Doctors need more training to address obesity

Hopkins doc: Even some physicians are biased against obese people.

Chances are someone close to you is obese or overweight; just look at the statistics. Worldwide, obesity has nearly doubled since 1980. Worldwide, more than 1.4 billion adults 20 and older are overweight, and of those, 500 million are obese. In the United States, more than two-thirds of adults and one-third of children ages 6 to 19 are overweight or obese. And obesity rates are higher in Baltimore than the national average: According to the Centers for Disease Control, almost 40 percent of Baltimoreans are overweight and almost 30 percent are obese.

Preventing people from becoming obese remains a major conundrum as obesity rates continue to rise worldwide and lead to a constellation of health, psychological and social problems, including heart disease, diabetes, cancer, high blood pressure, sleep disorders, bullying, depression and anxiety. But the other side of obesity control — the care and treatment of those who are already obese — also needs more attention. Many people who could benefit from medical care for obesity are not yet receiving it, even though obesity was designated as a disease by the American Medical Association in 2013 and accounted for an estimated $316 billion in health care costs in 2010. A survey by The Associated Press-NORC Center for Public Affairs Research found that nearly one half of people affected by obesity say they have not been advised by a physician about how to maintain a healthy weight.

A major reason why people aren't getting the care they need is that significant biases exist against people affected by obesity. And health care professionals aren't immune. Many mistakenly view obesity as a lifestyle choice, rather than a complex disease influenced by physiological, psychological, environmental and genetic factors. Studies show that some health care professionals find it difficult to talk about obesity, and even well-intended medical counsel can be perceived by patients as patronizing.

What's more, many still believe that a major reduction in weight is required to experience benefits, despite data that suggest that weight loss of 5 to 10 percent decreases obesity-related health risks, including hypertension, cardiovascular disease, hyperlipidemia, type 2 diabetes and obstructive sleep apnea.

In response to growing concerns about the lack of education about obesity and weight stigma among health care professionals, there have been increasing calls to improve medical training, education and treatment delivery. The formal establishment of the American Board of Obesity Medicine, which offers a certification process for education and competency in treating obesity, is real progress. But, beyond a few scattered attempts by some medical schools to integrate topics of obesity into medical training, few systematic efforts have occurred to improve health care professionals' understanding of obesity and comprehensive treatment approaches that can be delivered as part of patient care.

The Global Obesity Prevention Center headquartered at Johns Hopkins Bloomberg School of Public Health and including experts from across Johns Hopkins University ranging from the School of Medicine to the Whiting School of Engineering, is the first center in the world dedicated to bringing a systems approach to obesity prevention and control. This means understanding that obesity is not a single cause and effect problem but rather is caused by a complex system of biological, behavioral, social, cultural, environmental, economic and other factors. So, in caring for obesity, telling a person to just eat less and exercise more is not enough. You have to understand and address the whole person and everything around him or her. For example, what about the person's biology may make weight loss more difficult? How are the person's social circles or environment preventing or inhibiting treatment? What combination of interventions may be necessary? Addressing obesity is complex, and the proper training and expertise is needed.

The fact is many of us struggle with maintaining a healthy weight, and we all have loved ones who do. With increased education, conversation, support and action in the medical community, we can move closer to ensuring that health care providers have the tools they need to deliver comprehensive and compassionate care to patients affected by obesity, for all of us and our loved ones.

Dr. Bruce Y. Lee (brucelee@jhu.edu; Twitter: @bruce_y_lee) is director of the Global Obesity Prevention Center at Johns Hopkins and associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. Dr. Lee's editorial opinion is made in a personal capacity and is independent of his affiliation with Johns Hopkins University.

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