Teaching Medical Students to Help Patients Manage Their Weight: Outcomes of an Eight-School Randomized Controlled Trial

ABSTRACT BACKGROUND Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts. OBJECTIVE To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change. DESIGN A pair-matched, group-randomized controlled trial (2015-2020) included students enrolled in eight U.S. medical schools randomized to receive either multi-modal weight management education (MME) or traditional weight management education (TE). SETTING/PARTICIPANTS Students from the class of 2020 (N=1305) were asked to participate in an objective structured clinical examination (OSCE) focused on weight management counseling and complete pre and post surveys. A total of 70.1% of eligible students (N=915) completed the OSCE and 69.3% (N=904) completed both surveys. INTERVENTIONS: The MME implemented over three years included a web-based course, a role-play classroom exercise, a web-patient encounter with feedback, and an enhanced clerkship experience with preceptors trained in weight management counseling (WMC). Counseling focused on the 5As (Ask, Advise, Assess, Assist, Arrange) and patient-centeredness. MEASUREMENTS The outcome was student 5As WMC skills assessed using an objective measure, an OSCE, scored using a behavior checklist, and a subjective measure, student self-reported skills for performing the 5As. RESULTS Among MME students who completed two of three WMC components compared to those who completed none, exposure was significantly associated with higher OSCE scores and self-reported 5A skills. LIMITATIONS Variability in medical schools requiring participation in the WMC curriculum. CONCLUSIONS This trial revealed that medical students struggle with delivering weight management counseling to their patients who have overweight or obesity. Medical schools, though restrained in adding curricula, should incorporate should incorporate multiple WMC curricula components early in medical student education to provide knowledge and build confidence for supporting patients in developing individualized plans for weight management. NIH Trial Registry Number R01-194787

Nutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida

Nutritional challenges and a lack of activity can lead to health problems across the lifespan for people with spina bifida. Children and adults with spina bifida are also at greater risk of being classified as overweight or obese compared to their peers without the condition. Therefore, early recognition of nutrition problems, weight management counseling, and timely referrals for evaluation and management of diet and activity can help those with spina bifida and their families achieve a healthy lifestyle. This article details the development of the Nutrition, Metabolic Syndrome and Obesity Guidelines, which are part of the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida. It discusses the identification and management of poor nutrition and prevention of obesity for children, adolescents, and adults with spina bifida and highlights areas requiring further research.

Weight Management Counseling (WMC)p07 During Primary Care Clerkships: Preceptors Perceived Skills, Attitudes and Frequency of Modeling WMC to Students (P07-001-19)

Objectives The United States Preventive Services Task Force (USPSTF) 2018 guideline for the management of adults with obesity continues to support screening and offering or referring patients with obesity to intensive multi-component behavioral intervention. Training the primary care work force is important for implementation of guidelines. It is unclear to what degree medical school preceptors provide weight management counseling (WMC) training during primary care core clerkships. This study seeks to describe preceptors’ perceived skills and attitudes towards providing WMC to patients and the frequency of preceptors modeling WMC to medical students. Methods Primary care preceptors (family/community medicine and ambulatory internal medicine) from medical schools participating in a larger multi-modal curriculum intervention were recruited to participate in an anonymous 10-minute cross-sectional survey on their perceived skills, attitudes, and modeling WMC to medical students. Results The survey was completed by 77 eligible preceptors (response rate of 33%). Preceptors perceived themselves to be moderately skilled in WMC, with a perceived WMC skills mean of 2.8, sd 0.56 (range 1–4). Their mean attitudes score was 2.1, sd 0.5 (range 1–4). Preceptors agree they have a responsibility to provide WMC and can be effective with patients. Preceptors report sometimes modeling WMC behaviors to medical students, the mean was 3.26, sd 0.48 (range 1–5). Of those preceptors who never/rarely model referrals, the most common reason was lack of resources followed by patient cost barriers. Conclusions Preceptors do not consistently model WMC for medical students during primary care core clerkships. Skill perception and resource availability may contribute. Funding Sources Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1-TR001454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Evaluation of cancer patients’ perspectives on weight management counseling at a comprehensive cancer center.

e18041 Background: Over 2/3 of Americans are Overweight (OW) or obese (OB). Being OW or OB is a risk factor for a variety of cancers & denotes a worse prognosis for some. Evidenced based strategies on management of OW & OB patients (pts) are lacking. Data shows the majority of physicians are OW & OB and confidence in obesity counseling in these individuals is less compared with normal weight (NW) counterparts. Here we report the results of a survey on cancer pt’s opinions weight management counseling. Methods: An HRPP exemption was obtained. Pts asked to complete a 20-question (Q) survey. Clinical info collected: age, race, cancer type, weight class (underweight, NW, OW, OB, unsure but likely overweight). Survey Qs asked about optimal timing, type of weight counseling preferences. Also, Qs regarding importance of their oncologists (ONCO) BMI assessed. Secondary Qs about pt risk factors for obesity, pt willingness, & pt preferred modalities to change dietary & exercise habits also assessed. Statistical analysis: One-way ANOVA used to compare mean responses. P-values reported α = 0.05. Results: 245 cancer pts completed the survey. Demographics: 53% white, 37% black, 8% multiracial, 1% American Indian, 1% Asian. Majority of pts 51-65 years old (55%) and female ( > 75%). 71% (175/245) of pts were OW or OB vs. 29% (70/245) of pts with normal weight. 78% (191/245) of pts had breast cancer vs. 22% (54/245) other cancers. Main results: The best time for an ONCO to address weight reduction with pts is? “Anytime” = 45% (111/245), “First visit” = 27% (65/245), “After primary treatment” = 27% (65/245), “Never” = 1% (2/245) (p < 0.01). The approach pts prefer ONCO use to counsel on weight reduction is? “Educational approach” = 26% (65/245), “Direct approach” = 24% (59/245), “Passive approach” = 8% (20/245), “Passive & educational” = 18% (44/245), “Direct & educational” = 18% (43/245), “Other approaches” = 5% (12/245), “No approach, I don’t want counseling” = 1% (2/245) (p < 0.01). Who would you listen to MOST about weight loss advice? “Normal weight ONCO” = 41% (101/245), “The BMI of my ONCO does not matter” = 53% (131/245), “OB or OW” 5% (13/245) (p < 0.01). Results of secondary Qs included in presentation. Conclusions: Almost all pts would like to discuss weight loss with their oncologist on the first visit or after primary treatment has been completed. Also, most pts would like to receive counseling by their oncologist regardless of their oncologist’s weight. Furthermore, pts seem to prefer education about why weight loss is important be included in their weight loss counseling.

Six Month Abstinence Heterogeneity in the Best Quit Study

Background Understanding the characteristics of smokers who are successful in quitting may help to increase smoking cessation rates. Purpose To examine heterogeneity in cessation outcome at 6 months following smoking cessation behavioral counseling with or without weight management counseling. Methods 2,540 smokers were recruited from a large quitline provider and then randomized to receive proactive smoking cessation behavioral counseling without or with two versions of weight management counseling. A Classification and Regression Tree (CART) analysis was conducted to identify the individual pretreatment and treatment characteristics of groups of smokers with different quitting success (as measured by point prevalence of self-reported smoking of any amount at 6 months). Results CART analysis identified 10 subgroups ranging from 25.5% to 70.2% abstinent. The splits in the CART tree involved: the total number of counseling and control calls received, whether a smoking cessation pharmacotherapy was used, and baseline measures of cigarettes per day, confidence in quitting, expectation that the study would help the participant quit smoking, the motivation to quit, exercise minutes per week, anxiety, and lack of interest or pleasure in doing things. Costs per quitter ranged from a low of $US270 to a high of $US630. Specific treatment recommendations are made for each group. Conclusions These results indicate the presence of a substantial variation in abstinence following treatment, and that the total extent of contact via counseling calls of any type and baseline characteristics, rather than assigned treatment, were most important to subgroup membership and abstinence. Tailored treatments to subgroups who are at high risk for smoking following a quit attempt could increase successful smoking cessation.

Primary Care Providers Welcome Smartphone Apps That Assist in Pediatric Weight Management

Primary care providers (PCPs) have few resources to manage their overweight/obese patients. The purpose of study was to determine if technological resources, such as smartphone apps, may be useful for weight management counseling. PCPs were surveyed about their current use of resources for obesity management and whether smartphone apps would be helpful. Seventy-four PCPs completed the survey. Only 15% currently referred patients to smartphone apps at least sometimes or more often. When asked about features of apps, 66% were not aware of apps with interactive healthy eating games, yet if aware, 45% reported they would refer patients. Providers reported a greater likelihood of being more effective using an app compared with their current ability to manage overweight/obesity, 3.19 versus 2.85, P < .01. The majority of pediatric providers surveyed do not provide technological resources for their overweight/obese patients; yet, they appear interested in using smartphone apps as a resource.