Research Shows a Lack of Obesity and Nutrition Education in United States Medical Schools: Barriers and Opportunities to Further Engage the Next Generation of Caregivers

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.

---

Dear Readers,

In past editorials I have talked about the importance of educating and engaging our referring physician colleagues on the disease of obesity and its available treatments. Recent discussions and findings indicate the need and opportunity for us to reach out to another community—our future physicians.

The research. National surveys have been conducted to quantify the number of required hours of nutrition education at United States medical schools and the types of courses in which the instruction was offered. The National Academy of Sciences recommends a 25-hour minimum of required hours of nutrition education for medical school. One study[1] found that between 2008 and 2009, only 27 percent of 105 medical schools met the minimum required hours of nutrition education. What was startling is that this number was actually down from a previous study,[2] which reported that 38 percent (40 out of 104 schools) met the minimum requirements in 2004.

As Forbes contributor Bruce Y. Lee points out in a recent article,[3] “Yes, this number actually went down while the obesity epidemic went up.”

In 2016, Castillo et al[4] published results from an 18-question survey given to medical and osteopathic school graduates entering a pediatric residency program during resident orientation in June of 2011 and 2012. Their findings were in line with the previous cited studies, with incoming interns answering an average of only 52 percent of the questions correctly.

All studies arrived at the same conclusion—it is imperative that medical education focuses on preparing physicians to appropriately counsel all populations on proper nutrition. I can add a personal anecdote to this larger story. When I took my re-certification exam for internal medicine in 2015, I observed that there were almost no questions related to obesity. I can recall perhaps one question related to bariatric surgery and vitamin B12 deficiency.

Barriers and opportunities for improvement. In his article, Lee pointed out some very important barriers or reasons as to why there is a lack of nutrition and obesity education in United States medical schools. One listed possible reason was the “already overcrowded medical school curricula.” While this may be true, I believe we need to examine the fact that obesity is a disease that affects nearly every organ system in the human body.

Another possible reason listed: “Doctors assume that nutritionists and dietitians will always be available to help.” The multidisciplinary approach is crucial in caring for patients with obesity, and nutritionists and dietitians undoubtedly play an important role, but I think it is the responsibility of everyone caring for the patient to have background knowledge and comfort in addressing this disease. Clinicians can and should take the lead in starting the conversation with patients and guide their treatment.

The younger generation does seem to be more aware and have a better understanding of obesity as a disease. While residents may care for patients with obesity in the clinical setting, the research shows there is a lack of good background education on obesity, its related comorbid conditions, and its available treatment options. They may be comfortable treating obstructive sleep apnea (e.g., continuous positive airway pressure [CPAP]) or hypertension in the patient with obesity, but if they possessed expertise in the treatment of obesity as the overarching disease, that would improve patient care even further.

It would also be helpful to educate these students on the amount of weight loss necessary to improve weight-related comorbid medical problems they likely deal with on a daily basis. Education can be both through didactic courses and hands-on experiences. Like any learning experience, the students’ knowledge base should grow as they progress through their education. A huge opportunity for learning exists during clinical rotations, which usually occur during the third and fourth years of medical school.

So, how do we go about improving the education and awareness among medical school students? I think it starts with an “obesity education champion”—an organization on the medical or surgical side. We need a group of people that have a passion for the field as well as education.

One such “champion” exists and is already beginning to attempt to turn the tide. The recently formed Obesity Medicine Education Collaboration, jointly formed by The Obesity Medicine Association (OMA) and The Obesity Society (TOS) in 2016, and group within the National Academy of Medicine are planning to develop new educational recommendations.

Here at Geisinger, we have 2 to 3 individuals per year to complete an Obesity Medicine Fellowship. These fellowships provide a tremendous opportunity for my colleagues and I to guide and teach the next generation of caregivers. Moreover, I’m encouraged by the fact that we see 15 to 20 applicants per year.

I hope that we continue to see more efforts behind increasing obesity and nutrition within medical education I’m confident that we are a strong and powerful field, spreading awareness, education, and understanding of the disease of obesity at every possible opportunity.

Sincerely,

Christopher Still, DO, FACN, FACP

References

1. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537–1542.

2. Adams KM, Lindell KC, Kohlmeier M, Zeisel SH. Status of nutrition education in medical schools. Am J Clin Nutr. 2006;83(4):941S–944S.)

3. Lee BY. Medical Schools Need To Teach More About Obesity And Nutrition. Forbes. Jan 22, 2017. Accessed 2/3/17

4 Castillo M, Feinstein R, Tsang J, Fisher M. Basic nutrition knowledge of recent medical graduates entering a pediatric residency program. Int J Adolesc Med Health. 2016;28(4):357–361.

5. Kreimer S. Medical Schools and Teaching Hospitals Confront the Obesity Epidemic. November 01, 2016. https://news.aamc.org/patient-care/article/med-schools-teaching-hospitals-confront-obesity/. Accessed 2/3/17

Tags: Dr. Christopher Still

Category: Editorial Message, Past Articles