New course at Duke focuses on obesity

One day, weight management and obesity counseling may be as common in doctors' offices as discussions of ways to quit smoking. In an effort to move toward that goal, Duke University School of Medicine in North Carolina rolled out this year a four-week elective on obesity that covers weight loss and other obesity-related issues.

Jarol Boan, MD, an internist and clinical nutritionist at the Sarah W. Stedman Nutrition and Metabolism Center at Duke, developed the course. She said that with the school in the midst of revamping its curriculum and public awareness of the obesity problem at an all-time high, the timing was right for a new course on the topic.

"This has been traditionally missed in medical school training," she said. "It's just been in the last five years that it's made the news enough to make people aware of it."

Julie Dombrowski, MD, who just finished her fourth year at Duke's medical school, took the course this year. She was motivated to learn more on the topic after seeing overweight patients during all of her rotations.

Her physician teachers, with 15 minutes scheduled per patient, focused mainly on problems at hand, advising patients only in passing to lose weight. Dr. Dombrowski said it was frustrating to learn about how to treat hypertension or diabetes but not about how to address obesity with patients, even though it is often a significant contributing factor to both diseases.

A multidisciplinary approach

Obesity is second only to smoking as a cause of preventable deaths, according to the Centers for Disease Control and Prevention. Researchers estimate 435,000 deaths a year are caused by smoking, while poor diet and inactivity account for 400,000. In 2000, 64% of Americans were obese or overweight.

"Twenty five years ago when tobacco was named the leading cause of preventable deaths, screening for tobacco use was included as one of the standard things people asked in a social history," Dr. Boan said. "It's been included for so long now, medical students are exposed to that in many ways. Obesity is younger in its evolution. It's not considered a disease. If you code for treating for obesity you won't be reimbursed."

Dr Boan said Duke's program is multidisciplinary and does not focus only on weight loss. Students spend a day each week in Duke's hypertension clinic, pediatric clinic, diabetes clinic, weight-loss surgery center and diet and fitness center, as well as observe a bariatric surgical procedure.

Only a handful of students have gone through the course to date. Dr. Boan would like to make the course mandatory, but the logistics of clinic participation limits the course to one student at a time. The program is beginning to get some notice outside of Duke, and Dr. Boan said other schools have contacted her about duplicating the course in their settings.

Dr. Dombrowski says she feels better equipped now that she is familiar with the various diets out there and has learned how to counsel patients on weight loss.

"I went into the rotation understanding intellectually how hard it is to lose weight, but when I saw people who had struggled with obesity all their lives, tried a number of diets and exercise regimens and just couldn't lose the weight, I gained a better understanding of how immensely difficult it is," she said.

Dr. Boan hopes young physicians like Dr. Dombrowski will become the norm, not the exception, but progress is slow.

"I know a lot of doctors who recommend Atkins because they tried it or a patient started it and has been successful," Dr. Boan said. "Doctors are scrambling out there for what to tell their patients. They don't know what to recommend."

As Dr. Dombrowski begins her internal medicine residency, she's prepared to build on what she's learned.

"Obesity will be a relevant problem for the rest of my career," she said.