May 28, 2024 - Health

America's doctors need more obesity medicine training

Illustration of flying mortarboard with measuring tape replacing the tassel

Illustration: Sarah Grillo/Axios

The relatively small number of health care providers trained in obesity care can hardly keep up with Americans' demand for new weight-loss drugs.

Why it matters: Tens of thousands of U.S. patients each week are starting on treatments like Novo Nordisk's Ozempic and Wegovy, but obesity medicine specialists worry there are still too few providers with enough specialized training to help patients who likely have to remain on the drugs long term.

  • "There's a lot of room for error in prescribing these medications," said Sue Decotiis, an obesity medicine doctor in New York.

The big picture: It's getting easier for patients who want the new class of drugs, known as GLP-1 agonists, to obtain them.

  • There are more and more online platforms prescribing these drugs, and millions of more people are expected to become candidates for the drugs as they're shown to help address a range of conditions associated with obesity.
  • Many types of physicians are already prescribing the drugs, including primary care doctors, endocrinologists and pediatricians.

Yes, but: Patients taking these drugs are supposed to be regularly monitored by providers to ensure they're receiving the proper dosage, have help managing possible side effects that are common with GLP-1s, and get guidance on diet and exercise plans.

  • Though the drugs are highly effective, they don't work for every patient. And a sizable share go off the drugs in less than a year — often because of challenging side effects like nausea or other gastrointestinal symptoms — and regain weight.
  • "If an untrained clinician is prescribing the medicine without proper support, somebody could actually get sicker," said Rekha Kumar, chief medical officer for Found, a telehealth startup that prescribes weight-loss drugs and coaches patients.
  • If patients aren't properly using them, that could also undermine the case for insurers to more broadly cover the pricey drugs, Kumar said.

Zoom in: While over 4 in 10 Americans have obesity, doctors historically have received little training on its care during medical school or residency.

  • "There's been a big gap in translating ... all the science that we know into clinical practice to help make the lives of people better," said Ian Neeland, a cardiologist who co-authored a recent American Heart Association scientific statement on improvements needed in obesity care.
  • It wasn't until 2013 that the American Medical Association declared obesity a disease, signaling it warranted a medical approach.
  • Since then, almost 15 times more physicians have received a board certification in obesity medicine — meaning they've either completed a clinical fellowship in the specialty or taken 60 hours of medical education courses, both of which include training on anti-obesity drugs.
  • But the nearly 8,300 physicians who've been certified by the American Board of Obesity Medicine still represent less than 1% of the United States' physician workforce.

Safely meeting patient demand for GLP-1s requires a two-pronged approach, said Lydia Alexander, president of the Obesity Medicine Association.

  • Primary care doctors need better training on obesity prevention and early symptom management, and the health care system also needs more specialists who can handle severe cases.
  • "As obesity becomes advanced and the conditions around it become more serious, it's harder to manage in a very busy primary care setting," Alexander said.
  • Physicians should care for obesity like other illnesses, she said. For instance, primary care doctors "can put a patient on a statin or blood pressure medication. If it becomes more severe, then I would refer to a cardiologist."

Zoom out: A group of physician societies in 2019 developed core competencies for obesity medicine in medical school and residency programs, in a recognition that training left new doctors little prepared to manage the growing burden of obesity.

  • Comprehensive obesity education is "starting to spread in a way that it hadn't before," Alexander said.
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