Family Medicine Residency Breaks New Ground on Obesity Care
Extra Year to Provide Residents With Specialized Training, Leadership Opportunities
April 20, 2023, Michael Devitt — The Mercy Family Medicine Residency program at Mercy Hospital St. Louis in Missouri is taking an innovative approach to ensure that the next generation of family physicians are experts in obesity care.
The program recently received approval from the Accreditation Council for Graduate Medical Education and the ABFM to offer an optional fourth year to train residents in the prevention and management of obesity and related complications. The decision makes Mercy one of only a handful of family medicine residency programs in the United States that’s approved to provide future family physicians with an additional year of training, and the first to focus on obesity.
“As we considered our existing resources and program mission, we realized we had a unique opportunity to develop extra training in care of people who have obesity and associated conditions,” Mercy Family Medicine St. Louis Program Director Sarah Cole, D.O., told AAFP News.
“Many obesity management initiatives are led by subspecialists in tertiary care centers, which can be challenging for some patients to access,” Cole continued. “Because family physicians are not only their patients’ first point of contact, but often the ones managing those conditions associated with obesity, we decided to emphasize a community-based, primary care-led approach to management of obesity and its associated conditions.”
Ellie Hoover, D.O., a PGY-3 chief resident, will be the first person to enroll in the optional fourth year this fall.
“As family medicine physicians, we often manage the conditions that come from obesity, and prevention is more important than treatment after the fact,” Hoover said. “I’m lucky to have this opportunity to train for another year and continue working with amazing attending physicians.”
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Program at a Glance
During the additional year, residents will collaborate with Kara Mayes, M.D., medical director of Mercy Clinic Weight and Wellness, who will serve as core faculty and site director. They will work with multispecialty and interdisciplinary teams in behavioral and medical care related to obesity while also developing practical leadership. Residents will also learn how to assess for individual and community needs related to obesity management and prevention, and how to lead local initiatives to address these needs.
Individuals who complete the extra year of residency and achieve primary certification from the ABFM or the American Osteopathic Board of Family Practice will be eligible to sit for specialty certification from the American Board of Obesity Medicine.
Although the extra year is currently limited to one resident per class, Cole said Mercy might later expand the program to include more residents based on the availability of clinic space.
Cole outlined the program’s short- and long-term objectives with regard to patient health and the role of family physicians in patient education.
“The ultimate outcome of this year of training would be a decrease in the measured rates of obesity and related conditions, such as diabetes, hypertension, hyperlipidemia, gastroesophageal reflux, depression and anxiety in the populations served by graduates. This would be a long-term effect,” said Cole. “In the short term, we can measure steps along the way, such as establishment of weight management initiatives led by family physicians in communities where graduates practice, community stakeholder and patient satisfaction surveys indicating perceived effectiveness of these initiatives, or improved health metrics, such as lowered blood pressure or hemoglobin A1c in people with hypertension or diabetes.”
Statistics Indicate Worsening Obesity Crisis
The program’s decision to devote an extra year to training in obesity care comes as new evidence shows that obesity rates continue to climb.
A recent analysis of state-level data released by NORC (formerly the National Opinion Research Center) at the University of Chicago indicated that 42% of all U.S. adults have obesity, with the highest rates in the South and Midwest. A recent National Rural Health Association policy brief, meanwhile, said obesity rates are substantially higher in rural areas, due in part to health care workforce shortages and a lack of policies that fund and create more opportunities for rural health care professionals.
A March report from the World Obesity Federation predicted that 51% of the global population — more than 4 billion people — will have obesity by 2035, translating to more than $4 trillion per year in related health care costs.
In comparison, some organizations have estimated that as recently as 2008, the overall global obesity rate was between 12% and about 24%.
Cole said the continued rise in obesity helps explain the impetus for the additional training.
“The rate of obesity has escalated over the past decade for children and adults, so this is timely, important work,” said Cole. “We hope more programs adopt models similar to ours and we look forward to participating in learning collaboratives with them.”
Mercy’s decision to include an optional fourth year makes it something of an outlier, but the idea is not entirely new. The concept of a four-year family medicine residency has been presented elsewhere in the literature, and some programs that combine family medicine with another specialty may require as much as five years of training after graduating from medical school. On the other hand, some institutions have accelerated the medical school/residency process to as little as six years.
In Cole’s opinion, however, time should not be the overriding factor.
“Medical training has historically used duration of time as one surrogate marker for competence when determining which learners are ready for advancement to their next level of practice,” Cole said. “In reality, learners achieve competence in patient care and professional skills at different rates. Because of this, I do think it’s important that a medical student or resident have options for additional training across the specialty of family medicine.”