On-line source:
http://www.ama-assn.org/amednews/sit...o/prsc1112.htm
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Medical schools urged to teach about obesity
Institutions at the forefront weave knowledge into lectures and
clinical rotations.
By Myrle Croasdale, AMNews staff. Nov. 12, 2007.
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Obesity is a national epidemic, yet most medical schools are not
equipping their students to address it, nutrition advocates say.
The Assn. of American Medical Colleges would like to see this
situation change. In an August report, an expert AAMC panel lays out
guidelines on how medical schools can incorporate obesity prevention
and treatment into their science courses and clinical clerkships.
"This is a big issue confronting our future doctors, and we want
[medical schools] to better address these problems," said Rika
Maeshiro, MD, MPH, a co-author of the AAMC report and AAMC vice
president for public health and prevention.
Most schools teach nutrition, but no data exist on how many integrate
obesity into basic science and clinical courses. A few schools have
embraced curriculumwide changes, while others include lectures or
single clinical rotations with an obesity focus.
One school the report touted as a model is the University of Wisconsin
School of Medicine and Public Health in Madison. It made obesity part
of its curriculum 15 years ago, said Patrick McBride, MD, MPH, dean of
students.
"We saw the trend coming for quite a while and started emphasizing
prevention in our curriculum," said Dr. McBride, who chaired the AAMC
panel that developed the report.
Wisconsin's second-year students learn obesity's etiology and
pathophysiology during a nutrition class. In the third year, they get
a hands-on lesson before starting their clerkships that comes in the
form of a buffet lunch of whole grain salads, lean meats, fruits and
vegetables.
Students make their choices, then learn about how national guidelines
relate to what is on their plates. The goal is to show them that
healthy eating can taste good, while teaching them such practical
lessons as portion control, Dr. McBride said. Piling on three pieces
of chicken is two more than recommended, for example.
A collaborative clerkship curriculum in family medicine, general
internal medicine and pediatrics takes lessons further. Family
medicine emphasizes communication and interviewing. Students get a
weight and activity assessment and evaluation tool to assess a
patient's motivation for change and are taught to help patients
determine small behavioral changes.
Metabolic syndrome and treatment options, such as pharmacotherapy and
surgery, are stressed in the internal medicine clerkship. In
pediatrics, activity, diet and family history are focuses.
The goal is to give students in-depth exposure to these issues rather
than superficially dealing with them during each clerkship. The
training extends to residents as well.
Sarah Fox, MD, a third-year family medicine resident at Wisconsin,
said weight issues are a constant in her patient population. "People
come in for other things and hope the doctor doesn't mention it," Dr.
Fox said. "They hope for a silent endorsement of their lifestyle, or
they'll say they'll work on it and then ignore it."
But she has found that methods she learned are useful. She encouraged
an overweight, pre-diabetic patient with serious osteoarthritis in her
knees to try Tai Chi. Then she helped the patient decrease the amount
of simple carbohydrates in her diet and add more green vegetables.
When her blood glucose came down, the patient was motivated to try
walking.
"Now she is starting to lose weight," Dr. Fox said. "If I had started
with walking and dieting, she never would have gone through with it."
Efforts at Tufts University School of Medicine in Boston include the
surgical side of the equation. Scott Shikora, MD, surgical director of
the obesity consult center at the Tufts-New England Medical Center, is
adamant that students need to understand obesity's dynamics and become
familiar with the general clinical implications of bariatric surgery.
A third of Tufts medical students rotate through his surgical center.
"Whatever they go into, they will take care of patients who have had
this surgery or will counsel patients who are interested in having
this surgery," Dr Shikora said.
At the University of Pittsburgh School of Medicine, Goutham Rao, MD,
clinical director of the pediatric weight management and wellness
center, is driving obesity's place to the curriculum. He has opened up
the center for one-week clerkships and hopes to get students thinking.
"We treat high cholesterol, but don't pay attention to the fact the
patient weighs 300 pounds," Dr. Rao said. "We want students to stop
and say, 'Wait a second.' "
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Comments:
(1) As revealed by this article, most current physicians are simply
unable to help patients eat less, down to the optimal amount, because
they themselves do not know how to eat less nor do they know what is
the optimal amount.
(2) Bariatric surgery and not portion control has been clinically
proven to help people achieved sustained (> 5 yrs) clinically
meaningful amounts of weight loss (>10% body weight) that has resulted
in curing weight-related chronic conditions such as hypertension,
dyslipidemia, and type-2 diabetes.
(3) Weighing meals to eat less, down to the optimal amount is
bariatric surgery without the surgery.
(4) Note: This discussion will be mirrored on Sermo, which is like
Usenet but exclusively for physicians only.
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/PressRelease
Prayerfully in the infinite power and might of the Holy Spirit,
Andrew <><
--
Andrew B. Chung, MD/PhD
Lawful steward of
http://EmoryCardiology.com
Bondservant to the KING of kings and LORD of lords.
Medical schools urged to teach about obesity. 
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