Gaps in obesity education - thematic narrative analysis from healthcare graduates: findings from the Erasmus Mundus EMINENT project

Abstract

Background

Obesity is a complex, chronic disease with significant global health implications, yet its management remains underrepresented in medical and allied health education. Despite recommendations for structured obesity education, healthcare professionals (HCPs) report inadequate training, contributing to gaps in knowledge, competency, and clinical preparedness. This study explores the perspectives of newly qualified HCPs regarding their training in obesity management, aiming to identify educational deficiencies and inform future curriculum improvements.

Methods

A qualitative study was conducted using semi-structured interviews with 21 recently graduated HCPs from various disciplines, including medicine, physiotherapy, occupational therapy, and dietetics. Data were analysed using Braun and Clarke’s thematic analysis framework, allowing for an in-depth exploration of participants’ experiences and perceptions.

Results

Nine key themes emerged, highlighting a lack of structured curriculum, minimal teaching time, and limited clinical exposure to obesity management. Obesity was primarily taught as a comorbidity rather than a distinct disease, with a disproportionate focus on surgical interventions while neglecting lifestyle modification, pharmacotherapy, and behavioural counselling. Many graduates reported feeling underprepared for patient-centred discussions on weight management, with little training in addressing weight stigma. Clinical exposure was inconsistent, with obesity management rarely encountered outside bariatric surgery. Additionally, reliance on non-academic sources, such as social media, underscored the failure of formal education to provide evidence-based obesity training.

Conclusion

This study identifies critical deficiencies in obesity education, reinforcing the need for standardized, competency-based training across healthcare curricula. Integrating comprehensive obesity management, increasing hands-on clinical exposure, and incorporating structured training in lifestyle interventions and weight stigma awareness are essential steps to enhance HCP preparedness. Addressing these gaps is crucial to improving obesity care and patient outcomes in clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08236-x.

Background

Obesity is a complex, multifactorial chronic disease with profound implications for global public health. The condition is associated with increased morbidity and mortality due to its strong links with cardiovascular disease, type 2 diabetes mellitus, certain cancers, and a reduced quality of life [1]. Despite its high prevalence and significant economic burden on healthcare systems, training for healthcare professionals (HCPs) in obesity management remains markedly insufficient and inconsistent across educational institutions.

Healthcare professionals play a crucial role in obesity prevention, diagnosis, and management, clinicians report feeling inadequately prepared to address this public health challenge [2–4]. Studies indicate that many medical graduates lack the necessary knowledge, confidence, and clinical skills to provide evidence-based obesity care [5–7]. A comprehensive obesity management strategy necessitates an interdisciplinary approach, integrating lifestyle modification, behavioural counselling, pharmacotherapy, and surgical interventions. However, clinical education often falls short in providing structured, competency-based training in these areas, leading to significant gaps in clinical preparedness among newly qualified practitioners [8–10].

Despite recommendations from various national and international health organizations advocating for a structured approach to obesity education [2, 11–14], the actual implementation in medical and healthcare curricula is highly variable [8, 11, 14, 15] with little meaningful change [10, 14, 16]. This results in significant disparities in obesity-related competencies among healthcare professionals [10, 14, 17], influencing their ability to provide effective and equitable care to patients living with obesity. The existing educational shortcomings also contribute to implicit weight biases among HCPs, with significant attribution of blame and responsibility of obesity placed on the patient [16, 18]. further exacerbating stigma and negatively impacting patient-provider interactions.

There are very few studies looking specifically at obesity-training for healthcare professionals [4, 14, 15]. However, previous studies have highlighted several key deficiencies in obesity education. Many medical students report receiving minimal exposure to obesity as a standalone clinical issue, with most discussions limited to its role as a comorbidity in other conditions such as diabetes or cardiovascular disease, with little practical skills to address the issue [19]. Similarly, training in lifestyle modification strategies, patient-centred weight counselling, and pharmacotherapy remains inadequate, leaving HCPs feeling unprepared to engage in meaningful conversations with patients regarding weight management [3, 17, 19–21].

Addressing these deficiencies requires a re-evaluation of how obesity is integrated into healthcare education. The Obesity Medicine Education Collaborative (OMEC) has developed an interdisciplinary competency framework, advocating for the inclusion of obesity-related topics across six core domains and 32 associated competencies [11]. Similarly, national clinical guidelines from the United Kingdom [2], Ireland [12], Canada [13], and the United States [14] recommend incorporating obesity-specific education into medical training to ensure that future HCPs possess the necessary skills to manage obesity effectively. However, empirical data on the extent to which these recommendations have been adopted remain scarce [9].

This study aims to explore the perspectives of newly qualified HCPs on the training they received in obesity management during their university education. By conducting qualitative interviews, we seek to identify gaps in knowledge, competency, and clinical exposure to inform future educational strategies in postgraduate education, specialist training and beyond. Through an in-depth thematic analysis, this study contributes to the ongoing discourse on obesity education and provides insights for policymakers, medical educators, and healthcare institutions to improve training in this critical area.

Methods

Study design

We conducted a qualitative study using semi-structured interviews to explore experiences of obesity education among newly qualified healthcare professionals. The study followed Braun and Clarke’s reflexive thematic analysis framework [22].

Participants and recruitment

Participants were early-career healthcare professionals who had graduated within the previous two years from medicine, physiotherapy, occupational therapy, dietetics, or nursing programs in the Republic of Ireland or the UK. We limited recruitment to the UK and Republic of Ireland to ensure comparability across similar health-professional training structures and regulatory frameworks.

Recruitment used purposive sampling to capture a range of disciplines. Invitations were circulated via hospital posters, hospital department meetings, professional social media, professional messaging groups and the alumni network of University College Dublin, Trinity College Dublin, Royal College of Surgeons in Ireland, Dublin City University, and Queen’s University Belfast (August-October 2024). Interested individuals contacted the research team by email and were provided with a Participation Information Leaflet (PIL). Inclusion criteria were: (i) recent graduation (≤ 2 years), (ii) current clinical role, and (iii) provision of informed consent.

Of the 30 whom expressed interest, 21 participants consented and completed interviews (participation rate = 70%). Participants represented five disciplines (see Table 1).

Table 1.

Participant characteristics

Characteristic	n (%)
Total Participants	21
Field of Study
Medicine	16 (76.2%)
Physiotherapy	2 (9.5%)
Occupational Therapy	1 (4.8%)
Dietetics	1 (4.8%)
Nursing	1 (4.8%)
University
University College Dublin (UCD)	11 (52.4%)
Trinity College Dublin (TCD)	3 (14.3%)
Royal College of Surgeons in Ireland (RCSI)	2 (9.5%)
Queen’s University Belfast (QUB)	1 (4.8%)
University of Aberdeen	1 (4.8%)
University of Exeter	1 (4.8%)
Newcastle University	1 (4.8%)
Dublin City University (DCU)	1 (4.8%)
Country
Ireland	17 (81.0%)
United Kingdom	4 (19.0%)

Data collection

Semi-structured interviews were conducted on Zoom between November 2024 and May 2025 using a piloted interview guide (Supplementary File 1). Interviews lasted 26–62 min (median 40.5 min). The guide included domains such as curricular coverage of obesity, clinical exposure, communication training, and preparedness for practice. All interviews were conducted by one researcher (TYL.K), and were audio-recorded and transcribed verbatim. Field notes were made after each interview to capture initial impressions. No repeat interviews were conducted.

Data analysis

Data were analysed using reflexive thematic analysis. Two researchers (TYL.K., F.C.) independently coded transcripts in MAXQDA (v24.7.0). Codes were compared and refined through iterative meetings, with themes developed collaboratively through team discussion. After 19 interviews, no substantially new patterns were identified; 2 further interviews were conducted to ensure breadth across disciplines.

Reflexivity

The research team included clinicians and researchers with professional backgrounds in dietetics and medicine, three of whom work exclusively in the field of obesity care and research. This shared focus provided disciplinary insight but also the potential for bias in interpreting participants’ accounts. To mitigate this, the team engaged in ongoing reflexive discussions during coding and theme development, acknowledging their professional investments while prioritising participants’ perspectives as central to the analysis.

Ethics

The study received ethical approval from the University College Dublin Human Research Ethics Committee (Reference: LS-24–69-Najim). All participants provided informed written consent prior to interview. Participation was voluntary, and data were anonymised at the point of transcription.

Results

Interviews were conducted with 21 healthcare graduates from five professional disciplines, trained in institutions across Ireland and the UK. Table 1 provides a summary of participant characteristics.

Thematic analysis

Obesity medicine lacks standardized education, often integrated as a comorbidity rather than a core subject. Training is inconsistent, with minimal focus on practical management—non-surgical interventions are largely overlooked, while bariatric surgery receives the most attention. Clinical exposure is limited, with obesity rarely treated as a primary condition. Weight stigma training is minimal, leaving students unprepared for patient discussions. Many rely on self-directed learning, reinforcing gaps and leaving HCPs ill-equipped for effective obesity management. After qualitative thematic analysis, 9 key themes emerged (Table 2).

Table 2.

Themes

Themes Underpinning Research Questions	Extracted Quotes
1. Lack of Structure in Curriculum	“I think we had like a talk on it. But it wasn’t ever stressed as like important to the curriculum, or like I think, even when it came up in sort of like clinical scenarios, it was always something that was like brushed over, or it was always something that was used to like describe the morbidity or mortality of a patient rather than sort of in addition provide a more comprehensive picture of their care that is required. so yeah, I think very scant, very little in terms of like management. I don’t think any of the management you spoke about we went over in med school. I think maybe we would have done like a little bit just, but in like gastro clinical placements, where someone would have like mentioned something, and then had a quick chat about it. But it was definitely not something that was assessed on, and definitely not something that was stressed on. So yeah, very little.” “No, really, no. There, you know. like we never really get taught about obesity. To be honest, I thought I would be, because, you know, Physio, they really the exercise bit really comes into a big part to help them lose their weight. But we actually didn’t talk much about that. We all, we only know how to prescribe the exercise, like the principle behind it”. “I would say it’s lacking not to say that there was no education. I just think that it could be done better” “We might have had like a lecture just on obesity, but it wouldn’t have been like its own lecture series or anything, no would have been like one dedicated lecture at best that someone does on a whim”
2. Lack of Focus on Obesity as a Disease	“It was not talking about the mechanisms of obesity. It was more around that if a patient is obese they are at increased risk for adverse effects of surgeries or of other treatments, but that was the furthest they went in describing the role of obesity” “It was embedded amongst other things” “Yeah, we never had any specific dedicated teaching on obesity or any related topics. So never had a lecture on a seminar. Anything like that. All of the teaching surrounding obesity was in relation to other conditions. You know, obesity is a risk factor for this, or obesity worsens the outcome here, so on, so forth, but it we never then went to looking at obesity as a condition by itself” “We never were taught about medical management of obesity itself. Just management of complications”
3. Limited Time Spent on Obesity Education	“I think, one lecture combined in the 5 years” “It would be hanging around all the other systems. But it was never lectures directly focused on obesity other than that one bariatric lecture” “We never had any specific dedicated teaching on obesity or any related topics. So never had a lecture on a seminar. Anything like that.”
4. Lack of Academic Training in Lifestyle Management	“They talked about, you know again, the lifestyle modification that everyone generically states. Did they actually go into the modifications themselves? I think the exercise recommendations they did. They didn’t like talk about diet but like basic level of like x minutes of exercise x times a week would have been covered”.
5. Lack of Academic Training in Medical Management	“We didn’t really go into too much detail regarding the different types of pharmacotherapy, available sort of glossed over it. I think he was just trying to highlight the importance of treating obesity. but not so much the treatment options. He was just sort of flagging it to us, saying, Oh, actually, this is like very important numbers are increasing. So yeah, keep an eye on it. But yeah.”
6. Lack of Academic Training in Surgical Management	“Yes, we did have some lectures about obesity as a condition, and about specifically surgical management of obesity and medical management of obesity really wasn’t covered” “Maybe 2 lectures about obesity as a condition. and maybe 2 about the surgical management of obesity. and maybe one about the medical management. I would say” “There was a lot of focus on the indications for surgery…the process of how the surgery is carried out. and then about the complications of the surgery” “So the surgical one was just bariatric surgery and sort of the different types of bariatric surgery, and she talks about sort of inclusion, criteria. How inclusion, criteria, types of surgery, and how sort of like the benefits of each surgery and the cons of each as well”
7. Limited Clinical Exposure to Obesity Management	“In terms of the medical side, like endocrinology. I have zero experience with endocrinology. and even then, like obesity management is like a subspecialty, and I don’t know if anyone does it. But yeah, we’re just not exposed to it” “No, I do not think there was enough exposure throughout the undergraduate course” “It’s not a very like acute med problem. So I haven’t had much experience with like managing obesity. It’s always something that’s like highlighted. And then they get moved on to another ward, which hopefully does do all these management” “I have had some very small exposure on my GP placement, where there was a patient who had gained a significant amount of weight in quite a short period of time while undergoing cancer treatment as a side effect of steroids and reduced mobility due to their cancer treatment. And the GP did decide to start them on Ozempic and for weight loss. But that is the one and only situation where I’ve ever seen that happen, and I don’t know the guideline or the decision-making framework behind that.”
8. Limited Formal Training in Weight Stigma & Counselling	“You know how you could feel in that moment if you say the wrong thing, so I don’t think we’ve… I don’t think I’ve personally been adequately trained to deal with that conversation.” “Might have been like briefly touched upon when we’re talking like stigma of disease. But like I don’t. I don’t know. They’re probably in that obesity lecture. They probably mentioned it as like a barrier to getting treatment, but beyond that I don’t know. I don’t think they have like full on talk about. You know the stigma, and how it affects people beyond being a barrier to treatment.”
9. Using External, Non-Academic Sources for Information on Obesity	“All I know is from what I can see online social media, and through experience.” “I actually don’t know much evidence based about that. I feel like a lot of what I know about lifestyle interventions for obesity is things that I’ve picked up from just existing in society or from the Internet. I feel like that’s not really something I can speak on confidently in my role as a doctor” “In terms of management there’s all these new drugs coming down the line, and it’s very much a taboo I feel on the ground. I don’t know much about that. I’m currently trialing a drug myself. So I’m very early stage into that. So I’m kind of interested in that element of obesity now, but I’m still not confident enough to kind of talk about it publicly.” “I don’t read guidelines, and I’m not aware of the processes that I can refer people on, for so it would be anecdotal from my own lived experience and from you know my others, because I’ve been involved in sport, so I can, and I compete in a weight class sport. So therefore I’m quite familiar with weight management, and to me it’s very easy. but I realize for most people it’s not that easy. It’s not just a case of eating less, and whereas for me it is so I always, if people ask, I tend to steer them away from it. And I you know I if I’m in a hospital setting. go to dieticians I’ll refer to”.

Lack of structure in curriculum

Obesity medicine remains a neglected subject in medical education, lacking a standardized curriculum across institutions. When covered, the content varies significantly, with many healthcare professionals (HCPs) reporting minimal exposure. One participant described it as “very scant, very little in terms of like management”, noting that obesity was often mentioned in clinical scenarios as a risk factor rather than a condition requiring direct treatment. Another stated, “we never really get taught about obesity… I thought I would be, because, you know, Physio, really the exercise bit really comes into a big part help them lose their weight. But we actually didn’t talk much about that.”

For most, teaching focused on theoretical aspects such as pathology, policy, and public health rather than practical management strategies. One participant noted, “It was very much just the science behind it… the clinical condition and the policies… rather than the patient”, or “it was always something that was like brushed over”. Lifestyle modification, behavioral interventions, and medical management were rarely addressed, while surgical management received disproportionate attention. Another participant remarked, “We had a lot of lectures on managing the complications of obesity, but no lectures on fixing obesity, more preventing it.”

Even when education was provided, many found it insufficient. One participant commented, “I would say it’s lacking… not to say that there was no education. I just think that it could be done better.” Another recalled, “We might have had like a lecture just on obesity, but it wouldn’t have been like its own lecture series or anything… one dedicated lecture at best that someone does on a whim.”

Overall, the absence of structured and clinically relevant training leaves many newly qualified HCPs unprepared to manage obesity effectively, reinforcing gaps in care and contributing to a lack of confidence in treatment approaches.

Lack of focus on obesity as a disease

Obesity is rarely taught as a distinct condition in medical education and is instead embedded within broader modules, often framed as a comorbidity rather than a disease requiring direct management. One participant noted, “It was not talking about the mechanisms of obesity. It was more around that if a patient is obese they are at increased risk for adverse effects of surgeries or of other treatments, but that was the furthest they went in describing the role of obesity.”

Many students reported little to no dedicated teaching, with obesity primarily mentioned in the context of other diseases. One participant stated, “Yeah, we never had any specific dedicated teaching on obesity or any related topics. So never had a lecture on a seminar. Anything like that. All of the teaching surrounding obesity was in relation to other conditions. You know, obesity is a risk factor for this, or obesity worsens the outcome here… but we never then went to looking at obesity as a condition by itself.” Another added, “We never were taught about medical management of obesity itself. Just management of complications.”

Teaching on obesity, when present, was sporadic and inconsistent. Some students recalled only one or two lectures, while others reported no formal teaching at all. One participant reflected, “I think it was mentioned in other modules, but not in depth.” Another explained, “So there’s nothing that’s focused on obesity. But when we were doing endocrine, you know, you would have obesity shoehorned in there… but it was never lectures directly focused on obesity other than that one bariatric lecture.”

In clinical training, obesity was frequently addressed only as a secondary concern, with limited instruction on its direct management. One participant remarked, “If a patient was ever noticed to be obese, it was always in the management plan of like lose weight. Sometimes, even when it was like a respiratory issue… But it’s definitely something that is almost always mentioned as a plan if someone is noticed to be obese.” Another echoed this, stating, “They would then talk about managing that [other condition], not necessarily the obesity itself.”

Overall, obesity education in medical training is fragmented and lacks a standardized approach, leaving many HCPs underprepared to manage the condition effectively.

Limited time spent on obesity education

The amount of time spent in teaching obesity also varied. One respondent recalled 3 h of lecture content focused on obesity with 2 h of that dedicated to surgical management. Another, from the same medical school, reported the same with “I think we got 2 lectures for sort of medical or about obesity. and one lecture on bariatric surgery, so 3 in total”. Another HCP from a different medical school reported “I would say 2 to 3 lectures, and then one tutorial… I think I would say one definitely dedicated to obesity. And then 2 maybe, were about essentially digestive system pathophysiology, and then covering obesity, and the other one, I think, was on general surgery, management of obesity through that kind of perspective. So, and that was talking about obesity as well, but one lecture dedicated kind of completely to obesity”. Another respondent said “One lecture on children obesity management. That’s it. I haven’t get taught about like surgery on obesity management”. One medic described it as “I think, like one lecture, and maybe like combined in the 5 years out of like different topics of conversation, maybe like 2 h of like discussion around it [obesity]”. Another medic mentioned that they only had “one lecture dedicated kind of completely to obesity”. Another explained that “because you’re focused on trying to cover such a broad range of topics. Maybe we had one lecture on obesity or endocrine. But it wasn’t like a hard focus for the program”.

Some HCPs have mentioned no teaching in obesity at all. One respondent said “not obesity. So now, when I think about, I don’t really think we cover obesity in college feel like, so, yeah”. A physiotherapist said “No, not, I guess we barely. Well, I know that we definitely need to know the protocol after total hip replacement, but we barely touch about it, but we don’t even actually go through it. So I doubt that we’ll even dive into like obesity, surgery, management, that kind of stuff. So no, not really”. A medic mentioned that “I think by and large they didn’t touch on it [obesity] like almost at all”. Another respondent said that they only had one lecture that touched on obesity, but “not really on the management of obesity, but the like psychosocial impact of obesity. And how it’s like cyclical thing. So I think it was more of like a a psych, or like a a social sort of perspective on obesity rather than like the medical management even”.

At the same time, it was acknowledged by another HCP that “I think we probably got good education overall. Obviously, we could have gotten more. You always can, but I do realize that it’s a limited curriculum, and that there’s only a certain amount of lecture slots for different things and education”. This lack of priority in obesity education appears prevalent, as another explained that “I think it’s also something that, like you just don’t get taught because they’re more important things to learn about”. Furthermore, this impacts HCPs retention of their knowledge and skills in obesity management, as one respondent states “could have could have had a bit more repetition throughout the years at least. Not only kind of one focused session, and then not really touching on it again”.

Lack of academic training in lifestyle management

Despite the pivotal role of lifestyle modification in obesity treatment, medical education does not adequately cover dietary counselling, behavioural interventions, or exercise prescriptions. Many HCPs could not recall any structured teaching on lifestyle-based weight management, instead encountering only vague discussions on healthy eating within broader health promotion teaching.

When lifestyle management on obesity were included, it was reported to be insufficient. One respondent mentioned that they were taught to “have a healthy diet and do exercise and stuff, but that’s so great and fine, but it’s not actually good education. I don’t think, like everyone knows, that, I think, but it’s more so kind of like. More detailed management probably could have been probably further elaborated on. And kind of what does a healthy diet mean, you know, like as in that’s not very descriptive at all, and like everyone’s understanding of that is so dependent on their background and their education that they’ve received prior to this”. Another mentioned that “I think there’s a lot of same advice for everybody. And I think it’s not personalized. And I think that’s the biggest issue with lifestyle stuff”.

Lack of academic training in medical management

Many HCPs report no teaching and exposure at all in pharmacotherapy options for obesity. One medical trainee described their entire exposure to pharmacotherapy for obesity as learning about Ozempic (semaglutide) due to media attention rather than structured teaching. Another stated they only learned about GLP-1 receptor agonists incidentally through diabetes lectures, which led to confusion about which medications were specifically indicated for obesity treatment. They quoted “I feel like university normally went down the diabetes route. So a lot of our medications and things that we were recommended for people with obesity were normally had a crossover with diabetes”. Teaching of obesity pharmacotherapy appears to be underprioritized in the curriculum, with one respondent saying “Everything that we were told about were like statins and the anti-diabetic drugs they went into in great detail, but, like from an actual obesity point of view, we didn’t really have anything. you know there wasn’t much in in kind of primary care settings other than the lifestyle factors.”.

Many trainees felt unprepared to prescribe pharmacotherapy or counsel patients on medical weight management due to a complete lack of formal education on the subject. When asked about their knowledge on pharmacotherapy, one HCP said “I would say that the education is not where it should be. I think that I am not aware, and that’s the problem”. One went further to say they did not feel their education made them feel prepared for pharmacological management of obesity “because I’ve never learned it in medical school”, which is corroborated by another participant who said “I think it’s not something that was really touched on in uni”.

Lack of academic training in surgical management

In contrast to the minimal focus on lifestyle and medical treatment, surgical interventions for obesity received the most dedicated teaching time amongst medics. One respondent explained that “I don’t really remember preclinical. I won’t lie. I think that was a bit more like pathophysiology stuff. But clinically we went through quite a lot of the surgeries involved in bariatric surgery and causes. as well as kind of it, being like multifactorial, so like mechanical, metabolic”. However, one HCP did say that “based on what I learnt in medical school, no” when asked if they could describe the surgical management of obesity because “my medical school curriculum didn’t really didn’t cover it. I would say, actually, like, nothing”.

When it was covered, the standard of education quality was also mixed, with one respondent saying “There was. I think, one lecture on bariatric surgery, where he complained the entire time that his budgets were getting slashed, and that he could only operate like once a week or something because he didn’t get theater time, because it wasn’t a priority for the NHS. Was the takeaway message that I got from it, and I shouldn’t go into bariatric surgery because you have to fight everyone constantly to actually do your job”.

However, while HCPs valued this knowledge, they noted that surgical options represent only a small subset of obesity management, and this imbalance in teaching neglects the needs of the majority of patients who require non-surgical interventions.

Limited clinical exposure to obesity management

Clinical exposure to obesity management during medical training is severely limited, with many HCPs reporting little to no hands-on experience. One participant stated, “I have zero experience with endocrinology. And even then, like obesity management is like a subspecialty, and I don’t know if anyone does it. But yeah, we’re just not exposed to it.” Another added, “No, I do not think there was enough exposure throughout the undergraduate course.”

Obesity is frequently encountered as a secondary condition rather than the primary focus of care. One participant explained, “It’s not a very like acute med problem. So I haven’t had much experience with like managing obesity. It’s always something that’s like highlighted. And then they get moved on to another ward, which hopefully does do all these management.” Another reflected, “I haven’t witnessed any treatment for obesity at all. I don’t think… it was always as a comorbidity.” Similarly, another participant stated, “You know, I yes, I definitely was exposed to patients with obesity. But it was never the primary reason of care like it was not the chief complaint.”

Even in clinical placements, direct exposure to obesity management was rare and often restricted to bariatric surgery. One participant noted, “I had one week of bariatric surgery placement where we just watched bariatric surgery, and that’s it.” Another explained, “Some people got placements, obviously with Upper GI… bariatric surgery… But I think most of us didn’t. It was kind of a limited, actual clinical experience with that team.”

As practicing HCPs, many continue to report minimal exposure to obesity management. One participant stated, “Very little up until this point. I’ve largely worked in pediatrics, and I think… it really isn’t a discussion of medical or surgical management in that population.” Another remarked, “In a surgical setting. Yes, in the operating theatre… and as I said in GP, I definitely seen some kind of health promotion from GPs, and as if one person who has started on Ozempic during a consultation.”

When asked about direct, hands-on experience, “not at all” was a frequent response. One participant admitted, “Honestly, no. Now that just may have been kind of the way the cards fell in terms of my clinical rotations. Because again, some people rotated through endocrine. Some people didn’t.” Another noted, “That child is my first time to actually come across with an obesity person like even just in real life or from college. I rarely come across to meet with people that has obesity. So I feel like college doesn’t fully equip us how we should interact or how we can understand them better as well.”

Overall, HCPs universally reported insufficient clinical exposure to obesity management, reinforcing the broader gaps in obesity education within medical training.

Limited formal training in weight stigma & counselling

Medical education provides minimal training on weight stigma and effective patient communication regarding obesity. One participant admitted, “You know how you could feel in that moment if you say the wrong thing, so I don’t think we’ve… I don’t think I’ve personally been adequately trained to deal with that conversation.” Another noted, “Might have been like briefly touched upon when we’re talking like stigma of disease. But like I don’t… I don’t know. They’re probably in that obesity lecture. They probably mentioned it as like a barrier to getting treatment, but beyond that I don’t know.”

Discussions on weight stigma were often superficial or integrated into broader bias training rather than addressed as a distinct issue. One respondent explained, “Maybe, maybe indirectly. I remember in 1 st year we had sessions on bias and stigma, and it was kind of rolled all into one. So sex, religion, race, obesity, disability. It was all of those sort of biases and stigmas were rolled into one often.” Another added, “We probably talked about management of a patient who is also obese, and then possibly a bit about how you would talk about obesity. But really, it was not very standard for teaching and kind of a secondary objective of the session.”

Practical training on weight-related discussions was lacking, leaving many HCPs unprepared for real-world patient interactions. One participant stated, “Did I have any specific training on? You know, broaching this topic and addressing some of the challenges surrounding it, then? No, no, not at all.” Another acknowledged, “But to kind of tactfully approach the topic. No, I don’t think we actually got any like instruction on how to have social etiquette.”

Although some institutions briefly acknowledged bias, there was little focus on equipping students with communication strategies. One participant recalled, “I’d say at a couple of points that I was taught how to start that conversation, and like a sensitive way to bring it [weight] up, but never had to actually have that conversation.” Another reflected on the general lack of emphasis on stigma in medical training, stating, “I think the only area of medicine where we ever really discussed stigma was in our psychiatry module… but I think that also carries through to conditions like obesity, where there is a massive amount of stigma, and it’s just not discussed at all that I found in my medical education.”

Overall, while weight stigma was occasionally acknowledged, there was a significant gap in practical training on how to navigate weight-related discussions, leaving many HCPs feeling ill-equipped to approach these conversations effectively.

Using external, non-academic sources for information on obesity

Due to gaps in formal education, many healthcare professionals (HCPs) rely on self-directed learning, anecdotal experience, and social media for obesity management knowledge. One participant admitted, “All I know is from what I can see online, social media, and through experience.” Another acknowledged, “I actually don’t know much evidence-based about that. I feel like a lot of what I know about lifestyle interventions for obesity is things that I’ve picked up from just existing in society or from the Internet.”

One participant admitted that their primary exposure to obesity pharmacotherapy came from following social media discussions and popular trends rather than medical lectures, stating, “I only knew about Ozempic because it was a craze… But apart from that, I didn’t know about any other medications.”

Many HCPs acknowledged the limitations of their informal learning. One participant noted, “I don’t read guidelines, and I’m not aware of the processes that I can refer people on… So it would be anecdotal from my own lived experience.” Another recognized the risks of applying personal weight management strategies to patients, stating, “I [their weight] can go up and down at will. But I can’t then apply my own anecdotal case to my patients—that is completely unfair.”

Overall, reliance on non-academic sources reflects the inadequacies in structured obesity education, leaving many HCPs uncertain about best practices and unprepared to provide evidence-based care.

Theme analysis

Each theme not only highlighted a gap in clinical education but the rich narratives from participants also suggested potential underlying mechanisms by which these gaps are sustained. (Table 3).

Table 3.

Interpretive mapping of themes

Theme	Underlying Mechanism	Clinical Consequence
1. Lack of Structure in Curriculum	Curricular crowding (too many priorities); lack of designated obesity teaching	Graduates see obesity as peripheral; under-prepared for management beyond generic advice
2. Lack of Focus on Obesity as a Disease	Hidden curriculum: obesity framed only as comorbidity; absence of staging systems or disease frameworks.	Clinicians default to risk-factor framing, miss heterogeneity, and under-recognise obesity as a chronic, treatable disease.
3. Limited Time Spent on Obesity Education	Time allocation reflects institutional priorities; obesity not considered examinable or “high stakes.”	Minimal knowledge retention; learners forget isolated lectures; graduates unable to apply concepts in practice.
4. Lack of Academic Training in Lifestyle Management	Diffuse ownership (no specialty “owns” lifestyle teaching); lack of faculty expertise or confidence.	Graduates provide generic, non-individualised advice; risk of reinforcing ineffective strategies.
5. Lack of Academic Training in Medical Management	Pharmacotherapy under-recognised in curricula; linked more to diabetes/endocrinology than obesity per se.	Clinicians lack prescribing confidence; underutilisation of effective pharmacotherapies; risk of patients not receiving informed treatment discussions.
6. Lack of Academic Training in Surgical Management	Surgical pathways are more visible, structured, and examinable (clear rotations, defined curricula).	Disproportionate surgical focus skews perceptions of obesity care; non-surgical options under-taught and underused.
7. Limited Clinical Exposure to Obesity Management	Obesity rarely treated as primary condition in placements; lack of supervised obesity-specific clinics.	Graduates avoid obesity as a management target; perpetuates reliance on theoretical knowledge with little experiential skill.
8. Limited Formal Training in Weight Stigma & Counselling	Communication and stigma training undervalued in curricula; not linked to assessments.	Graduates avoid weight conversations, risk causing harm, and perpetuate stigma in care encounters.
9. Using External, Non-Academic Sources for Information	Curriculum neglect forces learners to self-teach; absence of structured, evidence-based resources.	Reliance on variable-quality sources (e.g., social media) → inconsistent knowledge, risk of misinformation.

The lack of structured curricula and minimal teaching time reflect curricular crowding and the absence of examinable competencies, which signals to students that obesity is a low priority. Similarly, the absence of dedicated teaching on lifestyle and pharmacotherapy stems from diffuse curricular ownership and lack of faculty expertise, leaving graduates reliant on generic or external sources of information. The overemphasis on surgery reflects a visibility bias, as surgical pathways have structured rotations and assessments. Finally, limited communication and stigma training reflects the low value placed on psychosocial competencies when they are not formally assessed. Together, these mechanisms offer suggestions to why graduates consistently reported feeling unprepared to manage obesity in clinical practice.

Discussion

This study explored the perspectives of newly qualified HCPs on their preparation for managing obesity in clinical practice. While these findings echo earlier reports of under-preparation in obesity management [3, 4, 8, 10, 16, 23], this study offers new insight into the mechanisms driving such gaps and the consequences for patient care.

Several systemic factors appear to underpin the lack of structured obesity education. First, curricular crowding means obesity content competes with numerous clinical priorities [24] and often receives little protected time [20, 25, 26]. In such environments, “hidden curricula”, or the implicit messages conveyed by faculty, also shape how learners value content [27, 28]. When educators themselves view obesity as peripheral, this perception is transmitted to trainees. Moreover, a qualitative study on medical educators in UK and Ireland found that even medical educators struggle with understanding the most effective way to support patients with obesity [9]. Second, assessment drives learning: participants reported focusing their efforts on examinable content, which they believe did not emphasize obesity. While evidence on the assessment of obesity-related competencies in the UK and Ireland remains limited, analyses from the United States corroborate these findings, showing that obesity is often under-represented, or entirely absent, in both licensing examinations and specialist board certifications [24, 29]. The result is that students do not treat obesity care as a core competency. Third, the surgical visibility bias explains why bariatric surgery is over-represented; education around bariatric surgery is reported consistently to be more structured, visible, and examinable, whereas lifestyle and pharmacological interventions remain under-developed in curricula. This reinforces the hidden curriculum phenomena that subtly communicates to students what is or is not important to learn as a clinician.

A recurring theme was the lack of emphasis on obesity as a chronic, heterogeneous disease rather than simply excess weight. This framing gap leaves graduates without tools to manage obesity alongside other chronic conditions such as diabetes or hypertension. Participants rarely reported exposure to staging systems (e.g., Edmonton Obesity Staging System) that account for individual heterogeneity including differences in contributing factors, complications, and psychosocial context. Without such frameworks, HCPs in our study default to weight-centric approaches, overlooking the wider clinical and functional consequences of obesity - which remains consistent in the literature in reports on patient attitudes to patients with obesity [30, 31]. This does patients injustice as the holistic assessment of the complexity of obesity is not addressed in the diagnosis stage, which is being increasingly recognised with the Lancet Commission’s diagnostic criteria for obesity that recognises pre-clinical obesity [32]. A weight-centric approach to obesity, which prioritises body mass reduction as the primary indicator of health, implicitly pathologizes higher body size and conflates weight with personal responsibility [33–35]. This narrow framing neglects the multifactorial biological, psychological, and social determinants of obesity, and in doing so reinforces negative stereotypes of individuals with higher weight as non-compliant or morally deficient [31]. Embedding disease-specific frameworks into teaching could help graduates recognise obesity as a complex, chronic disease requiring tailored management.

Minimal formal training in weight stigma and counselling emerged as a significant deficit. This is an extremely pressing concern, as up to 42% of adults with obesity experience weight discrimination [36]. Participants described discomfort initiating weight-related discussions, reflecting both lack of skills and fear of causing offence. The clinical impact is profound: avoidance of conversations, delayed interventions, and perpetuation of stigma in healthcare settings [36, 37]. Many clinicians tend to avoid addressing the issue due to a lack of confidence in their ability to do so without negatively impacting the clinician-patient relationship [38]. Contributing factors include discomfort in discussing obesity [39], perceptions that such counselling is futile [40], and the belief that it falls outside their remit [15, 16, 39]. These attitudes, often formed during medical training, remain largely unchanged throughout their career [19]. Specifically, doctors report that they are not skilled in strategies to provide effective obesity counselling or signposting to community resources [16]. This is a missed opportunity for optimal care as patients are more likely to try to lose weight following physician advice [40]. Fear of offending the patient and jeopardizing the therapeutic relationship were also highlighted as significant barriers [38, 41], underscoring the importance of training in addressing these concerns of clinicians.

The educational deficits identified in this study have direct and compounding consequences for patients living with obesity. When obesity is framed as a peripheral risk factor rather than a chronic, heterogeneous disease, clinicians default to generic, weight-centric advice that fail to account for individual drivers and complications. Patients have previously demonstrated that when HCPs acknowledge obesity beyond weight, including its genetic and multifactorial components, they experience less stigma and feel more empowered to seek clinical treatment and advice [42, 43]. The absence of training in the background science of obesity and stigma-aware communication leaves clinicians uncertain about how to initiate “weight conversations,” which in turn fosters encounter avoidance, brusque or moralising language, and patient perceptions of blame [30, 31, 44]. These interactions are linked to care delay, medical mistrust, lower adherence, and worse clinical outcomes, and can precipitate internalised stigma and maladaptive coping (e.g., care avoidance, disordered eating). Limited exposure to staging frameworks means heterogeneity is missed in practice: patients with medication-induced weight gain, sleep apnoea, osteoarthritis, or PCOS receive the same one-size-fits-all advice, while iatrogenic drivers (e.g., antipsychotics, steroids) may not be appropriately unaddressed. This weight-centric approach to obesity combined with a lack of skills in navigating weight stigma can further perpetuate the very stigma, and worsen health outcomes [36]. Inadequate pharmacotherapy training further narrows the therapeutic options, leading to effective, guideline-supported agents to be underused or deferred, and patients are not counselled on indications, monitoring, or alternatives; similarly, weak referral literacy delays access to dietetics, physiotherapy, psychology, and community programmes. An over-visible surgical pathway, uncoupled from balanced teaching about lifestyle and pharmacotherapy, can skew expectations (over- or under-referral) and compromise peri- and post-operative shared decision-making. Finally, because curricula do not reliably provide evidence-based content, trainees fill gaps with non-academic sources of variable quality, amplifying practice variability and inequity in who receives effective, stigma-free care. Together, these mechanisms may translate educational omissions into real patient harm - missed opportunities for early intervention, avoidable progression of comorbidities, and inequitable access to comprehensive, person-centred obesity care.

HCP’s reported reliance on external, non-academic sources (such as social media, podcasts, commercial courses) to fill knowledge gaps is also a notable finding. This reliance is not surprising given the limited formal teaching reported, but it carries risks of inconsistent quality and potential misinformation. In a study of Instagram posts on obesity, only 17% of posts came from doctors, while the health and wellness industry contributed 54.52%. Correct posts from doctors, nurses, and hospitals made up 54.93%, while others accounted for 37.7% [45], demonstrating the unreliability of this as a source of education. This highlights the urgent need for structured, evidence-based education to equip future clinicians with the skills and confidence to manage obesity effectively. A systematic review found that even short, brief interventions (less than three hours in duration) were effective in improving knowledge in obesity management [46]. It also highlights a missed opportunity: if health professional curricula do not provide credible, evidence-based training, trainees will inevitably seek knowledge elsewhere, fragmenting standards of care.

Actionable reforms

To address these systemic gaps, clinical education is recommended to include obesity-specific assessment-linked competencies, supervised clinical exposure, and referral skills. Crucially, embedding obesity into assessments such as MCQs, OSCEs, and workplace-based tools may drive student engagement and signal the legitimacy of obesity care as core practice [24, 27].

Competing curricular priorities must also be acknowledged. Health professional training is already densely packed, and not all graduates will go on to specialise in obesity management. This makes it unrealistic to expect extensive, disease-specific teaching in undergraduate curricula. Instead, the priority should be on embedding broad, cross-cutting competencies that every clinician will need in practice. These include initiating weight-related discussions in a way that mitigates stigma, adopting patient-centred and health-gain–oriented approaches, understanding the wider health system in which obesity care is delivered, and developing the skills to signpost appropriately to available services. Framing these as generic clinical competencies rather than specialist skills positions obesity education alongside other core chronic disease management tasks, ensuring that all graduates, regardless of specialty, are prepared to engage with people living with obesity in a safe, respectful, and evidence-based manner.

Even when healthcare graduates receive structured teaching in obesity management, they will not attain the depth of expertise that comes from several years of specialised training. This underscores the importance of teaching appropriate referral as a core competency in obesity management. Curricula should emphasise that optimal care requires interdisciplinary collaboration, where each member of the MDT is comfortable initiating weight discussions when appropriate, and directing the patient to the most appropriate MDT discipline for their care. Embedding referral pathways into teaching, case discussions, and assessments would normalise collaborative practice, reinforce professional boundaries, and ensure that patients benefit from comprehensive, team-based care.

This study has several strengths. By including graduates from medicine, dietetics, nursing, physiotherapy, and occupational therapy, it provides cross-disciplinary perspectives on obesity education, allowing themes to emerge beyond a single profession, and reflecting the multidisciplinary importance of obesity management. The inclusion of early-career clinicians, all of whom had graduated within the preceding two years, allowed insights that are recent and therefore less subject to recall decay.

There are also important limitations. Recruitment was restricted to the UK and Republic of Ireland to ensure comparability across similar training and regulatory frameworks, which may limit transferability to other international contexts. Participation was voluntary, creating the possibility of self-selection bias, and it is possible that those with stronger opinions about obesity training were more likely to participate. However, no participant expressed an interest in specialising in obesity. As with all self-report studies, recall bias and social desirability may also have influenced participants’ accounts, particularly around sensitive issues such as stigma. Finally, while online interviews improved accessibility, they may have constrained rapport compared to in-person settings. As with all qualitative work, the findings should be interpreted in terms of their transferability to similar contexts rather than statistical generalisability.

Conclusions

Without structured teaching, supervised clinical exposure, and assessment-linked competencies, graduates remain under-prepared to provide comprehensive, stigma-free obesity care. Clinical education as it stands currently leaves many gaps in the competency of healthcare professionals in navigating the complexity of the growing healthcare burden of obesity. Addressing obesity as a chronic, heterogeneous disease and equipping trainees with communication skills, referral pathways, and evidence-based management tools is essential if future healthcare professionals are to meet the needs of people living with obesity.

Authors’ contributions

LK, CLR, and WA conceived and designed the study. LK recruited participants and conducted the semi-structured interviews. LK and FC performed the data analysis and drafted the manuscript. CLR, WA, and FC critically revised the document and approved the final version of the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding

This research was funded by the European Commission’s Erasmus Mundus Design Measure grant number 101128158.

Data availability

The data generated and analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Prior to data collection, informed consent was obtained from all participants. Ethical approval for the study was granted by the UCD Human Research Ethics Board (Reference: LS-24-69-Najim). This study was conducted in accordance with the Declaration of Helsinki and its later amendments. Interview transcripts were anonymized, with identifying information removed during transcription. Audio recordings were deleted after transcription and were not retained or copied beyond the initial analysis phase. No identifiable data is included in this manuscript. Clinical trial number: not applicable.

Consent for publication

All authors and participants consent for this study to be published.

Competing interests

CLR reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, Keyron, and Boehringer Ingelheim. CLR is a member of the Irish Society for Nutrition and Metabolism, outside the area of work commented on here. He served as the Chief Medical Officer and Director of the Medical Device Division of Keyron in 2021. Both were unremunerated positions. No patients have been included in any of Keyron’s studies, and the company is not publicly traded. CLR was gifted stock in Keyron in September 2021 and divested all holdings the same month. He continues to provide scientific advice to Keyron without remuneration. W.A.-N. reports honoraria for presentations from Novo Nordisk and Boehringer Ingelheim. W.A.-N. provides dietetic services to ProHealth365 Physiotherapy & Nutrition and BeyondBMI, private obesity clinics.All other authors declare no conflicts of interest.