The Rise of a New Specialty

Published in February 2014 Issue             

The American Board of Obesity Medicine (ABOM) has certified more than 850 physicians in obesity medicine in the United States. While this number may seem small compared to the 78 million people in this country who have obesity, this relatively new specialty is experiencing double-digit growth and taking on new prominence in a brave new world that treats obesity as a disease and the people that have it, as patients in need of evidence-based treatment,
not condemnation.

Louis Aronne, MD

“The medical community has been better at treating the consequences of obesity than obesity itself, but there are signs that this is changing,” said Louis Aronne, MD, of New York Presbyterian Hospital/Weill Cornell Medical Center and a board certified obesity medicine specialist and vice chair of the ABOM. “The increasing recognition of obesity as a disease and a greater understanding of the science behind the disease process is leading to new thinking on how we can better manage patients and treat them, rather than ignore or blame them.”

Recent studies suggest doctors have a difficult time discussing obesity with their patients, much less recommending a treatment or intervention targeted specifically at obesity. A study last year in the journal Medical Care, showed that despite a rise in overweight and obesity, there has been a decrease in weight counseling offered by primary care doctors. The study found that slightly more than 6 percent of patient visits with primary care providers in 2007 to 2008 included weight counseling, which is 46 percent lower than it was between 1995 and 1996, when obesity rates were lower. Diabetes patients were 59 percent less likely to receive weight counseling, while high blood pressure patients were 46 percent less likely to receive it. Researchers noted that the lack of doctor counseling might be due to time limitations during medical appointments, pessimism that patients can change their lifestyle or insufficient training.

Robert Kushner, MD

"Obesity is vastly undertreated, underdiagnosed and insufficiently reimbursed,” said ABOM Chair Robert F. Kushner, MD, Professor of Medicine at Northwestern University Feinberg School of Medicine. “We need to change the model so health professionals have the right training and incentives to deal with obesity directly and not overlook it while addressing bread and butter issues like diabetes and high blood pressure."

While every physician is in some way dealing with obesity or an obesity-related condition in everyday practice, some are devoting themselves entirely to the study and treatment of obesity through specialization in obesity medicine.

According to the ABOM website, “this sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity.” This specialist employs interventions including diet, physical activity, behavior change and pharmacotherapy, and works with nutritionists, exercise physiologists and bariatric surgeons to help patients achieve optimal results. Specifically, ABOM says certified obesity medicine physicians “maintains competency in providing pre-, peri- and post-surgical care of bariatric surgery patients.”

Dana Brittan, MBA

“Obesity medicine physicians meet rigorous certification and recertification requirements and come from the worlds of family practice, internal medicine, pediatrics, OB/GYN, and increasingly bariatric surgery,” said Dana Rasis Brittan, Executive Director of
the ABOM.

To become board certified in obesity medicine, physicians must first be certified by an American Board of Medical Specialties (ABMS) board or osteopathic medicine equivalent and have completed at least 60 credit hours of continuing medical education (CME) on the topic of obesity (see ABOM Qualifications for Certification). The physician is then eligible to take the Certification Examination, a one-day written exam consisting of up to 250 questions on topics including epidemiology, nutrition, physical assessment, recognition and management of weight bias, interdisciplinary team coordination, pharmacotherapy and bariatric surgery. All physicians who successfully complete the certification exam become Diplomates of the ABOM. Recertification is required prior to the completion of their seven-year term.

Bariatric surgeon Wayne English, MD, from Michigan became a Diplomate in 2012 to enhance his knowledge about the medical aspects of obesity treatments.

Wayne Englsih, MD

“Much of the exam is focused on medical management, pharmacology and psychological counseling, areas less familiar to surgeons,” said Dr. English, who represents the American Society for Metabolic and Bariatric Surgery (ASMBS) on the board of the ABOM. “I feel it’s just as important for me to have an understanding of these things as it is for primary care providers to understand the challenges patients face before and after surgery and how to address them.”

Certified obesity medicine physicians can play a critical role in navigating a patient through a continuum of care and in facilitating appropriate referrals for surgery. But their job doesn’t end after a patient has surgery.

"We don’t hesitate to refer when surgery is necessary. In fact, we work side by side with surgeons,” said Dr. Aronne, who works with several bariatric surgeons in New York and across the country. “We see a role beyond the referral. We can help optimize outcomes and make sure patients get the care they need well after the operation.”