WINSTON-SALEM, N.C. – Oct. 31, 2012 -- It's no secret that obesity is a major problem in America.
More than one-third of adults and one-sixth of children are obese and it is one of the leading causes of preventable death. The costs associated with obesity are estimated at $99 million annually, comparable to the economic toll of cigarette smoking.
Despite all this, few U.S. medical schools are providing adequate, effective training on how to address weight issues in obese patients, according to researchers at Wake Forest Baptist Medical Center.
"Medical students are surrounded by the same environment that everyone is in this country, a culture of idealized images of physical attractiveness in which thin is good and fat is bad," said Mara Vitolins, Dr.P.H., R.D., professor of public health sciences at Wake Forest Baptist and lead author of the study that was published in the July issue of the journal Teaching and Learning in Medicine. "We just aren't doing a good enough job of teaching our students evidence-based methods of intervention and care for our obese patients."
The purpose of the study was to provide a systematic review of the literature examining obesity-related educational programs. In an effort to gauge the amount and effectiveness of medical school training related to obesity, the researchers reviewed literature from the National Institutes of Health's PubMed database from 1966 through 2010.
Of the 208 articles found, only five addressed ways to increase medical students' knowledge, attitudes and skills regarding overweight and obesity treatment. Only two of those five addressed medical student bias toward obese patients, and just one dealt with attempting to change this bias.
The lack of published studies in this area is consistent with physicians' reports of inadequate training in managing their patients' weight, the researchers reported.
"Our study shows clear gaps in medical education regarding obesity," Vitolins said. "Providing medical students with skills to address obesity is necessary to impact the national epidemic of obesity to decrease mortality and morbidity from chronic diseases related to excess weight.
"Our findings also highlight the need for medical school curricula to mitigate negative attitudes toward these patients, attitudes that may affect the care delivered."
In addition, the researchers did not find any study that included obesity education over all four years of medical school, including the basic science and clinical years. Although some medical schools require their students to teach prevention, including nutrition and weight management in community clinics, this approach still doesn't cover the full range of obesity counseling knowledge available.
"Utilizing multiple types of intervention approaches – lectures, standardized patient encounters and hands-on training – during multiple time points in the medical school curriculum is needed," Vitolins added. "Such training should be based on tried and true educational approaches and include education in bias and stereotyping, as well as specifically addressing obesity bias."
To help address the lack of obesity-related education in medical schools, the Wake Forest Baptist team has recently published a downloadable teaching and learning program for nutrition, exercise and weight management in MedEdPortal. According to Vitolins, the research team was committed to sharing their educational modules with others to improve nationwide efforts to reduce obesity.
Co-authors of the study are Sonia Crandall, Ph.D., David Miller, M.D., Eddie Ip, Ph.D., Gail Marion, Ph.D., and John Spangler, M.D., of Wake Forest Baptist.
The study was supported by the National Cancer Institute grant R25CA117887-01.
Journal
Teaching and Learning in Medicine