To the editor:—Similar to Ruser et al.,1 our Internal Medicine residency has also been studying obesity identification and management. In addition to an ambulatory chart review, for 3 years incoming residents were surveyed. In our chart review of resident practices at the Norwalk Community Health Center, structured similarly to a federally qualified health center,2 weight was documented in 63% of the charts reviewed and body mass index (BMI) in only 4%.3
There has been a trend of increasing awareness of obesity and its management among surveyed physicians in training. Over the last 3 years, 56 of 75 incoming residents (74.6%) completed a survey adapted from the literature using a 5-point Likert scale.3 Residents reported that maintenance of BMI in healthy range is important (98.2%) and that treatment for obese patients should be offered (67.8% when BMI>25 compared with 32.1% when BMI>30). Futhermore, 80.3% disagreed when asked whether treatment for overweight should be offered only when other risk factors such as Type II diabetes or hypertension are present.
Residents noted their lack of training in managing overweight and obesity (only 32.1% and 26.7% felt that they are professionally well trained to manage overweight and obese patients, respectively). Finally, residents compared self-rated importance of different approaches for weight management with their personal use of these approaches with their patients. As expected, self-reported practice fell short of self-rated importance: patient weight history (usually done 10.7% vs important 80.3%); dietary habits (usually done 10.7% vs important 482.1%); physical activity habits (usually done 12.5% vs important 85.7%); and readiness for change at first contact (usually done 5.35% vs important 80.3%). As seen with other physicians, it is challenging to integrate weight management into medical practice.4–6
These results expand on the study published recently in JGIM and reinforce the importance of improving practice among Internal Medicine residents toward obesity. It is critical that trainees become prepared to deal with what is one of the largest growing epidemics facing health care today and in the future.
REFERENCES
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