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Helping patients lose weight might require a change in world view – by physicians, according to research from Touro University College of Osteopathic Medicine. Similar to the transition that occurred with mental illness, study authors are seeking to alter physician thinking so that they consider obesity a treatable condition and not just individual responsibility.
"We know there are economic, cultural, political, and environmental elements causing this problem, yet our approach to treatment puts sole responsibility on the patient's behavior," Michael Clearfield, DO, dean of Touro University's College of Osteopathic Medicine, explained in a press release. "It's not unlike the way we treated depression 40 years ago. Only, instead of telling people to 'get over it,’ we say, 'just eat right and exercise.'"
The curriculum launched in 2012 and began with an assessment of student attitudes as measured on the Fat Phobia Scale. Once the future osteopathic physicians recognize their biased beliefs in stereotypes, such as obese people are "lazy" and have "poor self-control,” they are taught more about the causes and treatment of obesity.
Investigators conduct follow-up testing each year on students’ knowledge and attitudes toward obesity. Results indicate that bias dropped by an average of 7% in students who completed the program.
In the review of the program, 718 first- through fourth-year students were included, with 528 students completing the first year of the obesity curriculum, demonstrating significantly greater medical knowledge about obesity-related epidemiology, pathogenesis, biochemistry, pathophysiology, and metabolic factors; nutrition, diet, physical activity, self-control, and behavior modification; pharmacologic and nonpharmacologic interventions; and associated chronic disorders. Those findings were based on multiple-choice test scores compared with a control group.
“In all four years observed, there was a significant reduction in bias among first-year medical students after obesity curriculum (before: 3.65, 3.76, 3.57, 3.61, and after: 3.47, 3.38, 3.34, 3.37, respectively) (P < 0.05),” study authors reported. “The reduction in bias was also significantly sustained throughout the fourth year.”
"Sometimes, physicians don't believe that obese people will take care of themselves, so they spend less time with them and, as a result, they miss things in their examinations," Clearfield said.
That actually can cause health to worsen, he added, because patients pick up on physicians' attitudes and stop following medical advice or avoid getting check-ups because of embarrassment or a sense that the office is unwelcoming.
Success demonstrated in the four-year study encouraged Touro to expand its curriculum to an online platform, making it available to other medical schools and residency programs.