Medical schools urged to teach about obesity

Institutions at the forefront weave knowledge into lectures and clinical rotations.

By Myrle Croasdale — Posted Nov. 12, 2007

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Obesity is a national epidemic, yet most medical schools are not equipping their students to address it, nutrition advocates say.

The Assn. of American Medical Colleges would like to see this situation change. In an August report, an expert AAMC panel lays out guidelines on how medical schools can incorporate obesity prevention and treatment into their science courses and clinical clerkships.

"This is a big issue confronting our future doctors, and we want [medical schools] to better address these problems," said Rika Maeshiro, MD, MPH, a co-author of the AAMC report and AAMC vice president for public health and prevention.

Most schools teach nutrition, but no data exist on how many integrate obesity into basic science and clinical courses. A few schools have embraced curriculumwide changes, while others include lectures or single clinical rotations with an obesity focus.

One school the report touted as a model is the University of Wisconsin School of Medicine and Public Health in Madison. It made obesity part of its curriculum 15 years ago, said Patrick McBride, MD, MPH, dean of students.

"We saw the trend coming for quite a while and started emphasizing prevention in our curriculum," said Dr. McBride, who chaired the AAMC panel that developed the report.

Wisconsin's second-year students learn obesity's etiology and pathophysiology during a nutrition class. In the third year, they get a hands-on lesson before starting their clerkships that comes in the form of a buffet lunch of whole grain salads, lean meats, fruits and vegetables.

Students make their choices, then learn about how national guidelines relate to what is on their plates. The goal is to show them that healthy eating can taste good, while teaching them such practical lessons as portion control, Dr. McBride said. Piling on three pieces of chicken is two more than recommended, for example.

A collaborative clerkship curriculum in family medicine, general internal medicine and pediatrics takes lessons further. Family medicine emphasizes communication and interviewing. Students get a weight and activity assessment and evaluation tool to assess a patient's motivation for change and are taught to help patients determine small behavioral changes.

Metabolic syndrome and treatment options, such as pharmacotherapy and surgery, are stressed in the internal medicine clerkship. In pediatrics, activity, diet and family history are focuses.

The goal is to give students in-depth exposure to these issues rather than superficially dealing with them during each clerkship. The training extends to residents as well.

Sarah Fox, MD, a third-year family medicine resident at Wisconsin, said weight issues are a constant in her patient population. "People come in for other things and hope the doctor doesn't mention it," Dr. Fox said. "They hope for a silent endorsement of their lifestyle, or they'll say they'll work on it and then ignore it."

But she has found that methods she learned are useful. She encouraged an overweight, pre-diabetic patient with serious osteoarthritis in her knees to try Tai Chi. Then she helped the patient decrease the amount of simple carbohydrates in her diet and add more green vegetables. When her blood glucose came down, the patient was motivated to try walking.

"Now she is starting to lose weight," Dr. Fox said. "If I had started with walking and dieting, she never would have gone through with it."

Efforts at Tufts University School of Medicine in Boston include the surgical side of the equation. Scott Shikora, MD, surgical director of the obesity consult center at the Tufts-New England Medical Center, is adamant that students need to understand obesity's dynamics and become familiar with the general clinical implications of bariatric surgery. A third of Tufts medical students rotate through his surgical center.

"Whatever they go into, they will take care of patients who have had this surgery or will counsel patients who are interested in having this surgery," Dr Shikora said.

At the University of Pittsburgh School of Medicine, Goutham Rao, MD, clinical director of the pediatric weight management and wellness center, is driving obesity's place to the curriculum. He has opened up the center for one-week clerkships and hopes to get students thinking.

"We treat high cholesterol, but don't pay attention to the fact the patient weighs 300 pounds," Dr. Rao said. "We want students to stop and say, 'Wait a second.' "

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What med students need to know

The Assn. of American Medical Colleges recommends medical schools beef up their obesity curricula. The AAMC says graduates must show they can:

  • Calculate and categorize patients' body mass index.
  • Address weight with patients even when it is not the patient's primary reason for visiting.
  • Provide understandable information to patients and families sensitively and respectfully.
  • Understand potential barriers to patients' weight loss and approaches to address them.
  • Discuss comorbidities associated with excess weight.
  • Determine patients' readiness to change their behaviors, and negotiate a mutually agreeable plan for behavior change.
  • Understand the importance of physical activity to maintain weight loss and to decrease comorbidities.
  • Guide patients to credible sources of information and assistance.
  • Provide or refer obese adult patients for intensive counseling and behavioral interventions to promote sustained weight loss.
  • Distinguish the benefits and risks of pharmacological and surgical interventions.

Source: "Contemporary Issues in Medicine: The Prevention and Treatment of Overweight and Obesity," AAMC, August

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External links

"Contemporary Issues in Medicine: The Prevention and Treatment of Overweight and Obesity," Assn. of American Medical Colleges, August (link))

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