Record Number of MDs Graduate as Obesity-Medicine Experts

Pam Harrison

February 23, 2016

A record number of physicians graduated with flying colors from the American Board of Obesity Medicine's (ABOM's) certified examination in December 2015 as the nation struggles to fill the burgeoning need for specialists who know how to treat obesity.

Results from the ABOM show that 429 examinees passed the test late last year, including 10 physicians who were recertified. The latest group includes 141 internists, 123 family physicians, 33 endocrinologists, 28 pediatricians, 24 obstetricians/gynecologists, and 10 surgeons.

This latest group brings the number of first-time diplomates to have passed the ABOM certification exam to 761 in the past 2 years — 342 of them in 2014 — according to the National Board of Medical Examiners.

"I think more and more physicians are recognizing the serious nature of obesity and how it affects a patient's overall health," Louis Aronne, MD, chair, ABOM, Denver, Colorado, told Medscape Medical News. Dr Aronne is also professor of metabolic research at the Weill Cornell Medicine in New York.

"And now that we recognize obesity as a disease, as a problem that requires more sophisticated treatment, I think that physicians are seeing this and they are responding, much the same as we've seen in any other specialty over the years," he added.

ABOM Established 5 Years Ago

Formally established in 2011, the ABOM arose out of the combined efforts of the former American Board of Bariatric Medicine and the Certified Obesity Medicine Physician steering committee. The first doctors to achieve certification from the ABOM graduated in 2012, and in 2013, the American Medical Association (AMA) officially recognized obesity as a disease.

The continued need for more board-certified obesity-medicine specialists is supported by the ever-increasing girth of the nation. According to the Centers for Disease Control and Prevention, 78.6 million US adults are obese (34.9% of the population).

And while diet and exercise can help the obese lose weight, experts stress the solution isn't always as straightforward as counseling patients to be mindful of what they eat.

Obesity is becoming increasingly recognized as a brain disease in which critical signaling pathways in the brain are altered, with the result that often, as people increase intake of fattening foods, their metabolism slows down, creating "a vicious cycle," Dr Aronne explained.

In an effort to demonstrate why doctors need to be certified in obesity medicine, he recalls the story of one of his own patients.

"We saw a patient almost 2 years ago—260 lbs, 5'9", diabetes, poor blood sugar control, and on multiple medications," he explained. As the manager of a fancy food store in New York, the patient was convinced no physician could ever do anything for him, stating, "I eat for a living, so I am not going to listen to any advice about diet."

"Here was someone who had clearly failed," Dr Aronne noted.

"He was gaining weight, his blood sugar was getting worse, he had high blood pressure, high cholesterol, everything you associate with obesity, including a sleep disorder, and despite the fact that he was on nine medications, things were not going well."

Looking at the patient with expertise, however, Dr Aronne realized that four of the medications the patient was taking were actually contributing to his weight gain.

"I adjusted the medicines to ones that help with weight loss and asked the patient to do very simple dietary things, and the bottom line is, I saw him last week and he weighs less than 200 lbs, so [that's] a 60-lb weight loss, maintained for a year," he added.

"So the role of the obesity-medicine physician is to recognize the kinds of problems that can contribute to weight gain and to develop a management plan that pulls it all together," he explained.

More Endocrinologists Training; Obesity Moves to Mainstream

At first glance, it might seem somewhat puzzling that relatively few endocrinologists (n = 33) took the ABOM certification exam in 2015, but there are now a total of 69 endocrinologists board-certified in obesity, and the statistics indicate this is an upward trend, said Dr Aronne.

"In the past, endocrinologists were interested in pituitary, thyroid, bone, calcium, but I think a high proportion of the new generation of endocrinologists who are just coming on board see obesity as a serious problem that's part of what they need to know and they are getting trained to do so," he noted.

Of the four fellows now training at his institution, Weill Cornell, "all are interested in obesity," Dr Aronne explained, adding that they also have two ABOM-certified endocrinologists.

"Obesity is moving into the mainstream of healthcare, and I'm excited to see that physicians understand that training in obesity medicine is an important part of clinical practice," he concluded.

Dr Aronne is chair of the board of the ABOM.

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