What Exactly Do Doctors Learn in Medical School About How To Treat People With Obesity?
After all, obesity is incredibly common: 42 percent of adults in the U.S. have obesity, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
And it’s typically considered an important health marker: Obesity is linked to serious, chronic conditions—including certain cancers, type 2 diabetes, and heart disease—that lead to premature and preventable deaths, according to the Centers for Disease Control and Prevention (CDC).
That said, weight is only one metric. Having obesity does not automatically mean you're in poor health—just as having a low weight doesn’t equal good health. In fact, other health indicators beside weight can often reveal more about your overall health.
The causes of obesity are complex, and often outside of a person’s control: While what you eat plays a role, so do genetics, sleep habits, physical activity, and what’s known as social determinants of health (aka, non-medical elements, such as economic policies, racism, and climate change, that play a role in a person’s health), according to the CDC. Traumatic events during childhood, known as adverse childhood experiences (ACES), may also increase the possibility of obesity in adulthood, according to a May 2020 review in Physiology & Behavior.
And obesity treatment, which is often glibly boiled down to eating less and moving more, is incredibly challenging, often requiring a lifestyle overhaul or medication for long-term success.
Given obesity’s prevalence and the serious health consequences tied to it, it seems right that it should be a major topic in medical schools. Yet medical fatphobia and bias around obesity, along with language that places blame on people with obesity in a way that doesn’t typically occur with other health conditions, is far from uncommon.
For our Real Talk Rx series, we asked readers to send us their biggest health questions and then posed the most common to a panel of doctors. Many readers wondered how much of doctors’ medical training was devoted to the specific needs of people with obesity, and what exactly they learned about it. Here's what the experts had to say.
How much do doctors learn about obesity in medical school?
"As someone who completed med school, and also was on faculty for a medical school for several years, I can tell you there's a lot more that needs to be done in the way of medical education about obesity.
From my personal experience going through medical school, I think there is unintentionally implicit bias or stigma that gets attached to obesity. And some of that is because the research on obesity is just not as complete as it is for some other medical conditions that we learn about in medical school.
Some would argue the reason why the research in obesity is not as robust is because of biases that obesity is a personal failure or personal decision. We've known for a long time that's not true. Now, the research is catching up and demonstrating that. Personally, I love [helping patients with] weight management, but a lot of what I learned about weight management I learned after medical school.
I don't think medical training does obesity justice. I don't think it starts to call into question the sort of social nuances and social determinants of health that affect obesity. I'm looking forward to seeing where future medical education goes, because it's time to catch up.
It's really hard to get rid of the stigma that in some way, what a person eats is a personal choice. Because it is, to a certain extent — a person is putting food in their mouth. But that doesn't account for what sort of food is available in their environment. It doesn't account for what foods they can afford or are important to them culturally or what sort of advertising about food they are being inundated with 24/7.
We are learning more and more how the endocrine system changes once a person's weight starts to go up. And then once those changes are underway, it becomes even more challenging to change your weight. It's a vicious cycle. The more we learn about the mechanisms behind obesity, hopefully, the less of a social or personal issue it seems like. I hope people can appreciate it more for the scientific issue that it really is."
"I don't think medical training does obesity justice. I don't think it starts to call into question the sort of social nuances and social determinants of health that affect obesity. I'm looking forward to seeing where future medical education goes, because it's time to catch up." —Alexa Mieses Malchuk, MD
"I don't think there's anything lacking. In medical school, we learn anything and everything about obesity, especially because we’re being trained to serve in America. We learn everything from the psychosocial perspective to the physiological perspective, the pathophysiological perspective on what obesity entails, where it comes from, like a cultural standpoint, how it develops, and what it does to the body.
BMI is a standardized way to categorize people, but we're moving away from these categories, because it gives a goal-oriented society anxiety. There are a lot of demographic factors—your ethnicity, your geographical location, your lifestyle—that determine what your BMI is.
BMI is not a really good indicator, just in and of itself, of your health status. There are cholesterol levels, triglyceride levels, and many [other] parameters that we look at that give us a snapshot of your internal environment."
"The standard medical curriculum reviews the causes of obesity, treatments for obesity, and the complications from obesity. So we do receive a fairly comprehensive understanding of risks and how to treat it. It’s incorporated as part of an overarching education on other health issues.
Most medical school curriculums do teach their students how to interact with compassion and to treat the individual and not their disease. I will say, though, the American medical system really does need much better training on nutrition and how to live a healthy lifestyle. We do a lot of education on how to treat the complications of obesity, but we don’t do a really great job in teaching physicians—and then subsequently teaching our patients—how to prevent obesity."
The takeaway
Our experts agree: During medical school, future doctors learn about obesity, including its causes, risk factors, and treatment options. But some of the doctors we spoke with felt more could be done, not only to prioritize preventing obesity, but to provide judgment-free care that's free from bias and recognizes a person's weight is not due to their choices alone.
Confused about your health? Get answers to more common questions in our Real Talk Rx series.
—reviewed by Jennifer Gilbert, MD, MPH
Loading More Posts...
