The Failure of Medical Education on Obesity

Right now, it seems that medical education is failing to prepare students to deal with the most prevalent chronic disease in America – obesity. In an interview with STAT last month, FDA Commissioner Robert Califf noted this failure. “I think it’s a shame that you would need to depend on a pharmaceutical company for an educational program about something that’s affecting half of Americans,” he said. But academic health systems simply are not putting an emphasis here. Not yet.

A new editorial in the International Journal of Obesity gets even more specific. The U.S. Medical Licensing Exam (USMLE) simply does not test medical students whatsoever on the science of obesity, say Amber Olson, Fatima Cody Stanford, and Scott Butsch.

The exam tests them on rare metabolic problems (like lysosomal lipid storage disorders) they will likely never see. But the scientific understanding of obesity? Nope. Not a single question.

So we should not be surprised that physicians commonly carry popular misconceptions about obesity into their practices. Medical knowledge of obesity is effectively optional.

Gaps in Obesity Education at Every Level

Olson et al tell us the gaps in obesity content on the USMLE reflect gaps that are pervasive in medical education:

“Unfortunately, the lack of obesity coverage on USMLE Step 1 is consistent with the lack of obesity education at every level of medical training, leaving physicians unprepared to treat a disease that affects more than 40% of adults in the U.S. Medical education has comprehensively trained future physicians on chronic diseases like diabetes and hypertension. However, obesity is treated differently. It is often not thought of as a disease but instead attributed to a lack of willpower or moral failing.”

A Vacuum That Bias Fills

The void in medical education on the science of obesity and effective tools for treatment is one that bias fills quite readily. When popular culture equates fatness with moral failure, many health professionals are not equipped with deep knowledge to push back.

And thus we have pseudo-scientific arguments about diet culture versus fat acceptance. Most people who find that obesity is harming their health wind up with DIY diet and exercise as their only options. We risk the misuse of advanced obesity meds for short-term weight loss, when their true value lies in use for management of a chronic disease that too many physicians don’t fully understand.

This gap in medical education is one we must fill – with something other than bias and pseudoscience.

Click here for the editorial by Olson et al, here for the STAT interview with Califf, and here for further perspective.

Free Learning, illustration by BeeBringer / Wikimedia Commons

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April 11, 2023