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]
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, some physicians may not be 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:
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.
^Kushner, R. F. (26 September 2011). "Obesity Medicine--The Time Has Come". Nutrition in Clinical Practice. 26 (5): 510–511. doi:10.1177/0884533611418344. PMID21947633.
^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. PMID23047928.
^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. PMID24106932.
^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. PMID12744909.
^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. PMID19747026.