Obesity medicine

Obesity medicine is a field of medicine dedicated to the comprehensive treatment of patients with obesity. Obesity medicine takes into account the multi-factorial etiology of obesity in which behavior, development, environment, epigenetic, genetic, nutrition, physiology, and psychosocial contributors all play a role.[1] As time progresses, we become more knowledgeable about the complexity of obesity, and we have ascertained that there is a certain skill set and knowledge base that is required to treat this patient population. Clinicians in the field should understand how a myriad of factors contribute to obesity including: gut microbiota diversity, regulation of food intake and energy balance through enteroendocrine and neuroregulation, and adipokine physiology.[2] Obesity medicine physicians should be skilled in identifying factors which have contributed to obesity and know how to employ methods (behavior modification, pharmacotherapy, and surgery) to treat obesity. No two people with obesity are alike, and it is important to approach each patient as an individual to determine which factors contributed to their obesity in order to effectively treat each patient. Physicians specializing in obesity medicine may choose to obtain board certification by the American Board of Obesity Medicine.[3]

See also: Anti-obesity medication
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Human body weight
General concepts
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Obesity-associated morbidity
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Criticisms of the field

Some physicians do not feel as though obesity medicine should be its own sub-specialty. Rather, they feel as though obesity, as a complex disease process, should be treated by endocrinologists or physicians who have acquired additional training in the field of nutrition.[4]

Obesity as a chronic disease

In June 2013, the American Medical Association (AMA)[5] adopted policy that recognizes obesity as a chronic disease, a disease process which requires a range of medical interventions to prevent and treat.[6] While professionals from different professions (US senators, congressmen and congresswomen, physicians, and medical students) applauded this decision,[7] others were not so eager to categorize obesity as a disease.[8] Since the initial acknowledgement of obesity as a disease by the AMA, there has been an ongoing debate about the topic.[9]

Education

Obesity education in medical schools and residency

Only a few medical schools and residency programs offer training and education in the field of obesity.[10] As a result, many physicians fail to recognize obesity and are not equipped to treat it.[11][12][13] In order to address this issue, medical schools and residency programs will need to modify their curriculum to teach their students and residents about this disease process to ensure that the large subset of the patients that they encounter in their careers receive adequate treatment.[14]

Obesity medicine clinical fellowships

There are only a few dedicated programs which train clinicians in the field of obesity medicine:

  1. Harvard Medical School Obesity Medicine and Nutrition Fellowship[15]
  2. Nemours Pediatric Obesity Fellowship[16]
  3. UTHealth Center for Obesity Medicine and Metabolic Performance.

Obesity research fellowships

There are several research programs in the field of obesity:

  1. University of Alabama-Birmingham[17]
  2. Johns Hopkins Obesity Research in General Internal Medicine Fellowship[18]
  3. Minnesota Obesity Prevention Training (MnOPT)[19]
  4. Yale Program for Obesity, Weight and Eating Research (POWER)[20]
  5. Centers for Disease Control & Prevention Nutrition and Obesity Fellowship[21]
  6. University of Arizona, Nutritional Sciences Graduate Program, Training Grant in Obesity Research[22]
  7. Harvard Training Program in Nutrition and Metabolism.[23]

Obesity board certification
Main article: American Board of Obesity Medicine

Board certification in obesity medicine is offered by the American Board of Obesity Medicine.[3][24] Eligibility requires either the completion of a fellowship, or adequate continuing medical education.

References
  1. Ahmad, NN and Kaplan LM (April 1, 2010). "It is time for obesity medicine". Virtual Mentor. 12 (4): 272–277. doi:10.1001/virtualmentor.2010.12.4.medu1-1004. PMID 23148831.
  2. Kushner, R. F. (26 September 2011). "Obesity Medicine--The Time Has Come". Nutrition in Clinical Practice. 26 (5): 510–511. doi:10.1177/0884533611418344. PMID 21947633.
  3. Alexander, L (March 2019). "The Benefits of Obesity Medicine Certification". American Journal of Lifestyle Medicine. 13 (2): 161–164. doi:10.1177/1559827618818041. PMC 6378500. PMID 30800022.
  4. Apovian, CM (2012). "Obesity medicine: a new specialty in medicine or a focus in endocrinology? Nutrition is the real subspecialty in medicine". Endocrine Practice. 18 (5): 649–50. doi:10.4158/endp.18.5.y43467v45h52rk2u. PMID 23047928.
  5. "American Medical Association (AMA)". American Medical Association. Retrieved 16 December 2014.
  6. Breymaier, Shannon. "AMA Adopts New Policies on Second Day of Voting at Annual Meeting". American Medical Association. Retrieved 16 December 2014.
  7. "On Treating Obesity, the Disease". The New York Times. 2013-06-24. Retrieved 16 December 2014.
  8. Katz, DL (17 April 2014). "Perspective: Obesity is not a disease". Nature. 508 (7496): S57. Bibcode:2014Natur.508S..57K. doi:10.1038/508S57a. PMID 24740128.
  9. "Obesity Pros and Cons: Is Obesity a Disease?". ProCon.org. Retrieved 16 December 2014.
  10. Colbert, James A.; Jangi, Sushrut (10 October 2013). "Training Physicians to Manage Obesity — Back to the Drawing Board". New England Journal of Medicine. 369 (15): 1389–1391. doi:10.1056/NEJMp1306460. PMID 24106932.
  11. Ruser, CB; Sanders, L; Brescia, GR; Talbot, M; Hartman, K; Vivieros, K; Bravata, DM (December 2005). "Identification and management of overweight and obesity by internal medicine residents". Journal of General Internal Medicine. 20 (12): 1139–41. doi:10.1111/j.1525-1497.2005.0263.x. PMC 1490269. PMID 16423105.
  12. Block, JP; DeSalvo, KB; Fisher, WP (June 2003). "Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents". Preventive Medicine. 36 (6): 669–75. doi:10.1016/s0091-7435(03)00055-0. PMID 12744909.
  13. Melamed, OC; Nakar, S; Vinker, S (September 2009). "Suboptimal identification of obesity by family physicians". The American Journal of Managed Care. 15 (9): 619–24. PMID 19747026.
  14. Park, Alice. "The Need for Better Obesity Education–In Medical Schools". Time. Time Magazine. Retrieved 17 December 2014.
  15. "OBESITY MEDICINE AND NUTRITION FELLOWSHIP" (PDF). Massachusetts General Hospital. Retrieved 16 December 2014.
  16. "Nemours granted first accredited pediatric obesity fellowship in US". Nemours Children's Health System. Retrieved 16 December 2014.
  17. "Post-Doctoral Fellowship in Obesity Research". University of Alabama-Birmingham. Retrieved 16 December 2014.
  18. "Obesity Research". Johns Hopkins Medicine. Retrieved 16 December 2014.
  19. "Epidemiology Training Grants & Fellowships". University of Minnesota School of Public Health. Retrieved 16 December 2014.
  20. "Program for Obesity, Weight and Eating Research (POWER) Post-Doctoral Fellowship on Binge Eating & Obesity". Yale School of Medicine Psychiatry: Psychology Section. Retrieved 16 December 2014.
  21. "Behavioral Economics – Nutrition & Obesity Fellowship Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention". Oak Ridge Institute for Science and Education. Retrieved 17 December 2014.
  22. "University of Arizona, Nutritional Sciences Graduate Program, Training Grant in Obesity Research". SACNAS. Retrieved 17 December 2014.
  23. "Fellowships, Residencies, & GME:Harvard Training Program In Nutrition And Metabolism". Massachusetts General Hospital. Retrieved 17 December 2014.
  24. "American Board of Obesity Medicine (ABOM)". Obesity Medicine Fellowship Council.
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