In my day to day I often will supervise residents or medical students who have taken it upon themselves to learn more about obesity medicine. I say taken it upon themselves because despite diet and weight related/responsive conditions being huge contributors to a physician's caseload, medical schools and residency programs don't seem to think that nutrition and weight management are worth teaching.
For the past few weeks, Jill Trinacty, a fourth year medical student from the Annapolis Valley, Nova Scotia who will be graduating from Dalhousie University this spring, has been shadowing me here in the office. She will be completing her upcoming residency in Internal Medicine in Ottawa. She enjoys running, cycling and has an interest in obesity medicine, and when I asked her if she'd be willing to write a blog post on what she'd learned about obesity medicine prior to joining me here, she happily obliged. And to be clear - I asked her to focus on what she'd learned regarding obesity yet long term readers here know that healthful living is of concern to anyone at any weight and that the principles that might be involved in weight management and obesity specifically no doubt apply to everyone, and that scales measure neither health nor lack thereof.
Here's what she had to say:
I am in my fourth year of medicine. I have one week left of clinical placements. One exam left to write. One stage to walk across and then I will be set loose on the world as an MD!
I entered medical school four years ago knowing I wanted to be a “doctor”. I didn’t know which kind or what exactly it would entail but I envisioned myself changing lives and promoting “health”. Health to me meant eating nutritiously, being physically active, and generally being well. It seemed pretty straight forward. I wasn’t sure how I would go about inspiring people to be healthy but medical school would teach me that – right?
First year medical school set about teaching the basics of anatomy and physiology. Surely they would talk about obesity, weight management, basal metabolic rate, energy expenditure. No? Ok. Second year came around and again more physiology and medical basics. They measured our heights, weights, fasting glucose, lipids. Awesome! Now you’re going to demonstrate how to use these seemingly meaningless numbers to segway to leading a healthy lifestyle. No? Ok.
Clerkship. This is it. Rotating through all these medical specialties will be when I learn how to counsel people about healthy lifestyles, nutritious food, physical activity. After all, it applies to every area of medicine right? I started with surgery. Between gallstones, bariatric surgery, knee replacements, cancer, there were lots of opportunities to discuss obesity management. I heard a lot about obesity on those rotations, but it came in the form of murmurings and harsh comments. Pediatrics – this is the place to talk about it! We touched on nutrition and slightly on obesity in one lecture. We talked about iron deficiency anemia and growth theoretically. We practiced asking about dietary consumption. Did I once counsel on obesity? No. Ok. OBGYN, surely with all the risks of obesity during pregnancy and the opportunity to teach women to live a healthy life in hopes they will pass that on to their child. No? Ok. Psych, you’re up! The side effects of obesity and metabolic disorders from medications alone should provide ample opportunity to counsel on lifestyle, especially in a population that may have limited means of income. No? Ok. Internal medicine, you’ve got it all! Hypertension, diabetes, heart attacks, obstructive sleep apnea, hypoventilation syndrome. I was lucky enough to rotate through endocrinology department but the clinic was pressed for time and resources, and very few students experience this rotation.
So now I am finished medical school. I realize I have learned very little about how to manage and counsel on obesity – and so have my classmates. In a recent poll of my class of 2013, although many felt comfortable discussing obesity, they felt ill-prepared to effectively manage it and those that did say they felt they had some weight management strategies found that it came from a few select doctors or their own personal weight management challenges. Obesity affects a great deal of the population, affects every specialty and subspecialty and yet we don’t learn how to effectively manage it? We need to do a better job of recognizing the problem, reflecting on our own health behaviours and prioritizing teaching on the issue. If we’re not teaching our future physicians how to manage obesity effectively, who can people turn to for weight management help?