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”.