Scant obesity training in medical school leaves docs ill-prepared to help patients
A MARTÍNEZ, HOST:
Obesity is the most common chronic disease in the U.S. It's hard to overstate what it does to patients in the health care system. And while it's also linked to more than 200 other chronic conditions, doctors are taught very little about obesity in medical school and even less about how to help those who have it. As a result, they often perpetuate misconceptions about it, as NPR's Yuki Noguchi reports.
YUKI NOGUCHI, BYLINE: Medical student Tong Yan grew up in a Chinese American family that revered food but thought little of those who carry excess weight.
TONG YAN: Definitely, there was, like, an implicit fattist kind of perspective, you know, like, small comments that are made about people's weight. Also implied with that, that people who are obese are lazy and not motivated.
NOGUCHI: Such notions unwittingly influenced him. Then Yan attended an educational summit on obesity in medical school at George Washington University. It was there he took an implicit bias test that identified his preference for thinner people. Patients shared how discrimination in exam rooms affected them. And Yan learned how factors other than food and exercise - things like genetics, brain chemistry, stress level and community design - contribute significantly to the disease.
YAN: I think it is a start of sort of a reeducation, because whether or not we talk about it, like, we absorb all the messages about what it means to be called obese, what it means to have a larger body, since the time that we're very small.
NOGUCHI: But obesity education is lacking.
SCOTT KAHAN: Doctors traditionally learn nothing about obesity, not in medical school or residency.
NOGUCHI: Scott Kahan teaches at medical schools and directs a clinic called the National Center for Weight and Wellness.
KAHAN: What we learned is essentially just obesity is very prevalent. And you're going to see it in lots of your patients. And it's really important for people to eat less and exercise more. That's pretty much it.
NOGUCHI: Nor has the curriculum kept pace with scientific understanding of obesity, which has transformed in recent decades. It's now understood to be a complex disease involving many of the body's organs. Myriad factors, like genetics, lack of sleep, and even weight stigma can contribute to weight gain. Treating it, therefore, often requires more than just restricting or burning calories. Research on new and promising, if very expensive medications that act on the brain underscores how obesity is not just a disease of the body or simply a matter of willpower.
Yet today's standard medical training reflects little of that. One 2020 survey found medical schools spend, on average, 10 hours on obesity education. Half of schools say increasing that is a low priority or not a priority at all. Robert Kushner calls that insufficient. He's a professor of medical education at Northwestern University and co-authored the survey. He says the problem perpetuates itself.
ROBERT KUSHNER: There aren't a lot of people trained in obesity. If you weren't trained yourself in medical school and you didn't take it upon yourself to learn about it, you're not going to be in a position to be an informed, expert faculty member.
NOGUCHI: Plus, teaching tends to focus on organ systems, like cardiology or endocrinology. But obesity crosses many of those without fitting into one discipline. And, Kushner says...
KUSHNER: There's this prevailing bias that this is a soft science. This is really something we don't need to teach, or people just need to take better care of themselves.
NOGUCHI: The result, he says, is most physicians aren't equipped to help patients with obesity. That's something Tong Yan witnessed firsthand. Yan, now in his fourth year, recalls a supervising doctor talking to a patient with headaches related in part to obesity.
YAN: The doctor was a little bit behind and sort of frustrated or like, you need to get out and exercise. Can't just sit around and - reprimanding, like, don't you know this is an issue?
NOGUCHI: Yan recoiled. He knew that ran counter to what he'd learned in obesity and bias training. But the doctor's seniority scared both Yan and the patient into silence.
YAN: I am ashamed to say that I didn't really say much. It was just an observation that left a big impact.
NOGUCHI: The impact is deep for patients like Patty Nece. In 64 years, she's never been free from the stigma of living in a large body. She gets catcalled, compared to cows or whales, insults that amplify her own savage inner voice.
PATTY NECE: I had sort of become my own worst enemy, my own worst bully. You know, I've won awards as an attorney. And I've been active in community. And nothing overcame all the weight bias and stigma I'd face.
NOGUCHI: But, she says, the biggest clinical damage has come from doctors themselves. Several years ago, Nece visited an orthopedist for hip pain.
NECE: He just lectured me. He never really ever listened to what was going on with me. So many medical professionals think that people that carry excess weight don't know their bodies. Yet, I probably know my body much better because I think about it a lot. I think about my weight a lot.
NOGUCHI: Without examining or even touching her, the doctor blamed the pain on her weight.
NECE: And he said, see, you're even crying because of your weight, which was so far from the truth. I was crying because of him. I didn't want to see another physician in my life.
NOGUCHI: When she finally did, the root cause turned out to be a severe curve in her spine. Nece felt spurned for her weight by others, too - dietitians, mammographer, rheumatologists - then avoided care. Kofi Essel is a pediatrician and nutritionist. He says that kind of alienation is especially common in Black and Latino communities, where obesity rates run higher, yet people are diagnosed and treated less often.
KOFI ESSEL: Why? Because most of us in medical education come from middle- to upper-income backgrounds. So there is oftentimes economic discordance with many of our patients.
NOGUCHI: Essel says the answer again lies in more training in obesity, not just the science of it, but the compassion necessary for patients to respond. He directs the obesity summit at George Washington University and says it transforms students.
ESSEL: Their new awareness, their new knowledge, their new attitude, their new behavior is night and day.
NOGUCHI: Student Tong Yan agrees. He hopes to become a family physician in an underserved community.
YAN: I'm particularly motivated to, like, try to improve these kind of skills for the sake of my patients in the future.
NOGUCHI: Yuki Noguchi, NPR News.
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