Obesity training that could help reduce stigma is missing in medical school : Shots

Obesity is linked to many serious health conditions in the United States, but doctors have little training in its causes and treatment.

wagnerokasaki / Getty images

Obesity is linked to many serious health conditions in the United States, but doctors have little training in its causes and treatment.

wagnerokasaki / Getty images

Tong Yan grew up in Los Angeles, a Chinese-American enclave in a family that worshiped food, but gave little thought to overweight people.

“There is definitely a kind of implicit opinion about fat people, like little comments about people’s weight,” says Yan. Obesity doesn’t affect him or his family, but a friend – who isn’t even too heavy – has become a laughing stock. “This also implies that obese people are lazy and unmotivated,” he recalls.

It wasn’t until studying medicine at George Washington University that Yan thought more deeply about the weight stigma that is pervasive in American culture. In his sophomore year, he attended an obesity education summit organized by one of his professors. As part of the summit, Yan performed an implicit bias test to determine his slight bias towards thinner people. Patients also shared personal stories of exam room discrimination and how it affected their health and relationships with doctors.

And he learned how factors other than using willpower to diet and exercise — things like genetics, brain chemistry, stress levels, and community design — contribute significantly to this disease.

Now, Yan believes that such intensive training in obesity is essential for future doctors.

“I think that’s the beginning of a rehab, because whether we talk about it or not, we absorb all the messages about what it means to be called obese, what it means to be obese. having a bigger body, since the time we were ‘very small,’ he said.

However, obesity training in medicine is still relatively unusual.

“Doctors traditionally learn nothing about obesity, neither in medical school nor in boarding,” says Dr. Scott Kahan, who teaches at Johns Hopkins and George Washington Universities, and is medical director of the National Center for Weight and Wellness, a clinic in Washington DC.

“What we’ve learned is basically just: ‘Obesity is very common and you’ll see this in a lot of your patients. And it’s really important for everyone to eat less and exercise. sex more’; that’s all,” he said.

Obesity affects so many people – 42% of Americans – and is related to more than 200 other chronic diseases and major causes of death, from heart and kidney disease to diabetes. Its impact on patients and their healthcare is hard to overstate. And yet, even as the scientific understanding of the disease advances rapidly, doctors are taught little about the causes of obesity in medical school, and even less about how to counsel or help those who are sick. sick person.

A 2020 survey found that medical schools spend an average of 10 hours on obesity education. Half of the schools said the increase was a low priority or not a priority at all.

That’s not enough, given that obesity has far-reaching effects on the health sector, say Dr. Robert Kushner, a professor of medicine and medical education at Northwestern University and a co-author of the survey.

The problem persists, he says: “There aren’t many people trained in obesity,” he says, and “if you don’t have medical school training and you don’t educate yourself about it, you won’t be able to become a professional, knowledgeable instructor.”

Training is out of sync with science

Due to a lack of training, health care providers themselves often continue to stigmatize weight or misconceptions about the best treatment for patients with this condition.

Nor has the standard medical curriculum kept up with the obesity research that has transformed the field in recent decades. It is now understood as a complex disease involving many systems of the body. Factors like genetics, hormones, sleep quality, and even stigma can cause weight gain. Therefore, treating it often requires more than just restricting or burning calories.

New and promising — if very expensive – drugs acting on areas of the brain that regulate appetite emphasizes that obesity, like many other diseases, can be treated with medicine, not just willpower.

It’s hard to challenge old notions of obesity in medical training because classes tend to focus on specific organ-based specialties, like cardiology or endocrinology – but obesity has a lot going for it. Different Types. It tends to be mentioned a few minutes here and there, and only in the context of other illnesses, not an overarching illness by itself, Kushner says.

In addition, “there is a widespread bias that this is a soft science; this is not something we need to teach and people just need to take better care of themselves,” he added.

As a result, he says, most doctors aren’t equipped to help obese patients.

That is what Tong Yan witnessed with his own eyes. Yan, now in his fourth year of medical school, recalls one of his supervising physicians speaking to a patient who had tension headaches that were, in part, related to complications from obesity. Yan says the doctor was in a hurry – and was speaking to the patient through an interpreter, which took twice as long. And then he reprimands the patient, saying things like, “You need to get out and exercise. Can’t you just sit around,” or “Don’t you know this is a problem?”

Yan withdrew from the exchange. He knows that goes against what he’s learned during his training in obesity and bias. But the doctor’s seniority kept both Yan and the patient silent, without challenging the tone or content of the lecture.

“I’m ashamed to say that I didn’t really say much,” Yan admitted. “It was just one observation that left a big impact.”

Patients suffer because of doctors’ ignorance

The impact is profound for patients like Patty Nece, who at 64 says she has never escaped the stigma of living in a large body. She’s caught, compared to cows or whales – insults that amplify her own savage inner voice.

“I’m about to become my own worst enemy, my own worst bully,” she said. “I’ve won awards as an attorney and I’ve been active in the community and nothing beats all the stigma and weight stigma I face.”

However, she says, the biggest clinical damage comes from the doctors themselves, including from a chiropractor she consulted a few years ago about hip pain.

Almost immediately, without listening to her, examining her or even touching her, she said the doctor had begun lecturing about her overweight, claiming that the pain hers is due to obesity.

“He said, ‘See, you even cry about your weight,’ which is completely untrue; I cried for him,” Nece said. “I don’t want to see another doctor in my life.”

When she finally saw someone else to treat her hip pain, the root cause turned out to be her spine being severely curved. Nece said health care workers often seem to assume that overweight people don’t know their bodies, even though that’s something she always thinks about. She said the chiropractor wasn’t alone in firing her; she also feels rejected by others because of her weight – dietician, mammographer, rheumatologist.

That kind of alienation is especially harmful to racial minorities, where disparities in care create challenges. The same is true for obesity care in Black and Latino communities, where rates obesity increases the most, but people are not properly diagnosed and treated.

Kofi Essel, a pediatrician and dietitian in Washington DC, says young doctors often don’t come from the same background as those prone to obesity. They don’t understand how things like neighborhood design, food insecurity and access to fresh produce contribute to obesity.

“Why? Because most of us in medical education come from middle-to-high income backgrounds, so many of our patients are often economically disadvantaged,” Essel said.

Again, he argues, the solution is to increase training in obesity – not just in terms of the science but also on how to talk to patients with compassion and without stigma. Essel also directs the obesity summit at George Washington University, and says he has seen it change the way students think about obesity. “Their new awareness, new knowledge, new attitude, new behavior is day and night,” he said.

Student Tong Yan agrees. He plans to become a family doctor in urban areas without medical care.

“I’m particularly motivated to improve these types of skills for the benefit of patients in the future,” he says.


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