting noninvasive or non-pharmacological approaches to treating obesity. But Katz said that does not mean that there is no link between behavior-based treatment and results in patients.

"We recognize that the evidence is limited, but absence of evidence does not mean the evidence of absence," Katz said. "We have enough information to guide constructive practice."

Citing this shortage of evidence, some panelists held differing views on the value of shorter timeframes for counseling interventions. However, all panelists did agree "that physicians were in a position to influence the concerns and priorities of their patients," the report stated.

The report detailed a variety of specific suggestions for improving overweight- and obesity-related training "both vertically and horizontally" across all phases of the medical education continuum—in the lecture hall, in reading assignments, in case study review, and in standardized patient and similar interactions. In the clinical phase, for example, panelists said students should learn skills to assess a patient's weight status, such as calculating the Body Mass Index or BMI, which is based on height and weight measurements. The report recommended students gain a fuller understanding of related surgical and pharmacological treatment options, an appreciation of cultural and lifestyle factors that affect weight and weight management, the ability to refer patients to appropriate professionals or networks for intensive counseling, and the ability to take and apply a family history to the assessment of an overweight or obese patient's condition.

"The emphasis on family is important on this subject," Katz said." Medical students and physicians should learn to think in terms of the family here."

Basic science educators are encouraged by the report panel to provide more training in basic nutrition, metabolism, the physiologic aspects of diet and hunger, the mechanics of weight management in terms of energy intake and expenditure (or nutrition and exercise), the immunologic consequences of obesity, and the underlying mechanisms of various pharmacological obesity treatments.

Panelists favored an approach that spanned professional boundaries, incorporating tenets of public and population health into their model. Knowing public policies, certain aspects of health systems that will facilitate the prevention and treatment of overweight and obesity, and the potential demographic disparities that can affect access to healthy foods or beneficial activities should be integrated into a curriculum whenever possible, the report stated.

The report is the eighth from the AAMC's Medical School Objectives Project, an initiative designed to reach general consensus within the medical education community on the skills, attitudes, and knowledge that graduating medical students should possess.

—By Scott Harris

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