America's doctors need more obesity medicine training

• "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.