obesity medicine

[Doc446]

Hi everybody ,
I am a physician board certified in Internal medicine and practicing for 15 yrs ,I am looking to add some additional training and certification without having to go through a formal fellowship program . I've heard of obesity medicine and integrative medicine. Does anyone know about these programs or any others that may be useful?
Thank you

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[Raryn]

Hi everybody ,
I am a physician board certified in Internal medicine and practicing for 15 yrs ,I am looking to add some additional training and certification without having to go through a formal fellowship program . I've heard of obesity medicine and integrative medicine. Does anyone know about these programs or any others that may be useful?
Thank you

Integrative medicine as far as I know is (much like "functional medicine") pseudoscientific crap. Can probably make a lot of money peddling supplements, but it's nonsense.

Obesity medicine is a real field that does have a few fellowships, but the fellowships are not required to actually practice in it as of yet. Most of it is either PCPs or Endocrinologists who are interested in focusing on weight loss interventions such as medically supervised weight loss, medical nutrition therapy (including a subset of folks who peddle meal replacement plans), use of FDA approved weight loss medications, and the peri-bariatric surgery process. There's a certifying board (ABOM - https://www.abom.org ) and all that is required to certify (if you don't do a fellowship) is going to an obesity conference for 30 CME, then doing 30 additional hours of CME (60 total) related to obesity, then taking the test (offered in February each year iirc).

I've considered pursuing obesity certification myself, but the whole process is probably $5-6k worth of CME + exam.

 

[IM2GI]

Integrative medicine as far as I know is (much like "functional medicine") pseudoscientific crap. Can probably make a lot of money peddling supplements, but it's nonsense.

Obesity medicine is a real field that does have a few fellowships, but the fellowships are not required to actually practice in it as of yet. Most of it is either PCPs or Endocrinologists who are interested in focusing on weight loss interventions such as medically supervised weight loss, medical nutrition therapy (including a subset of folks who peddle meal replacement plans), use of FDA approved weight loss medications, and the peri-bariatric surgery process. There's a certifying board (ABOM - https://www.abom.org ) and all that is required to certify (if you don't do a fellowship) is going to an obesity conference for 30 CME, then doing 30 additional hours of CME (60 total) related to obesity, then taking the test (offered in February each year iirc).

I've considered pursuing obesity certification myself, but the whole process is probably $5-6k worth of CME + exam.

You will also continue to see a rise in GI taking a leadership role in obesity management with the rise of new devices and bariatric endoscopy.

 

[Raryn]

You will also continue to see a rise in GI taking a leadership role in obesity management with the rise of new devices and bariatric endoscopy.

I thought about mentioning those as they are something that is within the wheelhouse of the bariatric medicine specialist (that is, assessing the appropriate patient for it, managing them around that, sending them to GI), but I'm actually quite skeptical of the utility of the GI devices. Personally I think the Aspire Assist is medicalized Bulimia and cannot think of a single patient it would be appropriate for - I can't actually believe anyone at the FDA approved it. The gastric balloons and whatnot are better - but I'm skeptical of the long-term outcomes as compared to something like a Sleeve.

 

[IM2GI]

I thought about mentioning those as they are something that is within the wheelhouse of the bariatric medicine specialist (that is, assessing the appropriate patient for it, managing them around that, sending them to GI), but I'm actually quite skeptical of the utility of the GI devices. Personally I think the Aspire Assist is medicalized Bulimia and cannot think of a single patient it would be appropriate for - I can't actually believe anyone at the FDA approved it. The gastric balloons and whatnot are better - but I'm skeptical of the long-term outcomes as compared to something like a Sleeve.

We can do endoscopic sleeves now, and our portfolio will only continue to expand. I 100% agree with you re: Aspire and would never put one in a patient or use it in my practice. Newer modalities like duodenal resurfacing are also showing promise and others in the pipeline. I also see a role for meal replacement programs as they can be very effective if implemented correctly. Do you "peddle" metformin? "Food as medicine" is going to be an increasingly important concept as the obesity epidemic continues to rise.

If I had to guess, the realm of bariatric surgery will continue to shift more and more towards endoscopists over the next decade.

 

[Raryn]

We can do endoscopic sleeves now, and our portfolio will only continue to expand. I 100% agree with you re: Aspire and would never put one in a patient or use it in my practice. Newer modalities like duodenal resurfacing are also showing promise and others in the pipeline. I also see a role for meal replacement programs as they can be very effective if implemented correctly. Do you "peddle" metformin? "Food as medicine" is going to be an increasingly important concept as the obesity epidemic continues to rise.

If I had to guess, the realm of bariatric surgery will continue to shift more and more towards endoscopists over the next decade.

The peddling was really just throwing shade at the profit motive if you're the one actually selling the product. I prescribe plenty of drugs and devices - but I don't *sell* any.

 

[IM2GI]

The peddling was really just throwing shade at the profit motive if you're the one actually selling the product. I prescribe plenty of drugs and devices - but I don't *sell* any.

I just think it's interesting that if CVS makes money off of you prescribing an appropriate therapy that is fine, but if a practice makes money off of an appropriate therapy that is inherently a bad thing? I certainly agree that the strip malls full of "weight loss centers" selling mostly scams and supplements are not where we want to be going with obesity management.

I suspect as payment models continue to evolve into bundled services you will start to see expanded ancillary services offered by physician practices. Ophthalmologists have been doing this for years with integrated optometry/eye shops. I don't think these are inherently evil or to be shunned if they are providing a good related service to patients.