A New Way to Train Medical Students in Treating Obesity

In response to the worldwide obesity epidemic, doctors at Duke University Medical Center have developed a multidisciplinary course that teaches future physicians to effectively treat and counsel obese patients.

Fourth-year medical students who enroll in the course, called Clinical Management of Obesity, learn about the underlying causes of obesity and study available treatment options. The students learn how to manage overweight and obese patients non-judgmentally and counsel adults and children to make healthy lifestyle choices. Enrollees also treat patients in Duke’s Hypertension Center, Pediatric Obesity Clinic, Diabetes Clinic, Weight Loss Surgery Center and Diet & Fitness Center.

“Duke is one of the first medical schools in the country to establish an obesity management course for medical students,” said Jarol Boan, M.D., assistant professor of medicine and surgery and creator of the course.

The month-long course rotation fills a significant gap in the traditional medical curriculum, Boan added.

“Every physician who practices in the 21st century should have a basic knowledge of the principles of human nutrition and their application to a wide variety of clinical problems,” said Boan, of the Sarah W. Stedman Nutrition and Metabolism Center at Duke University Medical Center. “However, physicians have typically had very little exposure to obesity treatment. Part of the reason for this is that obesity is not considered a disease, so students don’t get training for obesity.”

About 64 percent of adults and 15 percent of children in America are either overweight or obese, according to the federal Centers for Disease Control and Prevention. The CDC defines overweight as a Body Mass Index (BMI) — a measurement tool used to determine excess body weight — of 25 or more. Obesity is a BMI of 30 or more, and severe obesity is 40 or more. About 9 million Americans are severely obese, says the American Obesity Association.

“There’s an obesity epidemic, and students need to be able to deal with the real world,” Boan said.

This has caused a lot of people to look for alternative ways to lose weight. Many are turning to gastric sleeve surgery.

As a clinician and researcher, Boan designed the course to expose students to Duke’s weight-loss programs and to research such as how nutrient levels can affect the expression of genes. The course also teaches students to evaluate overweight patients and to understand when surgery is an appropriate treatment option, Boan said.

“There are a variety of options available for treatment, ranging from lifestyle changes to bariatric surgery, but students weren’t necessarily being exposed to all the options,” she said. Bariatric surgery is performed on the stomach and/or intestines to help severely obese people lose weight.

“Not everyone is a candidate for bariatric surgery and physicians should understand how to individualize treatment plans for overweight patients,” Boan said.

Another primary goal of Boan’s class is to teach students to assess a patient’s motivation and readiness for change and provide specific goals and techniques for achieving better health. The techniques she and other Duke professors teach include adopting and maintaining a healthy lifestyle; establishing an appropriate diet and exercise goals; identifying barriers to weight loss; solving problems; achieving self-monitoring and self-reinforcement; and controlling stimuli that can compromise weight loss.

Students also examine how obesity and sedentary lifestyle contribute to chronic disorders such as hypertension, diabetes and high blood lipids. The broad spectrum of topics means students learn from surgeons, internists, nurses, pediatricians, dieticians and exercise physiologists, Boan said.

Fourth-year Duke medical student Julia Dombrowski said, “In no other rotation did I spend time with that many different groups of people.” Dombrowski is one of the first students to complete the course, first offered in fall 2003.

“The course was a great experience,” added Dombrowski, who plans to specialize in internal medicine. “It taught me things I hadn’t learned at any other time in medical school. Overweight and obesity are very common problems in any field of medicine, but I hadn’t learned much prior to the course about how to counsel patients regarding weight loss. I also learned how extraordinarily difficult it can be to lose weight and what people struggle with.”

A recent study from the Centers for Disease Control and Prevention showed poor diet and inactivity caused an estimated 400,000 deaths in 2000 and could soon become the leading preventable cause of death among Americans.