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US physicians feel under-trained for obese patients
US primary care physicians feel they are not sufficiently prepared to treat obesity, and that nutritionists and dieticians are more qualified to help obese patients lose or maintain their weight, according to a survey published in BMJ Open.
While over 90% of respondents said they felt competent giving diet and exercise counselling to obese patients, only 44% said that they were usually successful in helping patients lose weight. Only 39% of respondents said that primary care physicians are the most qualified professionals to help obese patients.
Physicians also reported poor levels of obesity-related training: 23% of respondents described their obesity-related training at medical school as “pretty good” or “very good”. This increased to 35% for training received in residency and 60% in continuing medical training.
"In order to begin improving obesity care, medical education should focus on enhancing those obesity-related skills primary care physicians feel most qualified to deliver, as well as changing the composition of health care teams and practice resources," said Dr Sara Bleich, lead author of the study and an assistant professor with the Bloomberg School's Department of Health Policy and Management.
Of those who had received training in obesity care, 93% reported nutrition counselling training was helpful, 92% said exercise counselling training was helpful, 90% said training on patient care after bariatric surgery was helpful. Motivational interview training and training on patient eligibility for bariatric training were seen as similarly helpful; 64% of respondents said weight loss medication training was helpful.
She said that 93% of respondents to the survey wanted BMI to be considered as a fifth vital sign, 89% thought that diet and exercise tips in patients’ charts would be helpful, and 85% wanted scales that could report their patients’ BMI.
While the survey sought to identify differences in training and opinions about obesity between physicians who had been practising for over 20 years and those who had been trained more recently, Bleich said that there were few significant differences between the two cohorts, which suggested that medical education regarding obesity in the USA had changed little over time.
However, more recent medical school graduates were more likely to think that societal issues, such as a lack of education regarding healthy eating and a lack of access to sources of healthy food, were important causes of obesity. They also reported a higher success rate at helping obese patients lose weight – 49% said that they were usually successful, compared to 36% for those who had graduated over 20 years ago.
The paper was based on responses to a survey from 500 physicians based across America. Of the 500, 222 reported that they had completed medical school over 20 years ago, while 278 said they had completed it less than 20 years ago.