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Obesity Medicine

Definition

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 play a role. There is phenotypic diversity in obesity such that persons may differ drastically with regards to factors such as age, adipose (fat) distribution, co-morbidities, eating behaviors, thermoregulation, and response to therapy. There is often a need for a range of treatment modalities to treat persons with obesity which include behavior, nutrition, medications, and surgery. Obesity has a profound impact, and there is often variation in how persons respond related to race/ethnicity, socioeconomic status, psychological status, and medical co-morbidities. While the field of bariatric medicine focuses primarily on weight loss through the use of behavior, nutrition, and pharmacologic means, the field of obesity medicine focuses on the wide spectrum of issues that a patient with obesity encounters including built environment, development of appropriate diagnostic tools, policy, use of weight promoting drugs, treatment algorithms, and weight bias and stigma.

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.

Obesity as a Chronic Disease

In June 2013, the American Medical Association (AMA) adopted policy that recognizes obesity as a chronic disease, a disease process which requires a range of medical interventions to prevent and treat. While professionals from different professions (US Senators, Congressmen and Congresswomen, physicians, and medical students) applauded this decision, others were not so eager to categorize obesity as a disease. Since the initial acknowledgement of obesity as a disease by the AMA, there has been an ongoing debate about the topic.

Treatment Options

Guidelines for Overweight and Obesity Treatment in Adults

In November 2013, the American College of Cardiology (ACC), the American Heart Association, and the The Obesity Society (TOS), developed the 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults.

In this report, they provide specific recommendations on:

1. Identifying patients who need to lose weight using body mass index (BMI) and waist circumference
2. Matching treatment benefits with risk profiles
3. Dietary strategies for weight loss
4. Lifestyle intervention and counseling
5. Selecting patients for bariatric surgical treatment for obesity

Guidelines for Overweight and Obesity Treatment in Children and Adolescents

Several organizations have developed guidelines on how to manage overweight and obesity in the pediatric populations. The Endocrine Society developed a set of clinical pediatric guidelines. In their guidelines, they provide a summary of recommendations which they outline as follows:

1. The problem with obesity
2. Diagnosis of overweight and obesity
3. Treatment of obesity- lifestyle, dietary, physical activity, psychosocial, pharmacotherapy, and bariatric surgery recommendations
4. Prevention of obesity
5. Societal barriers to implementation

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. As a result, many physicians fail to recognize obesity and are not equipped to treat it. 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.

Obesity Medicine Clinical Fellowships

There are only a few dedicated programs which train clinicians in the field of obesity medicine:

1. Massachusetts General Hospital/ Harvard Medical School Obesity Medicine and Nutrition Fellowship
2. Nemours Pediatric Obesity Fellowship

Obesity Research Fellowships

There are several research programs in the field of obesity:

1. Massachusetts General Hospital Obesity Metabolism & Nutrition Institute Post-Doctoral Fellowship
2. University of Alabama-Birmingham
3. Johns Hopkins Obesity Research in General Internal Medicine Fellowship
4. Minnesota Obesity Prevention Training (MnOPT)
5. Yale Program for Obesity, Weight and Eating Research (POWER)
6. Centers for Disease Control & Prevention Nutrition and Obesity Fellowship
7. University of Arizona, Nutritional Sciences Graduate Program, Training Grant in Obesity Research
8. Harvard Training Program in Nutrition and Metabolism

Obesity Medicine Physicians

Who is an obesity medicine physician?

• "A physician with expertise in the sub-specialty of obesity medicine. This sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity.
• A physician who employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy.
• A physician who utilizes a comprehensive approach, and may include additional resources such as nutritionists, exercise physiologists, psychologists and bariatric surgeons as indicated to achieve optimal results.
• A physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients, promotes the prevention of obesity, and advocates for those who suffer from obesity."

American Board of Obesity Medicine

History

"The American Board of Obesity Medicine (ABOM) was established through the cooperative efforts of the former American Board of Bariatric Medicine (ABBM) and the Certified Obesity Medicine Physician (COMP) steering committee in order to create a single unified certification process. The ABBM was an independent entity that had been administering an examination in obesity medicine since 1997. Formally, the ABOM was established in 2011 to serve the public and the field of obesity medicine through the establishment and maintenance of criteria and procedures for examination and certification of candidate physicians who seek recognition of their accomplishments in obesity medicine. Physicians who complete the ABOM certification process in obesity medicine are designated Diplomates of the American Board of Obesity Medicine."

Partner Organizations

Primary Obesity CME Partners

• American Society of Bariatric Physicians (ASBP)
• Harvard Medical School Blackburn Course in Obesity Medicine
• Columbia University Institute of Human Nutrition
• The Obesity Society (TOS)

Obesity Related CME Partners

• Canadian Obesity Network (CON)
• Cardiometabolic Health Congress (CMHC)
• Cardiometabolic Risk Summit (CRS)
• Cleveland Clinic Obesity Summit
• Let’s Go
• Mayo: Nutrition & Wellness in Health & Disease
• USF: Treatment Guidelines for obesity
• World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease (WCIRDC)

American Board of Medical Specialties (ABMS) Fields of Medicine Partners

• American College of Physicians (ACP)
• American College of Preventive Medicine (ACPM)
• American Congress of Obstetricians and Gynecologists (ACOG)
• American Gastroenterological Association (AGA)
• The Endocrine Society (ENDO)

Public Health Partners

• American Society of Metabolic and Bariatric Surgery (ASMBS) Foundation
• STOP Obesity Alliance
• The Obesity Treatment Foundation

Board of Directors

• Robert Kushner, MD, MS- Chair
• Louis J. Aronne, MD- Vice Chair
• Joan Temmerman, MD, MS- Secretary/ Treasurer
• Stephen Cook, MD, MPH- Director
• John B. Cleek, MD- Director
• Wayne English, MD- Director
• Dyan Hes, MD- Director
• Robert Huster, MD- Director
• Scott Kahan, MD, MPH- Director
• Judith Korner, MD, PhD- Director
• Shadrach Smith, MD-Director
• Susan E. Williams, MD, MS-Director

Test Content Outline

1. Basic Concepts- 25%

* Causes of Obesity
* Physiology/ Pathophysiology
* Epidemiology
* Nutrition
* Physical Activity

2. Diagnosis and Evaluation-30%

* History
* Lifestyle
* Physical Assessment
* Indications and Interpretation
* Screening Questionnaires
* Medical Clearance
* Research Tools

3. Treatment-40%

* Behavior
* Family Support and Participation
* Individual, Group, and Family Therapy
* Diet
* Physical Activity
* Pharmacotherapy/Pharmacology
* Alternative, Emerging, and Investigational Therapies
* Surgical Procedures
* Medical/Legal Consent Forms
* Patient Education
* Strategies

4. Practice Management- 5%

* Initial
* Office Procedures
* Interdisciplinary Team
* Other

Average Distribution of Medical Specialties and Number of Physician Candidates by Year

Sub-specialty Candidate Distribution

• Internal Medicine- ~45%
• Family Medicine- ~27%
• Obstetrics/ Gynecology- ~7%
• Pediatrics- ~6%
• Endocrinology- 5%
• Surgery-~4%
• Other- ~5%

Number of Physician Candidates by Year

The number of physician candidates has doubled from ~200 candidates when the certifying exam was first offered in 2012 to over 400 candidates for the 2014 test administration.

Diplomate Distribution Per Capita and By State

Diplomate Distribution Varies by State and Per Capita.