Most Internists in Training Feel Unprepared to Treat Obesity

Most resident physicians training in internal medicine don’t feel adequately prepared to manage obesity in their patients, a new survey from a California residency program finds. The results are published in a special supplemental section of the Journal of the Endocrine Society.

“We are not training our next generation of doctors to feel comfortable with or knowledgeable about management of obesity, a disease rapidly increasing in prevalence that underlies many other medical conditions,” says lead researcher Mita Shah Hoppenfeld, MD, a fourth-year internal medicine resident at Stanford University in Palo Alto, California, where she conducted the survey.

Hoppenfeld says their findings are concerning, given that more than 42% of US adults have obesity, according to recent statistics from the Centers for Disease Control and Prevention. Also of concern: Doctors completing an internal medicine residency will be on the front lines of treating patients with obesity and related complications in fields spanning primary care, endocrinology, cardiology, and many others.

Although studies have found that practicing internists are ill-equipped to approach the topic of weight loss with patients, Hoppenfeld says research on residents’ obesity management is scarce. To learn about residents’ comfort, knowledge, and practices managing obesity in their primary care clinics, she and her colleagues sent an electronic survey to all 125 Stanford internal medicine resident physicians at multiple clinical sites. Seventy residents, or 56%, responded.

The researchers found the following:

• Although 81% of resident physicians described feeling comfortable or somewhat comfortable with counseling patients about lifestyle changes such as diet and exercise, only 33% reported consistently providing such counseling.
• Barriers to providing lifestyle counseling included lack of time (93%), poor familiarity with resources (50%), and lack of training in motivational interviewing (36%). The top barrier (84%) to prescribing weight loss medications was unfamiliarity with them.
• Nearly one-third (31%) of residents correctly identified medically advisable indications for bariatric surgery, but only 9% of those reported referring patients they considered appropriate for surgery.
• When residents reported greater comfort with managing obesity, they were significantly more likely to take action.
• Most residents wanted their training to include more information about weight management medications (90%) and referrals for obesity specialty care (77%).

“The lack of comfort with obesity management occurred at all levels of training,” Hoppenfeld says. “Our findings suggest that increasing residents’ education in obesity management may improve care for patients with obesity. We need to improve medical training to include specific, evidence-based teaching on management of obesity as a disease.”

— Source: Endocrine Society