SCIENTIFIC
Rural Obesity Medical Education for Primary Care in West Virginia : A Needs Assessment
AUTHORS : Laura Davisson , MD , MPH , FACP 1 , 3
Melissa A . Hernandez-Pachon , BS 2 Treah S . Haggerty , MD , MS 3 , 4
1
Department of Internal Medicine , West Virginia University School of Medicine , Morgantown , WV
2
West Virginia University School of Medicine , Morgantown , WV , MS3
3
WVU Medicine Medical and Surgical Weight Loss Center ’ s Medical Weight Management Program , Morgantown , WV
4
Department of Family Medicine , West Virginia University School of Medicine , Morgantown , WV
CONFLICTS OF INTEREST :
The authors do not have any commercial or proprietary interest in any drug , device , or equipment mentioned in this article .
INTRODUCTION
Obesity is a serious disease associated with adverse health effects and costs . Its predominance has increased since the 1970s . The prevalence of persons with obesity in the United States adult population was 42.4 % in 2017-2018 . 1 The American Medical Association declared obesity to be a chronic disease in 2013 . 2 Since then , professional societies , such as the American Heart Association , American College of Cardiology , The Obesity Society , and others have recognized it as a disease and developed guidelines and recommendations of their own . The current philosophy of obesity medical experts is that obesity is a complex , chronic disease which needs lifelong treatment if patients are to achieve sustained weight loss and health benefits . 3
West Virginia ( WV ) is the only state located entirely in Appalachia , a region known for having health disparities and high rates of obesity and related conditions including hypertension , type 2 diabetes mellitus ,
ABSTRACT
INTRODUCTION Obesity is a serious disease associated with adverse health effects and costs . West Virginia ( WV ) has one of the highest obesity rates in the nation . Addressing obesity largely falls on primary care practitioners , but many feel ill-equipped to counsel patients on weight loss . It is critical for clinicians to be adequately trained to treat obesity . We conducted this study to assess the obesity medical education needs of WV primary care practices .
METHODS Data was collected from 17 health systems through WV Practice-Based Research Network ’ s Collective Outreach and Research Engagement survey . Survey results were analyzed using descriptive statistics to summarize demo graphics ; obesity treatment knowledge and confidence ; topics of interest ; and preferred educational delivery methods .
RESULTS
and cardiovascular disease . The Centers for Disease Control ( CDC ) and Prevention data from 2019 demonstrate that WV has one of the highest rates of obesity in the nation . 4 , 5 This rate continues to increase , reinforcing that obesity in WV is a widespread and grave issue . 5 It is therefore critical for WV clinicians to be adequately trained to address this condition . The American Board of Obesity Medicine certifies physicians to specialize in obesity medicine , but patients living in rural areas may not have access to the few practicing specialists in WV . Consequently , addressing obesity largely falls on primary care practices . Many primary care practitioners feel ill-equipped to counsel patients on weight loss which requires skills in the following areas : delivering lifestyle interventions , managing obesity pharmacotherapy , referring to specialty care when needed , and preventing regain in patients who have lost weight . 3
The majority of respondents agreed that medical training in obesity should be strengthened ( 96.4 %). Relatively low confidence levels were reported for prescribing anti-obesity medications ( 49.4 %), optimizing chronic medications for weight ( 61.0 %), and counseling / managing patients before / after bariatric surgery ( 52.4 %). Highest reported interest levels were in strategies for discussing weight with patients ( 87.2 %), food and nutrition ( 85.7 %), physical activity plans ( 84.4 %), motivational interviewing ( 84.0 %), and optimizing chronic medications for weight ( 79.2 %). The highest rated educational delivery method was virtual Continuing Medical Education ( 91.5 %) with lecture format ( 89.0 %).
CONCLUSIONS These results can be used to develop obesity medical education for primary care that can ultimately help to reduce health disparities in rural WV . An educational plan should ideally be delivered in virtual lecture format and should address lifestyle modifications , motivational interviewing , bariatric surgery , and obesity pharmacotherapy .
Primary care practitioners in WV need to have a strong foundation in obesity management to provide optimal care for this prevalent condition . This manuscript describes an assessment of the unique obesity medical education needs of WV primary care practices . This study sought to determine this group ’ s specific topics of interest and preferred education delivery methods . These results can be used to develop obesity medical education to ultimately help to reduce health disparities in rural WV .
METHODS
This study was approved by the West Virginia University Institutional Review Board . Data was collected through West Virginia Practice-Based Research Network ( WVPBRN ) annual Collective Outreach and Research Engagement ( CORE ) survey . The CORE survey consists of a limited number of questions compiled throughout the year and released annually to health-
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