As trends go, obesity continues its climb to epidemic levels. Likewise, over the last five years the number of physicians certified in obesity medicine has increased tenfold. For clinicians who treat obese patients, getting certified in this specialty is a viable option.  

As the obesity epidemic — and the need for evidence-based responses — continues to grow, many endocrinologists are reacting by gaining certification in obesity medicine. It is one of the newest and fastest growing fields of medicine, increasing from 200 board-certified obesity doctors in 2012 to almost 2,000 today.

“I got certified in obesity medicine because I wanted to push the field in an academic direction,” says Rekha Kumar, MD, an endocrinologist who is an assistant professor of medicine at Weill Cornell Medical College, New York, N.Y. “I felt like there should be strong guidelines, structure, and certain criteria that a physician who treats patients with obesity should meet. Just the way we do in any other field. My typical patients have fairly complex hormonal issues, with some kind of obesity problem as well. Obesity medicine overlaps several subspecialties, so being board-certified kind of forces you to understand some diabetes guidelines, lipid management, and hypertension, and basically to go back to the basics of a lot of metabolic disease.”

“I got certified in obesity medicine because I wanted to push the field in an academic direction. I felt like there should be strong guidelines, structure, and certain criteria that a physician who treats patients with obesity should meet.” – Rekha Kumar, MD, assistant professor of medicine, Weill Cornell Medical College, New York, N.Y.

The certification movement is an attempt to ensure the practice of evidence-based medicine in this relatively new field, according to Scott Kahan, MD, MPH, a member of the board of directors of the American Board of Obesity Medicine (ABOM) and medical director of the Strategies to Overcome and Prevent (STOP) Obesity Alliance at George Washington University. “Part of what ABOM is doing is standardizing the expected reasonable practices for obesity treatment and trying to weed out practitioners who are not practicing appropriately [with] evidence-based practices,” Kahan says.

“I practice obesity medicine in New York, where there are a lot of doctors who claim to do weight management,” Kumar says. “But when there is no proper licensure or board certification, sometimes you see practice habits or behaviors that might cross more into the cosmetic world or unregulated supplement world. Because I practice in an academic environment, I want to have a legitimate educational background and certification for my patients to know that I am practicing according to academic guidelines.”

The Certification ProcessThe ABOM obesity medicine certification process differs from those of other subspecialties in that there is no requirement for a fellowship or internship, which is a recognition that there are very few such training programs.

Certification requires completion of 60 hours of continuing medical education hours in obesity-related topics in 36 months, and passing an exam similar to those in other subspecialties. “We went through a very in-depth, systematic process to identify the key competencies that obesity medicine physicians need to know” in developing the exam, Kahan says. “We worked with the National Board of Medical Examiners to create appropriate, didactic testing for board certification.”

The American Board of Medical Specialties does not yet recognize the certification, but ABOM is working toward that goal. “It is about a decade-long process, and we are over halfway there,” Kahan says. He believes that ABMS recognition will be a step toward “better reimbursement for people who are certified in obesity. In the future, I anticipate that payers, whether Medicare or private payers, will select for board certification as a prerequisite for payment for specialists that are billing for obesity medicine services.”

Endocrinology is third among the specialties of those receiving certification, behind internal medicine and family medicine. Other specialties include obstetrics/gynecology, pediatrics, surgery, and gastroenterology.

Benefits of Certification

Kumar says that obesity is a complex disease, and “it is very difficult to treat if you haven’t been educated in it.” The certification process helped her learn the best practices for treating patients, for example, learning more about nutrition, a topic given little attention in most medical schools.

“I felt like there should be strong guidelines, structure, and certain criteria that a physician who treats patients with obesity should meet. Just the way we do in any other field. My typical patients have fairly complex hormonal issues, with some kind of obesity problem as well. Obesity medicine overlaps several subspecialties, so being board-certified kind of forces you to understand some diabetes guidelines, lipid management, and hypertension, and basically to go back to the basics of a lot of metabolic disease.” – Rekha Kumar, MD, assistant professor of medicine, Weill Cornell Medical College, New York, N.Y.

“Unless a physician understands the mechanism by which body weight is regulated, and what a complex disease obesity is, it is very difficult to treat,” she says. “You have to learn a fair amount of nutrition to take care of bariatric surgery patients, for example. It is easy to get lost in fad diets and things that are nonscientific. It is hard to differentiate the science from the non-science. What surprised me the most was learning the real science of basal metabolism and what determines how you burn calories. I think the biggest misconception for people who aren’t trained in this field is that there is one type of diet that is the proper diet to treat patients with obesity, when in reality, obesity is a very complex, heterogeneous condition, and a diet that is right for one person might not be right for another person.”

Choosing Among Options

Kahan says the advantage of board certification is that you have knowledge of the variety of obesity treatments, and can match patients with the most appropriate treatments. “I have everything at my fingertips. I don’t do surgery, but I have a number of surgeons that I refer appropriate patients to. I can talk to patients about what surgery is and what the expectations are and help to identify good candidates. I don’t do endoscopic procedures to insert gastric balloons, but I have a range of referrals, and I can talk to patients about the benefits and drawbacks of the procedures. Although I prescribe medications, they are not for everyone, and I can talk about the benefits and risks. I counsel on nutrition and behavioral changes, and I also have dietitians and behavioral specialists that I can refer patients to in our clinic,” he says.

“Board certification is the traditional accepted designation of professionalism in medicine, so if you are practicing obesity medicine, you should want to prove that by way of doing the requirements for certification and passing the exam to show that you have that expert level of knowledge and practice.” – Scott Kahan, MD, MPH, medical director, Strategies to Overcome and Prevent (STOP) Obesity Alliance, George Washington University, Washington D.C.

He says that obesity treatment is still “a ‘wild west’ sort of field. “You have lots of practitioners and clinics and strip mall centers that are doing some pretty crazy and inappropriate stuff around obesity treatment,” Kahan explains. “They are using supplements that have no data for efficacy for addressing obesity and that don’t have sufficient safety data. They are using concoctions of medications that are not approved for obesity and often selling them out of their offices. ABOM is standardizing the expected reasonable practices for obesity treatment and trying to weed out these practitioners who are not using appropriate evidence-based practices.”

Supporting the Field

“Board certification is the traditional accepted designation of professionalism in medicine, so if you are practicing obesity medicine, you should want to prove that by way of doing the requirements for certification and passing the exam to show that you have that expert level of knowledge and practice,” Kahan says.

“Another important reason to get certified is to support the movement of this field. We have worked hard over the past decade to take obesity medicine from an unrecognized field to one with a set of standards of knowledge and expertise. I think anyone involved in the field, even if they may not see immediate benefits in getting certified, has a responsibility to help move the field forward by supporting the ABOM and the process of board certification,” Kahan concludes.

Information on certification can be found at www.abom.org.

– Seaborg is a freelance writer based in Charlottesville, Va. He wrote about the increase in hip fractures in the May issue.