Obesity is a big health issue, so why aren't more doctors prepared to deal with it? One reason has to do with the licensing exams doctors must take. They ask few questions that even mention obesity, according to a new study, and those that do rarely ask about ways to treat or prevent it.So it's not surprising that when doctors first start seeing patients who are obese, they have little information to go on to help them.
Researchers looked at over 800 questions from recent The United States Medical Licensing Examinations (USMLE) to see how many contained obesity-related keywords, such as BMI or weight loss. The USMLE is a three-stage exam that medical students and first-year resident doctors must pass in order to obtain their license.
Most of the questions that did contain these terms (64%) turned out to be false alarms — they were totally unconnected to obesity.
Part of the problem is that obesity doesn't easily fit into the way licensing exams are structured or medicine is organized.
Questions that were obesity-related were often about other medical conditions that obesity makes worse such as diabetes, high blood pressure and sleep apnea. And few of these asked about obesity prevention or treatment.
Part of the problem is that obesity doesn't easily fit into the way the exam is structured or medicine is organized. The exam is divided into questions based on 17 different organ systems. Since obesity affects the entire body and many organs, it's hard to decide where obesity questions should be placed.
Obesity-related questions that did appear were spread among several areas, with the most, about 14%, found in endocrinology (glands and hormones).
“It's a trickle-down effect,” said Robert Kushner, the study's lead author and a professor of medicine at Northwestern University Feinberg School of Medicine. “If it's not being tested, it won't be taught as robustly as it should be.” Even medical school suffers from the problem of teaching to the test.
There are many medical specialties — family medicine, pediatrics, psychiatry, cardiology, etc., but there is no medical specialty for obesity medicine; another reason why so few doctors know how to help obese patients.
Over the past few years the exam has been broadening its question base with more questions on such non-traditional subjects as patient safety and medical ethics. The authors believe that it's time more questions on preventing and treating obesity were included as well.
There are many patients who would benefit. By one estimate, nearly 40% of the adults in the U.S. are obese. There's certainly plenty of territory for medical education and its associated exams to cover — from the role that economic and social factors play in obesity to evidence-based treatment.
The study appears in Teaching and Learning in Medicine and is freely available.