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Report VIII

Contemporary Issues in Medicine: The Prevention and Treatment ofOverweight and Obesity

Medical School Objectives Project

Association ofAmerican Medical Colleges

Learn

Serve

Lead

August 2007

Report VIIIContemporary Issues in Medicine: The Prevention and Treatment ofOverweight and Obesity

Medical School Objectives Project

August 2007

To request additional copies of this publication, please contact:

Rika Maeshiro, M.D., M.P.H.Association of American Medical Colleges2450 N Street, NWWashington, DC 20037T 202-828-0436 F [email protected]

© 2007 by the Association of American Medical Colleges. All rights reserved.


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Introduction

The burden of illness associated withoverweight and obesity in the UnitedStates and the rest of the world hasbecome an issue of growing concern tothe medical and public health commu-nities in the late 20th and early 21stcenturies. Data from 2003-2004revealed that in the United States,almost two-thirds (66.3%) of adults 20years and over were overweight orobese, an increase of more than 150%since the early 1970s.1,2 Prevalenceamong children and adolescents hasdoubled in the past 2 decades in theUnited States. Currently, 18.8% of6- to 11-year-olds and 17.4% of 12- to19-year-olds are at or above the 95thpercentile of Body Mass Index (BMI)on standard growth charts.1 From aninternational perspective, the WorldHealth Organization stated in 2005that more than 1.6 billion adults (ages15 years and older) across the globewere overweight, and at least 400million were obese.3

Chronic disease risk factors and co-morbidities associated with overweightand obesity include type 2 diabetesmellitus, gallbladder disease, cardiovas-cular disease, dyslipidemia, hyper-tension, stroke, osteoarthritis, sleepapnea and respiratory problems, andcertain cancers (breast, colon,endometrium, gallbladder, andkidney).4,5,6 Researchers state thatobesity was associated with at least100,000 excess deaths in the UnitedStates in 2000,7 and that increasingobesity rates are associated with higherrates of disability.8 Obese adults payan estimated additional $395.00 peryear in medical costs compared tonormal weight adults.9 From a nationalperspective, overweight- and obesity-

attributable medical spending accountedfor 9.1% of total annual U.S. medicalexpenditures in 1998 (as high as $78.5billion in 1998 dollars, $92.6 billion in2002 dollars).10

The general public, the media, and thepublic and private sectors areconcerned about overweight andobesity. A national survey in 2000revealed that 46% of women and 33%

Association of American Medical Colleges, 2007

20

15

10

5

0

6-11 years 12-19 years

2-5 years

2001-2

1999-001988-941976-801971-741966-70

1963-65 2003-4

Perc

ent

Note: Overweight is defined as BMI>= gender-and weight specific 95th percentile from the 2000 CDC Growth Charts

Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, II and 1999-2004, National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

Trends in Child and Adolescent Overweight

70

60

50

40

30

20

10

0

Overweight or obese

Obese

1976-80 1999-002001-2

2003-41988-94

* Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-39, 40-59, and 60-74 years. Overweight defined as BMI>=25; Obesity defined as BMI>=30.

Perc

ent

Source: National Health and Nutrition Examination Surveys II, III and 1999-2004, National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

Trends in Adult Overweight and Obesity, ages 20-74 years

of men reported trying to lose weight,but that less than a quarter of themreported consuming fewer calories andfollowing physical activity guidelines.11

In 1995, the Institute of Medicinereported that $33 billion was spentyearly on weight reduction products,although not by only overweight orobese individuals. In 2003, 15% offood-related media coverage was onobesity/weight management, comparedto 5% two years earlier.12 According toCDC’s database, since 2003, all 50states have considered legislationaddressing nutrition and physicalactivity in efforts to prevent and treatoverweight and obesity.13

In light of the public health, healthcare system, and medical implicationsof overweight/obesity and thetremendous public attention to thetopic of weight control, current andfuture physicians must be betterinformed about the science of weightregulation and be prepared to workeffectively with increasing populationsof overweight and obese patients todecrease their health risks. Equallyimportant, they must understand theirroles in working with all patients tohelp prevent unhealthy weight gain.Recognizing this important challengeto medical education, the Associationof American Medical Colleges(AAMC) convened an expert panel todevelop a Medical School ObjectivesProject (MSOP) report on theprevention and treatment ofoverweight and obesity. Thirteenpanelists, including leaders from

academia, government agencies, andprofessional organizations, and amember of the U.S. Preventive ServicesTask Force, were chosen from themedicine, medical education, andpublic health communities withexpertise in mental health, nutrition,physical activity, and a variety ofmedical specialties, including bariatricsurgery, internal medicine, familymedicine, pediatrics, and preventivemedicine.

In March 2005 the panelists convenedto address two questions:

What should medical students learnabout the prevention and treatment ofoverweight and obesity (learningobjectives)?

What kinds of educational experienceswould allow students to achieve thoselearning experiences?

The expert panel approached thesequestions from individual- andpopulation-based health perspectives,reviewed relevant literature and educa-tional resources, and arrived at thefollowing suggestions for the educationof all medical students, not just thosewho are interested in pursuing medicalfields that focus specifically onoverweight and obese patients.

Background

Concern regarding the adequacy ofnutrition education in medical schoolshad resulted in a number of initiativesin the 1960s through the early 21stcentury14 to enhance this aspect ofundergraduate medical education.Because a better appreciation ofnutrition is an important cornerstoneof understanding the prevention andtreatment of obesity, the expert panelincluded participants in the NutritionAcademic Awards (NAA), a program toimprove nutrition education formedical students sponsored by theNational Heart, Lung and BloodInstitute of the National Institutes ofHealth (NIH). The NAA’s NutritionCurriculum Guide for TrainingPhysicians,15 along with other contem-porary resources on overweight andobesity, including the NIH publicationThe Practical Guide to theIdentification, Evaluation, andTreatment of Overweight and Obesity inAdults,6 and materials submitted byindividual panelists16 were reviewed bythe expert panel.

The panel also reviewed the generalobjectives that had been outlined inthe first report of the Medical SchoolObjectives Project, Learning Objectivesfor Medical Student Education-Guidelines for Medical Schools. Thegeneral learning objectives from this1988 report were organized by 4principles: altruism, knowledge, skill,and dutifulness.17 The panelists foundthat many of the learning objectivesspecific to the topic ofoverweight/obesity aligned well withthe broad learning objectives from thisreport (Figure 1).


2 Association of American Medical Colleges, 2007



BarriersAdding new content into the alreadycrowded undergraduate medicalcurriculum is always a challenge. Thepanel noted that additional challengesto the successful integration ofoverweight/obesity content into themedical school curriculum includedthe attitudes of clinicians, the dearthof evidence supporting effectiveapproaches to treat overweight andobesity in the primary care setting,and health care system barriers toimplementing practice approachesthat would serve as models formedical students.

Attitudes: The treatment of overweight andobesity can be difficult and frustratingto patients and their providers.Successful behavior change usuallyrequires comprehensive, longer-termclinical interactions which includethorough assessment and negotiatedbehavior change or treatment.Multidisciplinary programs have beenthe most successful in assisting withlong-term weight loss. Physicians whodo not have the opportunity topractice in, or refer to, a multi-disci-plinary system may be less inclined toaddress these topics with theirpatients and when interacting withmedical students. They may notconsider referrals to intensiveprograms to assist patients withweight control, and they may notappreciate their responsibility toeducate patients. Negative stereotypesabout overweight and obese patientssometimes may be explicitly orimplicitly communicated to medicalstudents.18

Figure 1.

General learning objectives from MSOP Report 1 that are consistent with specific learning objectives for overweight/obesity

Physicians must be knowledgeable:

• Knowledge of the molecular, biochemical and cellular mechanisms that areimportant in maintaining the body’s homeostasis.

• Knowledge of the altered structure and function (pathology and patho-physiology) of the body and its major organ systems that are seen invarious diseases and conditions.

Physicians must be altruistic:

• Compassionate treatment of patients, and respect for their privacy anddignity.

• An understanding of, and respect for, the roles of other health care profes-sionals, and of the need to collaborate with others in caring for individualpatients and in promoting the health of defined populations.

• The capacity to recognize and accept limitations in one’s knowledge and clinicalskills, and a commitment to continuously improve one’s knowledge and ability.

Physicians must be skillful:

• The ability to obtain an accurate medical history that covers all essentialaspects of the history, including issues related to age, gender, and socio-economic status.

• The ability to interpret the results of commonly used diagnostic procedures.

• The ability to construct appropriate management strategies (both diagnosticand therapeutic) for patients with common conditions, both acute andchronic, including medical, psychiatric, and surgical conditions, and thoserequiring short- and long- term rehabilitation.

Physicians must be dutiful:

• Knowledge of the important non-biological determinants of poor health andof the economic, psychological, social, and cultural factors that contribute tothe development and/or continuation of maladies.

• Knowledge of the epidemiology of common maladies within a definedpopulation, and the systematic approaches useful in reducing the incidenceand prevalence of those maladies.

• The ability to identify factors that place individuals at risk for disease or injury, toselect appropriate tests for detecting patients at risk for specific diseases or in theearly stage of disease, and to determine strategies for responding appropriately.



Evidence:Preventing and treating overweightand obesity in clinical settings areevolving fields. The U.S. PreventiveServices Task Force found sufficientevidence to recommend screening alladult patients for obesity; offeringobese patients intensive counseling andbehavioral interventions to promotesustained weight loss;19 and offeringadult patients with risk factors forother chronic diseases medium- tohigh-intensity dietary counseling.20

Less evidence exists currently tosupport recommendations for otherpopulation groups. The Task Forcefound insufficient evidence21 torecommend for or against counselinginterventions to promote healthydiets19 or physical activity22 in thegeneral population, and insufficientevidence for the effectiveness ofscreening, behavioral counseling, orother preventive interventions withoverweight children and adolescentsthat can be conducted in primary caresettings.23 The long-term outcomesand effects of surgical and pharmaco-logic interventions are also topics ofon-going study. Despite the recog-nition that maintaining weight lossrequires long-term behavioral changesin diet and high levels of physicalactivity, long-term outcome data forsuccessful clinical approaches tosupport such changes are limited.With these uncertainties, medicalschool faculty may be less inclined toincorporate the complexities of weightmanagement into the curricula, despitethe magnitude of the health problem.

Healthcare systems:Multi-disciplinary, intensiveapproaches to the prevention andtreatment of overweight and obesityare more likely to be effective, butmany medical practices may notfunction within systems that supportthese approaches or provide modelsfor students to follow. With growingdemands on physicians’ time, many areunable to provide the intensecounseling that is most effective.Access to a referral network thatincludes specialists inobesity/overweight treatment(including health professionals otherthan physicians) is critical. Healthcaresystems may not place an appropriateemphasis on the value of primaryprevention to help patients maintain ahealthy weight before becomingoverweight. Reimbursement policiesmay not compensate physicians fortheir preventive efforts nor for theirtime devoted to overweight and obesitymanagement. Finally, the relative lackof emphasis on public health inacademic medical centers does notfacilitate physician awareness ofeffective population-level interventions.

Despite these barriers, the panelstrongly affirmed the critical need tointegrate overweight and obesityinstructional themes into the medicalschool curriculum.

Curriculum Content

Guiding PrinciplesThrough the panel’s deliberations, thefollowing overarching themes wereidentified:

• The universal importance of weightmanagement, including the preventionof overweight and obesity, should beemphasized in the medical schoolcurriculum: Physicians should help allpatients understand that weightmanagement, through propernutrition and physical activity, is ahealth issue that affects everyone.Educational efforts to encourage theprevention of overweight and obesityare vital.

• Medical education should notcontribute to the stigmatization ofoverweight and obese patients: Toprovide compassionate and effectivecare, future physicians must betrained to be sensitive to theostracism experienced by manyoverweight and obese patients.

• The current uncertainties regardingsome aspects of preventing andtreating overweight and obesity shouldnot prevent future physicians fromlearning about overweight andobesity: Educators are responsible forimparting the knowledge, skills, andthe appropriate attitudes to futurephysicians so that they can criticallyassess breakthroughs in the field andaddress overweight and obesity moreeffectively in their practices.



• The ideal setting to treat patients whoare overweight or obese includes socialsupport and behavioral treatmentwith a multidisciplinary team: Amulti-professional, intensiveapproach to treating overweight orobese patients, including access toexperts as needed in medicine,nutrition, physical activity,psychology, and surgery, is effective.

• Physicians must better appreciate andsupport population-based efforts toprevent and control overweight andobesity: Many of the actions that willhelp correct the problem ofoverweight and obesity will takeplace outside of the clinical setting,but will be important interventionsfor physicians to support.

The panel’s learning objectives for theprevention and treatment ofoverweight and obesity are presentedbelow, divided into the traditionaldivisions of basic science and clinicalcontent along with population health,an area receiving increasing attentionin medical education.

Basic scienceResearchers are continuing to under-stand more about the mechanismsunderlying the development ofoverweight and obesity, and the impactof excess weight throughout the body.The fields of molecular genetics andneurochemistry have helped to explainthe hormonal and neurochemicalmechanisms responsible for the energyimbalance that generates obesity.Future insights into the genetic basis ofdifferences in the hormones andneurotransmitters responsible for

regulating satiety, hunger, lipogenesis,and lipolysis will refine understandingof the risks for overweight and obesity,and may lead to more effectivetherapies. The basic science curriculumoffers many opportunities to incor-porate these recent breakthroughswhen teaching biochemistry, genetics,metabolism, pharmacology andphysiology.

For its part, the medical school mustensure that before graduation a studentwill have demonstrated, to the satis-faction of the faculty, the following:

• Basic knowledge of the expression ofobesity phenotypes, by under-standing the interaction of genes andthe environment.

• Basic knowledge of the physiologicaspects of diet and hunger.

• Knowledge of the physiologic aspectsof physical activity and energyconsumption.

• Knowledge of the basic principles ofnutrition, including an under-standing of calories and the caloriecontent of carbohydrates, proteins,fats, and alcohol.

• Basic knowledge of physical activity,including:

º The beneficial effects of physicalactivity and the detrimental effectsof inactivity on the cardiovascular,musculoskeletal, pulmonary, andneurological systems.

º The relative contribution of basaland resting metabolism, dietarythermogenic influences, and

physical activity to the total dailyenergy expenditure (TDEE).15

• Understanding that weightmanagement (weight gain, loss, andmaintenance) is based on the balancebetween nutrition (energy intake) andphysical activity (energy expenditure).

• Knowledge of the metabolic, genetic,physical, and physiologic factors thatcontribute to overweight andobesity, including the role of theneuro-endocrine system.

• Knowledge of the metabolic andimmunologic consequences ofoverweight and obesity.

• Knowledge of the mechanismsunderlying the pharmacologicalapproaches to treating overweightand obesity.

• Knowledge of the mechanisms forweight loss and potential long-termconsequences associated withsurgical treatments for obesity.

Clinical SciencesDuring clinical training, a respectful,sensitive, and informed approach tooverweight and obese patients shouldbe emphasized, along with skills toassess the weight status of all patients.Because evidence is insufficientcurrently to support the effectiveness ofbehavioral counseling in a primary caresetting to promote healthy diets orphysical activity in the general patientpopulation (i.e., patients who are notidentified as “higher-risk”), panelistshad different perspectives on the valueof training medical students to providebrief counseling interventions, particu-

larly in the absence of an accompa-nying multi-disciplinary, multi-component approach to support thecounseling. All panelists did agree thatphysicians were in a position toinfluence the concerns and priorities oftheir patients, and that they wereresponsible for educating their patientsabout the influence of weight on theirhealth and the importance of physicalactivity and proper nutrition. Thepanel believed that physicians had a“crucial” role in addressing overweightand obesity issues, but acknowledgedthat specialized and intensive educa-tional and counseling services may bedelivered by others, particularly whentreating patients who are trying to losesubstantial weight. With the evolutionof surgical interventions and theincreasing numbers of patients who areopting for surgery to control obesity,the panel believed that all future physi-cians should be familiar with thegeneral clinical implications of bariatricsurgery. Future physicians would alsobe expected to keep abreast of devel-oping pharmacologic interventions.Panelists advocated for a “coherent”clinical curriculum that legitimizesthe importance of theoverweight/obesity problem and itsmany comorbidities and reinforcesthe appropriate knowledge, skills, andattitudes longitudinally.

For its part, the medical school mustensure that before graduation a studentwill have demonstrated, to the satis-faction of the faculty, the following:

• The ability to assess all patients foroverweight/obesity, including:

º Calculation of and categorizationof Body Mass Index (BMI).

º Measurement and categorizationof waist circumference.

• The ability to assess risk for futureoverweight or obesity through amedical history, including:

º Family history.

º Social history, including nutritionand physical activity (work andleisure).

• An appreciation of the importanceof preventing excessive weight gainin patients of all ages and weights.

• The ability to address weight even ifit is not the primary reason for thepatient encounter by addressingweight control as a part of healthpromotion.

• The ability to recommend simplestrategies to increase physical activityin daily routines, including how toovercome common barriers.

• An appreciation for the behavioral,emotional, cultural, andfamily/household influences thatmay impact food consumption andthe treatment of overweight andobesity.

• An understanding of the role ofovereating and portion size controlin unhealthy weight gain.

• The difference between moderate andvigorous physical activity and theclassification of various physical activ-ities by their energy expenditure rates.

• An understanding of the effects ofinactivity in promoting unhealthyweight gain.

• An understanding of the role ofphysical activity in preventingoverweight and obesity.

• The ability to consider the differentialdiagnosis (secondary causes) ofpatients who are overweight or obese.

• An understanding of the co-morbidities associated withoverweight and obesity.

• An understanding of evidence-based algorithms for the care ofoverweight children and overweightor obese adult and geriatricpatients, and the ability to considerthe guidance of reputable expertpanels when evidence-basedalgorithms do not exist.

• An understanding that a 5-10%weight loss can improve health risksand that some patients will regainsome of their lost weight.24

• The ability to provide under-standable information to patientsand families with overweight andobesity in a sensitive and respectfulmanner, including to patients withlimited health literacy.

• An understanding of potentialbarriers to patients’ weight loss andmaintenance and possibleapproaches to addressing thesebarriers.

• The ability to discuss comorbiditiesassociated with overweight andobesity with patients.

• The ability to determine patients’readiness to change behaviors.

• The ability to encourage patientinput, listen carefully and to





negotiate a mutually agreeable planfor behavior change.

• An understanding of how to helppatients make behavioral changes.

• An understanding of the importanceof physical activity to maintainweight loss and to decrease comor-bidities associated with overweightand obesity.

• An understanding of how self-management skills must be impartedto patients in order to maintainweight loss.

• An appreciation for the importantimpact of family in addressingoverweight and obesity, and thepotential of families and groups toprovide social support to facilitateweight loss and maintenance.

• The ability to guide patients tosources of credible information andassistance regarding overweight andobesity.

• The ability to provide or to refer allobese adult patients for intensivecounseling and behavioral interven-tions to promote sustained weight loss.

• An awareness of the benefits andrisks associated with pharmaco-logical and surgical interventions inobesity treatment, and of the need tostay abreast of future developmentsregarding these treatment options.

• The ability to monitor patient effortsto achieve or maintain a healthyweight.

Population health sciencesThe prevention and control ofoverweight and obesity are anothercontext in which future physiciansshould appreciate the potentialsynergies between individual, clini-cally-based health care interventionsand broader, population-health basedinterventions. The panelists identifiedthe Accreditation Council forGraduation Medical Education’s“systems-based practice” competencyas a context in which the systems- andpopulation-basis for the preventionand treatment of overweight andobesity could be promoted.

For its part the medical school mustensure that before graduation a studentwill have demonstrated, to the satis-faction of the faculty, the following:

• An understanding of the epidemi-ology of overweight and obesity,including associated risk factors andhealth disparities across populations.

• An understanding of the social andphysical environmental determinants(including the built environment)that may contribute to decreasedphysical activity, overweight andobesity.

• An understanding of current U.S.dietary and physical activity guide-lines.

• An understanding of the kinds ofpublic policies that might affect theincidence and prevalence ofoverweight and obesity.

• Recognition of evidence-based,community interventions that havebeen shown to be effective inpromoting physical activity andcontrolling overweight and obesity.

• The ability to identify the character-istics of health systems that will facil-itate the prevention, identification,and treatment of overweight andobesity.

• An understanding of potentialdisparities in access to healthy foodsor to safe recreational activities thatcan influence a community’s risk foroverweight and obesity.

• An appreciation that reducing theprevalence of overweight and obesitycannot be accomplished solely in theclinical setting and that communitypartnerships must be created toaddress this issue

• An understanding of the limits ofour current understanding of thehealth effects of overweight andobesity and the uncertaintiesassociated with our current treat-ments.

• The ability to examine future healthresearch on this issue to look for waysto improve our understanding ofcausal risks and effective treatments.

• An understanding of the relation-ships among the basic, clinical, andpopulation health science aspects ofoverweight and obesity.

Learning Opportunities

General principlesOverweight and obesity-related learningobjectives should be integrated verticallyand horizontally in all four years ofmedical school.

Panelists agreed that curricular contentshould be integrated into the basic,clinical, and population health sciencesacross all four years of medical schooleducation. Overweight and obesity canbe integrated readily into basic sciencesstudies in anatomy, biochemistry, cellbiology, immunology, and physiology.Because the prevention, treatment, oreffects of overweight and obesity arerelevant to all clinical specialties,ranging from primary care (internalmedicine, family medicine, obstetricsand gynecology, and pediatrics) tosurgical specialties and psychiatry, allclinical clerkships should devote someattention to these topics.

A combination of didactic and inter-active instructional methods should beemployed.

Panelists agreed that teaching methodsshould be appropriate for the infor-mation to be learned and for the stageof the learner. Early content may bepresented in didactic sessions, butinteractive activities, includingproblem-based approaches to applythis and more sophisticated infor-mation should also be provided,particularly to provide studentsopportunities to exercise theirknowledge, skills, and attitudes inclinical settings.

Because the prevention and treatmentof overweight and obesity continue tobe evolving fields, a commitment to

critical appraisal and lifelong learningshould be fostered.

New insights into the mechanisms,prevention, and treatment ofoverweight and obesity are publishedregularly in the medical literature.Medical students should be preparedto continue to follow the relevantbreakthroughs in their chosenspecialty, and should also criticallyassess the quality of the evidencesupporting the new findings.

Educational strategiesThe panelists endorsed a variety ofteaching and learning strategies tomeet the needs and level of thelearners. They recommended a flexibleapproach to the teaching of overweightand obesity-related topics, includingself-teaching opportunities that arereinforced through the curriculum.Panelists also encouraged schools toprovide interactive learning opportu-nities when possible.

Educational strategies to help studentsmaster curricular content related tooverweight and obesity include:

• Lectures

• Directed reading

• Review and discussion of case studies

• Use of standardized patients

• Use of online/web-technologies

• Self-directed learning

• Use of empathy suits

• Preceptorships with dieticians/nutri-tionists

• Problem-based learning examples

that highlight the relevance ofbiochemistry, nutrition, and othercourses to overweight and obesity

• Projects which include diet andphysical activity analyses

• Work with patients on weight issuesduring clerkships with role modelingprovided by physician preceptors

• Experiences in clinics that specializein overweight and obesity

• Experiences in public health depart-ments to learn about population-based approaches to overweight andobesity




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Implementation strategies

Panelists considered the challenges toimplementing effective curricula inoverweight and obesity. They saw animportant need to make medical schooldeans and other stakeholders (faculty,students, and others) aware of themagnitude of the overweight andobesity crisis, and the need to improvemedical education in the area. Thepanelists concurred that in order toprovide the best models for physicianbehavior to help prevent and to treatoverweight and obesity, the health caresystem itself would need to undergo aparadigm shift in which prevention wasprioritized and in which inter-profes-sional collaboration was valued andfostered.

Resource developmentPanelists identified the need for curricularresources and resources to facilitatelinkages with community stakeholders:

• Medical school faculty need readyaccess to curricular resources thatare current, reliable, and tailored tomedical students. The panelists feltthat medical schools would benefitfrom resources to fund the devel-opment, dissemination, and imple-mentation of effective curricula. Acatalogue of critically appraisededucational resources was alsothought to be of value.

• Medical school faculty need opportu-nities and incentives to createrespectful and productive relationshipswith the community in order to betterunderstand the importance ofpopulation based approaches tooverweight and obesity. Through theserelationships, faculty may be able toprovide valuable experiential learningopportunities for their students.

Faculty developmentLike other cross-cutting subjects thatcannot be housed in a single basicscience or clinical department, devel-oping faculty expertise in overweightand obesity topics for the purposesof medical student education can bechallenging. While medical schoolsmay have researchers and clinicianswith expertise in specific aspects ofoverweight and obesity, they may notbe prepared to present general infor-mation on the topics that would bemost relevant to medical students. Tothis end, the panelists recommendedthat medical schools consider estab-lishing incentives and rewards toencourage excellence in teaching inthis area. Panelists also acknowledgedthat resident physicians arefrequently the role models andteachers for students so thatattention to graduate medicaleducation was also needed. Otheractivities that would promote facultydevelopment in overweight andobesity include:

• Developing evidence-basedcontinuing education opportunitiesfor current faculty to better under-stand how overweight and obesityimpacts their practices and how tobetter manage this problem withtheir patient population.

• Identifying overweight and obesityexperts and “champions” withinmedical schools to encouragenetworking across schools.

• Establishing and evaluating formalprograms in faculty developmentand scholarship in overweight andobesity, as has been done previ-ously in the field of substanceabuse.

Evaluation activitiesStudent competency in overweight andobesity prevention and treatment canbe measured through existing systems,but the panelists also recommend thatmedical students be given an oppor-tunity for self assessment to gauge theappropriateness of their attitudes andbehaviors with regard to the evidence-based prevention and treatment ofoverweight and obesity. More tradi-tional methods of evaluation includewritten examinations and clinical skillsexaminations. The expert panel alsosuggested that overweight and obesity-associated questions should also beincluded in the United States MedicalLicensing Examination (USMLE).

Conclusion

The United States and much of theworld are experiencing an epidemic ofoverweight and obesity. The epidemicappears to be driven mostly by anincrease in caloric consumption and adecrease in physical activity, facilitatedby societal and other environmentalchanges. Further research is needed toclarify the etiologies of overweight andobesity, and to identify and to developeffective clinical interventions to preventand treat overweight/obesity. Additionalefforts are needed to implementevidence-based population approachesto controlling overweight and obesity.

Medical education must assure thatfuture physicians will be better preparedto provide respectful, effective care ofoverweight and obese patients and toappropriately participate inoverweight/obesity prevention efforts.Education on assessing, preventing andtreating overweight and obesity should beincluded in basic sciences, clinical experi-ences, and population health sciences.


Examples of Innovation

Several schools have responded to thegrowing public health challenge by incor-porating overweight and obesitythroughout their curricula. While not acomprehensive list, these schools havedeveloped innovative and effectiveapproaches to teaching these topics andmay serve as models for other schools:

Medical College of Wisconsin (MCW)Obesity is a recognized and welldocumented health care priority forWisconsin. At MCW, limited clerkshipcoordination and collaboration havecontributed to educational gaps aboutobesity. A collaborative curriculum onobesity (CoCO) across three partneringclerkships (family medicine, generalinternal medicine and pediatrics) will: 1)advance the competence of medicalstudents, including knowledge and care ofobesity, 2) improve MCW’s coordination of3rd year ambulatory clerkships to fosterobesity education quality, and 3) raisevolunteer preceptors’ knowledge andsatisfaction with obesity teaching. CoCO issupported by a state-wide AdvancingHealthier Wisconsin grant.

This three-year project began in early 2006with formation of a Steering Committeethat includes students and communitypreceptors. In CoCO’s first year, an on-linemodule was developed and implementedas part of third year MCW students’“Transition to Clerkship” course. Thisweb-based module focused on the case ofa middle-aged, female outpatient withjoint pain and concerns about her weight,and who has a positive family history ofobesity. The module emphasizes epidemi-ology, assessment and interviewing skills,and it includes a pre-test, tutorials, andpost-test. Results showed that studentspossessed and could appropriately applyimportant information about comorbiditiesassociated overweight and obesity. The

post-test also showed that studentsimproved their communication approachesto addressing overweight and obesity afterexposure to the tutorials. A chronicdisease/obesity website is being developedto house CoCO curricular material as wellas an obesity toolkit for physicians andstudents.

An emphasis of CoCO is the clustering ofspecific obesity objectives and themes(e.g., diet and activity, metabolicsyndrome, communicating for lifestylechange) within each of the three clerk-ships. The clusters are unique to each ofthe three clerkships. During familymedicine, communication and inter-viewing skills are emphasized. Duringinternal medicine, metabolic syndromeand treatment options—including pharma-cotherapy and surgery—are emphasized.In pediatrics, diet, activity and familyhistory are the focus. These clusters allowstudents to receive in-depth exposure tothese issues efficiently rather than super-ficial introductions during each clerkship.Clusters will include practical “tools,” foruse with patients and students; teachingmethods; and evaluation strategies, allpiloted in year two of the project. A CMEConference will be held near the end ofyear two for preceptors to introduceinnovative “obesity toolkits” that containupdated guidelines, nutritional aids,activity guides, motivational interviewingtemplates, tape measures and otherpractical and evidence-based tools specifi-cally useful to each specialty. Obesitytoolkits will become the focus of medicalstudents’ “service learning” projects atcommunity sites where obesity skill appli-cation is emphasized for both patients andproviders.

Evaluation will show how CoCO has influ-enced medical education and Wisconsin’shealth. Student and preceptor reaction toCoCO will be used to improve curriculumplanning. Increased student competencewill be demonstrated via OSCEs, patient

satisfaction, and toolkit use, leading toimproved care quality for obese patientsand at-risk families. As of early 2007, fourpeer-reviewed presentations about CoCOhave been made or accepted at profes-sional meetings, and CoCO has been thefocal topic in a regional medical educationnewsletter. CoCO collaborators willcontinue to disseminate project resultsacross their specialties and in medicaleducation.

Contact:Jeffrey A. Morzinski, Ph.D.Associate Professor, Family andCommunity MedicineDirector, Professional DevelopmentDivision Chair, CoCO Advisory CouncilMedical College of [email protected]

The Warren Alpert Medical School of Brown UniversityAt Brown, obesity/overweight/nutritiontopics were previously part of a 22-hournutrition course that students received inthe second year. There is no longer aseparate course. Instead nutrition,including topics related toobesity/overweight, is incorporated as atheme throughout the curriculum. ANutrition Theme Committee meets twice ayear to discuss where and how nutritionand obesity/overweight topics are woveninto the curriculum.

In the first year, nutrition andoverweight/obesity-related topics aretaught along with biochemistry. In thesecond year, as part of the year-longPathophysiology course, nutrition andobesity topics are incorporated in severalways. In the first semester, a series of fivelectures (Macronutrients, Micronutrientsand Other Dietary Components, EnergyBalance, Nutrition Assessment, andPopular Diets) are incorporated into thecurriculum over four weeks, with a




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separate exam on these topics at the end.In the second semester, the teaching ismore case-based with lectures and corre-sponding small groups. Nutrition is incor-porated into the Endocrinology,Gastroenterology and HumanReproduction sections. For example, in thefour-week Endocrinology section, fourlectures address obesity: ObesityPathophysiology, Obesity Assessment andManagement, Lifestyle Management ofObesity, and Medical/Surgical Treatment ofObesity. Following these lectures, studentsbreak into small groups for case-baseddiscussions that are student-led and jointlyfacilitated by a team of physicians anddietitians.

Teaching about nutrition andobesity/overweight is also incorporatedinto several of the clerkships in the thirdand fourth clinical years includingMedicine, Pediatrics, Surgery and FamilyMedicine. For example, the six-weekrequired clerkship in Family Medicineaddresses nutritional issues surroundingobesity and cardiovascular disease (CVD)prevention in several ways. The studentsspend 20% of their time in didacticexperiences, including a series of paper-cases discussed in small group settings anda series of skills workshops. One of thecases addresses an adult male with ahistory of peripheral vascular disease whohas poorly controlled hypertension, hyper-lipidemia and obesity (BMI = 30). Readingsassociated with this case include a chapterfrom a family medicine text book onWeight Management and Nutrition, andthe executive summary of the ATP IIIguidelines (which covers therapeuticlifestyle changes for LDL-lowering). One ofthe discussion questions for the smallgroup session addresses “how to educateand empower the patient” to follow ahealthy diet. This case is paired with athree-hour workshop on CVD risk factors.Approximately 20 minutes of theworkshop are devoted to specific dietarycounseling for LDL-lowering and for

obesity. These sessions incorporate use ofbrief assessment tools such as Rate YourPlate, REAP and WAVE (tools and relatedpublications available from Dr. Gans).

The remaining 80% of the student’s timein the Family Medicine Clerkship is spentseeing patients with a family physician inthe community. While ambulatoryteaching is less structured, we know fromthe students’ PDA-based patientencounter logs that 16% of encountersare adult full physicals, 10.5% addresshypertension, 4.5% address diabetes, and4.5% address hyperlipidemia. Thus, in atleast one-third of their patient encounters,weight management and diet should bediscussed. In addition, when medicalstudents and family medicine residents seepatients in the Family Medicine Clinic whoare obese or need dietary counseling forother reasons, they work jointly with aphysician and dietitian preceptor to assessand treat these patients.

Contact:Kim Gans, Ph.D., M.P.H., L.D.N.Associate Professor (Research), CommunityHealthDeputy Director, Institute for CommunityHealth PromotionThe Warren Alpert Medical School ofBrown [email protected]

University of Colorado School of Medicine The Cultural Competence and DiversityThread (CCDT) is a four year curriculum,integrated into basic courses and clinicalinternships. As part of the Digestive,Endocrinology and Metabolic Systems(DEMS) Block and the CCDT curriculum anintegrated session was developed by thedirectors of both groups. This integratedsession presented health disparities inobesity/overweight within the context ofsocial determinants of health. Medicalstudents were exposed to obesity andoverweight risk factors from a perspective

not traditionally included in the medicalcurriculum. The session included:

1) Presentation of health disparities dataon life style risk factors (physical activity,smoking, and healthy weight & obesity)for chronic conditions approached in theDEMS block (e.g., diabetes);

2) Exploration of the relationship betweenoverweight/obesity and lower socio-economic status (SES) and education usingthe social determinants of healthframework, including:

• Why are racial /ethnic minorities morelikely to have unhealthy diets?

º Current Population Survey FoodSecurity data;

º Energy density (ED) and food costdata, illustrating the comparativeED/cost ratio of food more likely tobe in the racial/ethnic minorities’regular diet

º Practical example: “Real Cost of aHealthy Diet,” a community-basedfood security project at the BostonMedical Center(http://dcc2.bumc.bu.edu/csnap-public/HealthyDiet_Aug2005.pdf),which provides comparative data on:1) costs of the USDA Thrifty FoodPlan (TFP) versus a very realistichealthier diet version of the TFP;2)availability of food items atdifferent types of stores and neigh-borhoods for the TFP vs. the HealthyDiet; and 3) average nutrition assis-tance programs (food stamps, schoolbreakfast, school lunch) compared tothe actual food costs.

• Why are racial/ethnic minorities less likelyto be physically active?

º Reduced access to physical activityfacilities, including schoolplaygrounds and other public facilities


º Racial/ethnic minorities are morelikely to be exposed to “obesogenic”environments: neighborhood socialand physical disorder, lack of safety

3) Interactive presentation of physicianroles and responsibilities from a publichealth/population health perspective:

• The health inequalities iceberg concept:life exposures/stresses at the bottom,and access to care/quality of care at thetip of the iceberg

• Graham’s 2004 social determinants ofhealth and Farmer’s 2006 structuralviolence frameworks

• The failure of purely medical interven-tions without structural interventions inprevention of chronic conditions such asoverweight and obesity

• Examples of structural interventionsinitiated by health care providers(Freeman’s Navigators and Sauaia et al.’sPromotoras) and how they are part ofthe physicians’ job

Contact:Angela Sauaia, M.D., Ph.D.Associate Professor of Medicine andPreventive MedicineDirector of the Cultural Competence andDiversity ThreadUniversity of Colorado School of [email protected]

University of Nevada School of MedicineProgram Goals. The nutrition educationand research program was restructured in2003 to become the Division of MedicalNutrition, Department of InternalMedicine. The program received aNutrition Academic Award that facilitatedmany of the enhancements outlinedbelow. While the current programprovides comprehensive clinical servicesand translational research opportunities,

an additional focus has been educatingmedical students, residents, and otherhealth professionals in training. A majorpriority is obesity and weightmanagement.

Program Structure. The medical educationmodel emphasizes integration withinexisting basic and clinical courses. Forexample, nutrition content was added tobasic and clinical problem sets during thefirst two years and to clinical caseproblems in year three. In addition, atwenty hour nutrition course is required ofall students. Students may also opt toreceive a “Special Qualifications InNutrition (SQIN)” by pursuing a four-yearsequence of educational experiences.Students and residents also learn aboutobesity and weight management duringfourth year medical electives, and residentclinics in primary care internal and familymedicine.

An interdisciplinary team, including physi-cians, nutritionists/registered dietitians,exercise physiologists, and behavioralhealth specialists provide faculty to deliverclinical and educational training. The coreof the program emphasizes empoweringand supporting patients to become moreaware of what they are consuming, theneed to exercise, ways to increase theirdaily physical activity and to move theirbodies regularly, and to develop a healthylife style and stress managementstrategies. The major components of thecurriculum include:

• Students complete nutritional selfassessment assignments in the firstsemester of Introduction to Patient Carecourse. This includes opportunities forpersonalized consultations and measure-ments (metabolism, body composition).

• A 20-hour Medical Nutrition Coursewith lectures and Web-basedinstruction emphasizing the devel-opment of problem solving and clinical

skills in nutrition assessment andtreatment of common chronic diseases.

• A Special Qualifications in Nutrition(SQIN) track in which medical students(as well as other health professionals intraining) are required to devote 40 ormore hours per year toward specializedtraining in nutrition that is integratedinto their medical school education. This individualized training incorporateslongitudinal clinical training as well aseducational and translational researchprojects that students present at nationalmeetings. Medical students receivedspecial recognition upon graduation.

• Nutritional curricular enhancementsthroughout the general medicalcurriculum in basic and clinical courses,case-based and clinical problem solvinginterdisciplinary courses, and specializedclinical and research training electives.

Additional information is available atwww.unr.edu/med/dept/mednutrition/

Program Outcomes. In addition toproviding nutrition education to allmedical students, since 1996, the programhas:

• Engaged 26 medical students in SQIN

• Graduated 19 students from 7 classes

• Resulted in 18 trainees funded by NIHGrants (NAA, R01s); 9 trainees fundedby the Reno Cancer Foundation, 1funded through a Pathology Grant

• Development of collaborative GeriatricInterdisciplinary Summer Internship(GISI)-SQIN program

• Fostered 4 award-winning presentationsat national meeting; and the submissionof 11 abstracts, 6 manuscripts, and 2related grants

• Expanded to include training for medicalresidents




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Contact:Sachiko St. Jeor, Ph.D., R.D.Professor and Chief, Division of MedicalNutritionDepartment of Internal MedicineUniversity of Nevada School of [email protected]

University of Pittsburgh School of MedicineThe University of Pittsburgh School ofMedicine integrates obesity and nutritionas a longitudinal curricular theme to helpaddress the obesity epidemic.

In basic science courses, overweight andobesity content is introduced in thecontext of other coursework, particularlywhere its impact as a co-morbid conditionhelps students gain perspective on theimpact of obesity on health.

In the Behavior, Illness and Society coursetaught during the later half of the firstyear, the curriculum includes severalsessions on overweight and obesity. In aninteractive lecture, students learn aboutthe epidemiology and consequences ofchildhood obesity. During this session, theyare encouraged to think about solutionsfor individual patients and for populations,including changes in public policy.Subsequent course sessions addressbehavioral aspects of diet and nutrition;psychosocial, behavioral, and therapeuticissues in obesity; fad diets; and surgicaltreatments. The timing of this curricularcontent is ideal for raising studentawareness of the pervasiveness of thisproblem, as they begin to develop theirown perspectives on clinical medicine. Inthis course, students also have an earlyexposure to the theory of and practicalapproaches to counseling for behaviorchange.

The obesity theme is then contextualizedin the clinical curriculum. Students receivemore in-depth training on how to

encourage behavior change effectively intheir patients during the CombinedAmbulatory Medicine and PediatricsClerkship. Students have opportunities topractice counseling techniques withstandardized patients while in the midst ofa clinical rotation where they can immedi-ately apply what they have learned.

During the Combined AmbulatoryMedicine and Pediatrics Clerkship, one-third of third-year students spend a weekin the Weight Management and WellnessCenter at Children’s Hospital, in a coursesegment on Preventive Cardiology andPediatric Obesity. Students evaluate newpatients for behavioral factors thatcontribute to obesity. They also identifyand treat obesity-related illnesses in thispediatric population. This uniqueexperience gives students the skills torecognize obesity and its consequences,and to execute practical strategies forweight loss in children. Another fraction ofthe class rotates on the bariatric surgeryservice each month as part of the thirdyear surgery clerkship.

The importance of this topic is reinforcedin all four years by including obesitycounseling and therapy as explicit items inexperience logs submitted during the firstand second year Clinical ExperienceCourses, and in the clinical clerkships.

Contact:Goutham Rao, M.D.Associate Professor, PediatricsClinical Director, Weight Management andWellness CenterUniversity of Pittsburgh School [email protected]

University of Texas Medical School at HoustonThe University of Texas Medical School atHouston incorporates information andskills relevant to the prevention and

treatment of overweight and obesitythroughout its curriculum. Students alsohave opportunities to work with adult andpediatric patients who are overweight orobese in several clinical settings.

Body Mass Index (BMI) is introduced inBiochemistry within the context of energybalance and energy requirements. Toreinforce this didactic material, a Web-based module Nutrition in PreventiveMedicine is a required component inIntroduction to Clinical Medicine. Themodule allows students to work with aninteractive BMI calculator and to reviewobesity as a chronic disease. The ClinicalNutrition Elective, a lecture series for firstand second year students in the springsemester, provides a one-hour lecture ontreatment of obesity including diet andlifestyle, pharmacologic, and surgicalapproaches. A Problem Based Learningcase in second year presents a morbidlyobese patient with sleep apnea whoundergoes bariatric surgery. The PediatricClerkship in third year provides studentsan opportunity to work with overweightchildhood and adolescents. In the fourthyear, a clinical nutrition elective is offeredin the Department of Internal Medicinewhich focuses on prevention andtreatment of obesity, diabetes, and cardio-vascular disease. This popular electiveprovides students the opportunity torotate through the Wellness Center andthe Diabetes and Cardiovascular Out-Patient Centers at Memorial HermannHospital, the primary teaching hospital forthe University of Texas Medical School atHouston.

Contact:Marilyn Edwards, Ph.D., R.D.Associate ProfessorDivision of Gastroenterology, Hepatology,and NutritionDepartment of General Internal MedicineUniversity of Texas Medical School [email protected]


University of Wisconsin School of Medicine and Public HealthThe University of Wisconsin School ofMedicine and Public Health uses anintegrated curricular approach to theimportant topics of obesity and obesityprevention. Students learn about theseissues beginning in the basic sciencescourses of physiological chemistry,genetics, population health, and in thesecond year Clinical Nutrition course.Nutrition curriculum expansion had beenfacilitated by a NHLBI Nutrition AcademicAward from 2000 to 2005. Studentsparticipate in small group, problem-basedlearning on clinical examples of theseproblems, and also complete self-assess-ments on nutrition and physical activity.Specific skills are developed in nutritionand obesity evaluations in the Patient,Doctor and Society course in the first andsecond year.

Students also have opportunities to doresearch in pediatric and adult obesityduring the summer after the first year ofschool. Additional teaching and experienceis provided in the curriculum in severalclinical clerkships, including primary care,pediatrics, internal medicine, and surgery.Specific lectures and projects are providedto students during their 3rd and 4th yearrotations on the topics of overweight,metabolic syndrome, obesity andnutrition/lifestyle change. For example,students are fed a lunch which meets therecommendations of national guidelineson nutrition during the orientation to the3rd medicine clerkship. During the orien-tation, nutritional assessment andcounseling are taught and students’attitudes toward nutrition recommenda-tions are assessed. Students areencouraged to choose nutrition-basedprojects during primary care rotations, andnutrition curricula are included in primarycare and surgery clerkships. Web-basedresources are also provided for inpatientand outpatient management of nutritional

issues, including overweight and obesity. A Clinical Nutrition or PreventiveCardiology elective are also available to4th year students. Teaching on thesubjects of obesity, metabolic syndrome,weight loss treatments, and nutrition areprovided to family medicine, pediatric, andinternal medicine residents as well as forcardiology fellows by the faculty and staffof the Preventive Cardiology Program andprimary care faculty. A one-year PreventiveCardiology fellowship is offered to gradu-ating residents from cardiology, internalmedicine, and family medicine.

Contact:Patrick McBride, M.D., M.P.H.Professor of Medicine and Family MedicineAssociate Dean for StudentsUniversity of Wisconsin School of Medicineand Public [email protected]

Wright State University BoonshoftSchool of MedicineThe Boonshoft Physician LeadershipDevelopment Program is a five-yearcurriculum that provides medical studentswith the opportunity to participate inseminars that develop leadership skills aswell as completing either an M.B.A. orM.P.H. degree.

Beginning in 2005, these students weregiven a special project to developpopulation health critical thinking skillsand presentation skills. Each class mustcreate a population health-based approachto address obesity. The students areencouraged to use analytical skills andcreativity. Students prepare by visitingneighborhoods and schools as well asdoing formal literature research. Proposalsare presented using standard presentationsoftware and may not exceed 20 minutes.

Presentations have included the analysis ofgeographic proximity of grocery storesoffering fresh fruits and vegetables in poorurban neighborhoods; the lack ofplaygrounds, walking trails, and even

sidewalks in newer suburban communities;a Web-based “concierge” service thatwould make it possible for working people“on the run” to track their dietary intake,plan daily menus, and obtain informationon correct choices when eating out;school-based initiatives including rollingback corporate influence through vendingmachine contracts or implementing newprograms designed to encourage dailyphysical activity for all students rather thancompetitive programs for elite athletesonly. Two of the proposals were selectedfor presentation at a recent regionalmeeting concerning the obesity epidemic.

Although created as a contemporaryhealth problem for medical students in adual degree leadership developmentprogram, this project would work well forsmall-group peer-led presentations in thestandard curriculum.

Contact:James R. Ebert M.D., M.B.A.Associate Professor, Department ofCommunity Health and Department ofPediatricsProgram Director, Boonshoft PhysicianLeadership Development ProgramDivision of Health Systems ManagementWright State University Boonshoft Schoolof [email protected]




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Electronic and PrintResources

Internet Resources(Please note that this list is not exhaustive.)

American Academy of Pediatricswww.aap.org/obesity/

American Academy of Pediatrics policystatement titled Prevention of PediatricOverweight and Obesity.

American College of PreventiveMedicinewww.acpm.org/polstmt_weight.pdf

American College of PreventiveMedicine Practice Policy Statement onWeight Management Counseling forOverweight Adults

American College of Sports Medicinewww.acsm-msse.org/pt/re/msse/positionstandards.htm;jsessionid=GQSTVL4Yg438fJl1pLChvvl15tzzh27GtW4XyTKpLyTyyJJT7rQt!370594218!181195629!8091!-1

A collection of the American Collegeof Sports Medicine’s official “PositionStands”, including the 2001 PositionStand, Appropriate InterventionStrategies for Weight Loss andPrevention of Weight Regain for Adults

American Medical Associationwww.ama-assn.org/ama/pub/category/10931.html

The American Medical Association’sRoadmaps for Clinical Practice series:Assessment and Management of AdultObesity.

www.ama-assn.org/ama1/pub/upload/mm/433/ped_obesity_recs.pdf

Expert Committee Recommendations onthe Assessment, Prevention, andTreatment of Child and AdolescentOverweight and Obesity, released June2007.

Centers for Disease Control andPreventionwww.cdc.gov/nccdphp/dnpa/obesity/

CDC activities and educationalresources on overweight and obesityprevention and treatment, including:

Nutrition Resources for HealthProfessionalsIncludes the Weight ManagementResearch to Practice series whichsummarizes the science of weightmanagement for health profes-sionals, patients, and communities.www.cdc.gov/nccdphp/dnpa/nutrition/health_professionals/practice/index.htm

Overweight and obesity trendsData and maps tracking the preva-lence of overweight and obesity.www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm

Dietary Guidelines for Americans 2005www.health.gov/dietaryguidelines/dga2005/document/

Dietary guidelines developed every 5years since 1980 by the U.S.Department of Health and HumanServices and the U.S. Department ofAgriculture. The Guidelines provideadvice for people two years and olderabout good dietary habits and serve asthe basis for Federal food andnutrition education programs.

Food and Drug Administrationwww.cfsan.fda.gov/~dms/foodlab.html

How to understand and use thenutrition facts label.

National Institutes for Healthhttp://obesityresearch.nih.gov/about/about.htm

National Heart, Lung, and BloodInstitute (NHLBI)Clinical Guidelines on theIdentification, Evaluation, andTreatment of Overweight and Obesityin AdultsThe first evidence-based guidelinesdeveloped by the FederalGovernment to address overweightand obesity conditions. The guide-lines were developed in cooperationwith the National Institute ofDiabetes and Digestive and KidneyDisease. Includes treatmentalgorithms and other references toaid clinicians.www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm

Obesity education initiative slide setsIncludes publicly available slide setsfor the Clinical Guidelines on theIdentification, Evaluation, andTreatment of Overweight and Obesityin Adults and Portion Distortion apatient- and community-awarenesscampaign.http://hp2010.nhlbihin.net/oei_ss/menu.htm

Nutrition Academic AwardProducts developed through theNutrition Academic Award (NAA), a5-year grant awarded by NHLBI andthe National Institute of Diabetesand Digestive and Kidney Disease to


medical schools from 1997-2006 toencourage the development orenhancement of medical schoolcurricula in nutrition with anemphasis on preventing cardiovas-cular diseases, obesity, diabetes, andother chronic diseaseswww.nhlbi.nih.gov/funding/training/naa/index.htm

NHLBI Working Group onCompetencies for Overweight andObesity Identification, Prevention,and TreatmentThe summary of the May 2005meeting of this group includesrecommendations for under-graduate, graduate, and continuingmedical education.www.nhlbi.nih.gov/meetings/workshops/overweight/

We Can!We Can! is a national educationprogram designed for parents andcaregivers to help children 8-13 yearsold stay at a healthy weight. The siteoffers parent, families, communitygroups and health professionalsresources to implement programsfor parents and youth to encouragehealthy eating, increase physicalactivity, and reduce sedentary orscreen time.www.nhlbi.nih.gov/health/public/heart/obesity/wecan/learn-it/about.htm

National Institute of Diabetes andDigestive and Kidney Disease(NIDDK)Provides an overview of NIDDK-sponsored research in overweight andobesitywww2.niddk.nih.gov/Research/ScientificAreas/Obesity

National Initiative for Children’sHealthcare Quality’s ChildhoodObesity Action Networkwww.nichq.org/NICHQ/Programs/ConferencesAndTraining/ChildhoodObesityActionNetwork.htm

The Childhood Obesity Action Networkis a Web-based national network toshare knowledge, successful practicesand innovation. The Network includesa broad constituency of health profes-sionals, quality improvement leaders,childhood obesity experts and childhealth advocates who design anddisseminate policy interventions thatwill enhance the ability of thehealthcare system to address the obesitychallenge. Resources and technical assis-tance to improve clinical care areavailable on this website, including theObesity RecommendationsImplementation Guide to helpimplement the June 2007 ExpertCommittee Recommendations on theAssessment, Prevention, and Treatmentof Child and Adolescent Overweightand Obesity.

The Guide to Community Preventive Serviceswww.thecommunityguide.org/

The Guide to Community PreventiveServices is developed by the Task Forceon Community Preventive Services, anindependent decision-making bodyappointed by the Centers for DiseaseControl and Prevention. The Guidesummarizes what is known about theeffectiveness, economic efficiency, andfeasibility of interventions to promotecommunity health and prevent disease.Current recommendations addresspopulation-based approaches tonutrition, obesity, and physical activity.

U.S. Preventive Services Task Forcewww.preventiveservices.ahrq.gov

This independent panel of experts inprimary care and prevention systemat-ically reviews the evidence of effec-tiveness and develops recommenda-tions for clinical preventive services.Current recommendations areavailable for: nutrition counseling,screening for overweight in childrenand adolescents; screening for obesityin adults; and physical activitycounseling.

Print Resources

Bessesen, DH and Kushner R.Evaluation & Management of Obesity.Hanley & Belfus, Inc.: Philadelphia,PA, 2002.

Obesity Committee of the Council onNutrition, Physical Activity, andMetabolism. Obesity andCardiovascular Disease:Pathophysiology, Evaluation, and Effectof Weight Loss An Update of the 1997 AmericanHeart Association Scientific Statementon Obesity and Heart Disease.Circulation. 2006;113:898-918.




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MSOP Expert Panel onOverweight and ObesityPrevention and Treatment

Jarol Boan, M.D., M.P.H.Associate Professor of MedicineDirector of Penn State Weight Loss ClinicDivision of General Internal MedicinePenn State College of Medicine

William Dietz, M.D., Ph.D.Director, Divison of Nutrition andPhysical ActivityNational Center for Chronic DiseaseControl and PreventionCenters for Disease Control andPrevention

Kim M. Gans, Ph.D., M.P.H., L.D.N.Associate Professor, Institute forCommunity Health PromotionThe Warren Alpert Medical School ofBrown University

Russell Harris, M.D., M.P.H.Professor of MedicineSheps Center for Health Services ResearchUniversity of North Carolina at ChapelHill School of MedicineMember, U.S. Preventive Services Task Force

James Hill, Ph.D.Professor of PediatricsDirector, Center for Human NutritionDirector, Colorado Clinical NutritionResearch UnitUniversity of Colorado Health Sciences Center

Joylene John-Sowah, M.D., M.P.H.Senior Scientist, Medicine and Public HealthThe American Medical Association

David L. Katz, M.D., M.P.H.Director, Yale Prevention Research CenterAssociate Professor Adjunct in Public HealthYale University School of Medicine

Patrick E. McBride, M.D., M.P.H.(Chair of the Panel)Professor, Department of Medicineand Family MedicineAssociate Dean for StudentsUniversity of Wisconsin School ofMedicine and Public Health

Russell R. Pate, Ph.D.Professor, Department of Exercise ScienceThe Arnold School of Public HealthUniversity of South Carolina

F. Xavier Pi-Sunyer, M.D., M.P.H.Director, Obesity Research CenterSt. Luke's-Roosevelt HospitalProfessor of MedicineColumbia University,College of Physicians and Surgeons

Charlotte Pratt, Ph.D., R.D.Director, Nutrition Academic Award Program National Heart, Lung, and Blood InstituteNational Institutes of Health

Scott Shikora, M.D.Professor of SurgeryTufts University School of MedicineSurgical Director,Obesity Consult CenterTufts-New England Medical Center

Tracy L. Veach, Ed.D.Professor, Psychiatry & Behavioral SciencesAssociate Dean for Faculty Affairs andDevelopmentUniversity of Nevada School of Medicine

AAMC Staff

Carol Aschenbrener, M.D., M.S.Executive Vice PresidentDivision of Medical Education

Rika Maeshiro, M.D., M.P.H.Assistant Vice President for PublicHealth and PreventionDivision of Medical Education

Rajeev Sabharwal, M.P.H.Senior Research AssociateCenter for Workforce StudiesDivision of Medical School Affairs

Michael E. Whitcomb, M.D.*Editor, Academic Medicine

Marquita WhitingDivision of Medical Education

* Michael E. Whitcomb, M.D., convened the expert panel while he was Senior Vice President of the Division of Medical Education.


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24. Pi-Sunyer FX. A review of long-term studies evaluating the efficacy of weight loss in ameliorating obesity. Clin.Therapeut. 1996;18:1006-35.


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