Letter to the Editor of ObesityPillars from the Obesity Medicine Fellowship Council

To the editor:

We are writing as members of the Obesity Medicine Fellowship Council (OMFC) [1], the organization that represents Obesity Medicine fellowship programs within the US and Canada. As described by Fitch et al. [2], the rapid increase in the prevalence of obesity and its complications over the past half century has catalyzed growing professional interest in specialized care for this disorder. This interest and desire for specialized education and recognition has spurred the formation of professional organizations to promote and support Obesity Medicine as a distinct discipline within healthcare. As described by Fitch and colleagues [2], the American Board of Obesity Medicine (ABOM) was formed in 2011 to recognize and certify physicians educated in this area. The OMFC was formed in 2018 to support the development and operations of full-time clinical training programs in Obesity Medicine, most notably subspecialty fellowships in this area.

As with most disciplines of medicine, effective and accessible obesity care requires active engagement by both generalists and specialists. As a new and emerging discipline, however, obesity medicine is in its infancy, and formal education and training in the care of people with obesity is absent from most medical curricula. Generalists who wish to make obesity care a focus of their practice are likely to be the largest group of physician providers to advance high quality and efficient management of obesity. Indeed, they are the only group of physicians numerous enough to effectively address the number of patients affected. The CME Pathway to certification by ABOM recognizes this important group of physicians and their specialized education and dedication.

As with all other medical specialties, a smaller group of physicians who wish to focus their professional activities within the specialty seek more intensive training, providing them with advanced skills in relevant diagnostic and therapeutic techniques, the management of particularly complex or challenging patients, promotion of research, and dissemination of specialized knowledge to the many generalists working in the discipline. The need for and interest in this more highly specialized training has stimulated the development of 19 new Obesity Medicine fellowship programs over the past 5 years (a total of 24 programs) [1], more than quintupling the total number of fellowship positions available annually. For these fellowship-trained specialists, ABOM has established a parallel pathway to certification that mimics the pathway used by most other specialties. It is this pathway that we anticipate will one day allow Obesity Medicine to be recognized and sponsored by one or more of the 24 certifying boards that are members of the American Board of Medical Specialties (ABMS). However, as quickly as Obesity Medicine is growing, no group of subspecialized providers in any discipline can accommodate the needs of patients with diseases as prevalent as obesity. For other disciplines facing this challenge, generalists with a focused interest in particular subspecialties (e.g., senior health, women's health, preventive cardiology, etc.) often provide the volume of high-quality clinical care required.

Decisions about how best to promote and provide specialized care in Obesity Medicine need to reflect the complementary needs of these two groups of physicians. In particular, the lack of any significant education in obesity biology, prevention, or treatment in most medical schools and post-graduate training programs makes the need for CME-based and fellowship-based training that much more critical. For the foreseeable future, it is almost certain that we will need both types of training to accommodate the growing needs of our patients. Over the long term, however, as with other specialties, the need for clinically trained Obesity Medicine specialists to support ongoing research, clinical progress, and the training of future generations should promote expansion of fellowship training opportunities and certification within the ABMS structure. We look forward to that day but recognize that it is likely to be in the more distant future and cannot be the only solution to the critical challenges in obesity care that we face today.

Declaration of competing interest

Drs. Ahn and Taormina are the 2023-2024 Obesity Medicine Fellow representatives to the Obesity Medicine Fellowship Council (OMFC). Dr. Tchang, an OMFC member, co-directs the Obesity Medicine fellowship program at Weill Cornell Medicine, and Drs. Srivastava, Schmidt and Kaplan currently serve as the Vice-Chair, Administrative Director, and Chair of the OMFC, respectively.