Addressing Disparities in Geographic Distribution of U.S. Obesity Medicine Physicians
Key findings
- As of February 2019, 2,577 U.S. physicians were certified by the American Board of Obesity Medicine
- The geographic distribution of those diplomates ranged from 36% in the South to 19% in the West
- Only 38% of the diplomates had training in a pediatric medicine discipline
- The number of available diplomates in each state did not necessarily match the burden of obesity in that state
According to a forecast by the U.S. Centers for Disease Control and Prevention (CDC), half of U.S. adults will be affected by obesity by 2030. The CDC has also determined that the South and Midwest have the greatest burdens of adult obesity, with nearly identical prevalence in those two regions.
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In multiple studies, primary care physicians have reported insufficient training about obesity management and low confidence in their ability to help patients lose weight. To address those problems, in 2011 the American Board of Obesity Medicine (ABOM) established a certification program in which physicians complete either an obesity medicine fellowship or 60 hours of continuing medical education, followed by an examination.
Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician-scientist at Massachusetts General Hospital, Kimberly Gudzune, MD, MPH, associate professor at the Johns Hopkins University School of Medicine, and colleagues recently studied the number and distribution of ABOM diplomates in the U.S. In Obesity, they report that many states do not have enough of these physicians relative to their prevalence of obesity.
Trained Physicians
From the ABOM member directory, the researchers identified 2,577 U.S. physicians who were certified as of February 2019. The average experience in the practice of obesity medicine was 4.6 years, and only one percent of the physicians had completed an obesity medicine fellowship.
The researchers divided physician training into three categories:
- 79% had training in an adult medicine discipline (internal medicine, family medicine, or internal medicine and pediatrics)
- 38% had training in a pediatric medicine discipline (pediatrics, family medicine, or internal medicine and pediatrics)
- 15% had training in surgery or other fields
Geographic Distribution of Physicians
The researchers grouped states into the regions defined by the U.S. Census Bureau. ABOM-certified physicians were distributed as follows:
- 36% in the South
- 23% in the Midwest
- 22% in the Northeast
- 19% in the West
All states had at least two ABOM-certified adult medicine physicians. California had the most at 204.
South Dakota had no ABOM-certified pediatric physicians and Vermont had only one; all other states had at least two. Texas had the most ABOM-certified pediatric physicians at 88.
The number of available diplomates in each state did not necessarily match the latest CDC data on the prevalence of adult and pediatric obesity. For example, the number of adults with obesity per ABOM diplomate ranged from 18,529 in Delaware to 104,442 in South Dakota. Even in the best-case scenario, then, it is unreasonable to expect ABOM-certified adult medicine physicians to care for all adults with obesity in their state.
How Important Is ABOM Certification?
These findings raise the question of whether all individuals affected by obesity should be cared for by an ABOM-certified physician. Other research has shown that, compared with primary care physicians, physicians preparing for the ABOM examination give higher effectiveness ratings to anti-obesity medications and bariatric surgery and place higher importance on the biologic basis of obesity.
In another study, obesity medicine physicians were more familiar with obesity management guidelines than primary care physicians, endocrinologists and cardiologists were, and they were more likely to have realistic expectations of the weight loss achievable with medications and bariatric surgery.
These differences may reflect a knowledge gap among physicians who have not had obesity medicine training. Primary care clinicians should consider which patients are candidates for referral to obesity medicine and know where ABOM-certified physicians are located in their state. The ABOM member directory is freely available online.
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