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Obesity Medicine
[edit]Definition
[edit]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. [1]
Criticisms of the field
[edit]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.[2]
Obesity as a Chronic Disease
[edit]In June 2013, the American Medical Association (AMA)[3][4] adopted policy that recognizes obesity as a chronic disease, a disease process which requires a range of medical interventions to prevent and treat.[5] While professionals from different professions (US Senators, Congressmen and Congresswomen, physicians, and medical students) applauded this decision[6], others were not so eager to categorize obesity as a disease.[7] Since the initial acknowledgement of obesity as a disease by the AMA, there has been an ongoing debate about the topic.[8]
Treatment Options
[edit]Guidelines for Overweight and Obesity Treatment in Adults
[edit]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.[9][10]
In this report, they provide specific recommendations on:
- Identifying patients who need to lose weight using body mass index (BMI)[11] and waist circumference[12]
- Matching treatment benefits with risk profiles
- Dietary strategies for weight loss
- Lifestyle intervention and counseling
- Selecting patients for bariatric surgical treatment for obesity
Guidelines for Overweight and Obesity Treatment in Children and Adolescents
[edit]Several organizations have developed guidelines on how to manage overweight and obesity in the pediatric populations. The Endocrine Society[13][14] developed a set of clinical pediatric guidelines[15]. In their guidelines, they provide a summary of recommendations which they outline as follows:
- The problem with obesity
- Diagnosis of overweight and obesity
- Treatment of obesity- lifestyle, dietary, physical activity, psychosocial, pharmacotherapy, and bariatric surgery recommendations
- Prevention of obesity
- Societal barriers to implementation
Education
[edit]Obesity Education in Medical Schools and Residency
[edit]Only a few medical schools and residency programs offer training and education in the field of obesity.[16] As a result, many physicians fail to recognize obesity and are not equipped to treat it.[17][18][19] 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.[20]
Obesity Medicine Clinical Fellowships
[edit]There are only a few dedicated programs which train clinicians in the field of obesity medicine:
- Massachusetts General Hospital/ Harvard Medical School Obesity Medicine and Nutrition Fellowship[21]
- Nemours Pediatric Obesity Fellowship[22]
Obesity Research Fellowships
[edit]There are several research programs in the field of obesity:
- Massachusetts General Hospital Obesity Metabolism & Nutrition Institute Post-Doctoral Fellowship[23]
- University of Alabama-Birmingham[24]
- Johns Hopkins Obesity Research in General Internal Medicine Fellowship[25]
- Minnesota Obesity Prevention Training (MnOPT)[26]
- Yale Program for Obesity, Weight and Eating Research (POWER)[27]
- Centers for Disease Control & Prevention Nutrition and Obesity Fellowship[28]
- University of Arizona, Nutritional Sciences Graduate Program, Training Grant in Obesity Research[29]
- Harvard Training Program in Nutrition and Metabolism[30]
Obesity Medicine Physicians
[edit]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."[31][32]
American Board of Obesity Medicine
[edit]History
[edit]"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."[33]
Partner Organizations
[edit]Primary Obesity CME Partners
[edit]- American Society of Bariatric Physicians (ASBP)[35]
- Harvard Medical School Blackburn Course in Obesity Medicine[36]
- Columbia University Institute of Human Nutrition [37]
- The Obesity Society (TOS)[38][39]
Obesity Related CME Partners
[edit]- Canadian Obesity Network (CON)[40]
- Cardiometabolic Health Congress (CMHC)[41]
- Cardiometabolic Risk Summit (CRS)[42]
- Cleveland Clinic Obesity Summit[43]
- Let’s Go[44]
- Mayo: Nutrition & Wellness in Health & Disease[45]
- USF: Treatment Guidelines for obesity[46]
- World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease (WCIRDC)[47]
American Board of Medical Specialties (ABMS) Fields of Medicine Partners
[edit]- American College of Physicians (ACP)[48]
- American College of Preventive Medicine (ACPM)[49]
- American Congress of Obstetricians and Gynecologists (ACOG)[50][51]
- American Gastroenterological Association (AGA)[52][53]
- The Endocrine Society (ENDO)[54][55]
Public Health Partners
[edit]- American Society of Metabolic and Bariatric Surgery (ASMBS) Foundation[56]
- STOP Obesity Alliance[57]
- The Obesity Treatment Foundation[58]
Board of Directors
[edit]- Robert Kushner, MD, MS- Chair [60][61]
- Louis J. Aronne, MD- Vice Chair[62] [63][64]
- Joan Temmerman, MD, MS- Secretary/ Treasurer[65]
- Stephen Cook, MD, MPH- Director[66][67]
- John B. Cleek, MD- Director[68][69]
- Wayne English, MD- Director [70][71]
- Dyan Hes, MD- Director[72][73]
- Robert Huster, MD- Director[74][75]
- Scott Kahan, MD, MPH- Director[76][77][78]
- Judith Korner, MD, PhD- Director[79][80]
- Shadrach Smith, MD-Director[81][82]
- Susan E. Williams, MD, MS-Director[83][84]
Test Content Outline
[edit][85] 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
[edit]Sub-specialty Candidate Distribution
[edit]- Internal Medicine- ~45%
- Family Medicine- ~27%
- Obstetrics/ Gynecology- ~7%
- Pediatrics- ~6%
- Endocrinology- 5%
- Surgery-~4%
- Other- ~5%
Number of Physician Candidates by Year
[edit]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
[edit]Diplomate Distribution Varies by State and Per Capita.[87]
- ^ Ahmad, NN and Kaplan LM (April 1, 2010). "It is time for obesity medicine". Virtual Mentor. 12 (4): 272-277. PMID 23148831.
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(help) - ^ Apovian, CM. "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. PMID 23047928.
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(help) - ^ "American Medical Association (AMA)". American Medical Association. Retrieved 16 December 2014.
- ^ "American Medical Association". Wikipedia. Retrieved 16 December 2014.
- ^ Breymaier, Shannon. "AMA Adopts New Policies on Second Day of Voting at Annual Meeting". American Medical Association. Retrieved 16 December 2014.
- ^ "On Treating Obesity, the Disease". NY Times. Retrieved 16 December 2014.
- ^ Katz, DL (17 April 2014). "Perspective: Obesity is not a disease". Nature. 508 (7496): S57. doi:10.1038/508S57a. PMID 24740128.
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(help) - ^ "Obesity Pros and Cons: Is Obesity a Disease?". ProCon.org. Retrieved 16 December 2014.
- ^ "2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society". Circulation. 129 (25 Suppl 2): S102-138. 24 June 2014. doi:10.1161/01.cir.0000437739.71477. PMID 24222017.
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(help) - ^ Jensen, Michael D.; Ryan, Donna H.; Donato, Karen A.; Apovian, Caroline M.; Ard, Jamy D.; Comuzzie, Anthony G.; Hu, Frank B.; Hubbard, Van S.; Jakicic, John M.; Kushner, Robert F.; Loria, Catherine M.; Millen, Barbara E.; Nonas, Cathy A.; Pi-Sunyer, F. Xavier; Stevens, June; Stevens, Victor J.; Wadden, Thomas A.; Wolfe, Bruce M.; Yanovski, Susan Z. (July 2014). "Executive summary: Guidelines (2013) for the management of overweight and obesity in adults". Obesity. 22 (S2): S5-9. doi:10.1002/oby.20821. PMID 24961825.
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(help) - ^ "Calculate Your Body Mass Index". National Heart, Lung, and Blood Institute. Retrieved 16 December 2014.
- ^ "Calculating Your Waist Circumference". WebMD. Retrieved 16 December 2014.
- ^ "The Endocrine Society (ENDO)". The Endocrine Society. Retrieved 16 December 2014.
- ^ "The Endocrine Society". Wikipedia. Retrieved 16 December 2014.
- ^ "Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion" (PDF). The Endocrine Society. Retrieved 16 December 2014.
- ^ 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. PMID 24106932.
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(help) - ^ Ruser, CB; Sanders, L; Brescia, GR; Talbot, M; Hartman, K; Vivieros, K; Bravata, DM (December 2005). "Identification and management of overweight and obesity by internal medicine residents". Journal of general internal medicine. 20 (12): 1139–41. PMID 16423105.
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(help) - ^ 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. PMID 12744909.
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(help) - ^ 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. PMID 19747026.
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(help) - ^ Park, Alice. "The Need for Better Obesity Education–In Medical Schools". Time. Time Magazine. Retrieved 17 December 2014.
- ^ "OBESITY MEDICINE AND NUTRITION FELLOWSHIP" (PDF). Massachusetts General Hospital. Retrieved 16 December 2014.
- ^ "Nemours granted first accredited pediatric obesity fellowship in US". Nemours Children's Health System. Retrieved 16 December 2014.
- ^ "Fellowships, Residencies, & CME: Postdoctoral Fellowship in Obesity Medicine and Nutrition". Massachusetts General Hospital. Retrieved 16 December 2014.
- ^ "Post-Doctoral Fellowship in Obesity Research". University of Alabama-Birmingham. Retrieved 16 December 2014.
- ^ "Obesity Research". Johns Hopkins Medicine. Retrieved 16 December 2014.
- ^ "Epidemiology Training Grants & Fellowships". University of Minnesota School of Public Health. Retrieved 16 December 2014.
- ^ "Program for Obesity, Weight and Eating Research (POWER) Post-Doctoral Fellowship on Binge Eating & Obesity". Yale School of Medicine Psychiatry: Psychology Section. Retrieved 16 December 2014.
- ^ "Behavioral Economics – Nutrition & Obesity Fellowship Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention". Oak Ridge Institute for Science and Education. Retrieved 17 December 2014.
- ^ "University of Arizona, Nutritional Sciences Graduate Program, Training Grant in Obesity Research". SACNAS. Retrieved 17 December 2014.
- ^ "Fellowships, Residencies, & GME:Harvard Training Program In Nutrition And Metabolism". Massachusetts General Hospital. Retrieved 17 December 2014.
- ^ "What is an obesity medicine physician?". http://thinforlife.med.nyu.edu/non-surgical-weight-loss/what-obesity-medicine-physician. Retrieved 17 December 2014.
{{cite web}}
: External link in
(help)|website=
- ^ "American Board of Obesity Medicine". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "History". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Partner Organizations" (PDF). American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "American Society of Bariatric Physicians". American Society of Bariatric Physicians. Retrieved 17 December 2014.
- ^ "Blackburn Course in Obesity Medicine: Treating Obesity 2015". Harvard Medical School Department of Continuing Medical Education. Retrieved 17 December 2014.
- ^ "Institute of Human Nutrition". Columbia University College of Physicians and Surgeons. Retrieved 17 December 2014.
- ^ "The Obesity Society (TOS)". The Obesity Society. Retrieved 16 December 2014.
- ^ "The Obesity Society". Wikipedia. Retrieved 16 December 2014.
- ^ "Canadian Obesity Network". Canadian Obesity Network. Retrieved 17 December 2014.
- ^ "Cardiometabolic Health Congress". Cardiometabolic Health Congress. Retrieved 17 December 2014.
- ^ "Cardiometabolic Risk Summit Spring and Fall". Cardiometabolic Risk Summit. Retrieved 17 December 2014.
- ^ "10th Annual Obesity Summit". Cleveland Clinic Center for Continuing Education. Retrieved 17 December 2014.
- ^ "5210 Let's Go". Let's Go. Retrieved 17 December 2014.
- ^ "Mayo Clinic Nutrition and Wellness in Health and Disease". Mayo School of Continuous Professional Development. Retrieved 17 December 2014.
- ^ "14th Annual Conference on Obesity- Making Sense of Treatment Guidelines for Obesity". CE Search Engine. Retrieved 17 December 2014.
- ^ "World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease". World Congress on Insulin Resistance, Diabetes, and Cardiovascular Disease. Retrieved 17 December 2014.
- ^ "American College of Physicians". American College of Physicians. Retrieved 17 December 2014.
- ^ "American College of Preventive Medicine". American College of Preventive Medicine. Retrieved 17 December 2014.
- ^ "American Congress of Obstetricians and Gynecologists (ACOG)". American Congress of Obstetricians and Gynecologists. Retrieved 16 December 2014.
- ^ "American Congress of Obstetricians and Gynecologists". Wikipedia. Retrieved 16 December 2014.
- ^ "American Gastroenterological Association (AGA)". American Gastroenterological Association. Retrieved 16 December 2014.
- ^ "American Gastroenterological Association". Wikipedia. Retrieved 16 December 2014.
- ^ "The Endocrine Society (ENDO)". The Endocrine Society. Retrieved 16 December 2014.
- ^ "The Endocrine Society". Wikipedia. Retrieved 16 December 2014.
- ^ "American Society for Metabolic and Bariatric Surgery (ASMBS)". American Society for Metabolic and Bariatric Surgery. Retrieved 16 December 2014.
- ^ "Strategies to Overcome Obesity and Prevent Obesity Alliance". Stop Obesity Alliance. Retrieved 17 December 2014.
- ^ "The Obesity Treatment Foundation". American Society of Bariatric Physicians. Retrieved 17 December 2014.
- ^ "Board of Directors". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Robert F. Kushner, MD, MS". Northwestern Comprehensive Center on Obesity. Northwestern University Feinberg School of Medicine. Retrieved 17 December 2014.
- ^ "Dr. Robert Kushner, Chair". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Louis J. Aronne, M.D." Weill Cornell Physicians. Retrieved 17 December 2014.
- ^ "Louis Aronne". Wikipedia. Retrieved 17 December 2014.
- ^ "Dr. Louis Aronne, Vice Chair". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Dr. Joan Temmerman, Secretary/Treasurer". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Dr. Stephen Cook, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Stephen R. Cook, M.D., M.P.H." University of Rochester Medical Center. Retrieved 17 December 2014.
- ^ "Dr. John Cleek". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Vanderbilt Center for Medical Weight Loss". Vanderbilt University Medical Center. Retrieved 17 December 2014.
- ^ "Dr. Wayne English-Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Wayne J. English, MD, FACS- Surgery, Bariatric, Trauma". UPHCN. Retrieved 17 December 2014.
- ^ "Dr. Dyan Hes, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Dr. Dyan Hes Bio". Gramercy Pediatrics. Retrieved 17 December 2014.
- ^ "Dr. Robert Huster, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Robert M. Huster, M.D. Gynecology & Medical Weight Management". Roberthustermd. Retrieved 17 December 2014.
- ^ "Dr. Scott Kahan, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Scott Kahan, MD, MPH". National Center for Weight and Wellness. Retrieved 17 December 2014.
- ^ "Scott I Kahan". Wikipedia. Retrieved 17 December 2014.
- ^ "Dr. Judith Korner, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Judith Korner, M.D., Ph.D." Columbia University Department of Medicine. Retrieved 17 December 2014.
- ^ "Dr. Shadrach Smith, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Shadrach Smith, M.D." Kansas City Internal Medicine (KCIM). Retrieved 17 December 2014.
- ^ "Dr. Susan Williams, Director". American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Susan Williams, MD". Cleveland Clinic. Retrieved 17 December 2014.
- ^ "Test Content Outline" (PDF). American Board of Obesity. Retrieved 17 December 2014.
- ^ "Candidate Trends" (PDF). American Board of Obesity Medicine. Retrieved 17 December 2014.
- ^ "Distribution Heat Maps" (PDF). American Board of Obesity Medicine. Retrieved 17 December 2014.