Whether you are a GI fellow interested in weight loss treatments and, perhaps, incorporating them into your practice one day or headed toward a different area of practice, encountering and caring for obese patients is a significant part of today's gastroenterology care. Here, I share tips and insights to help fellows improve their management and learning of obesity during fellowship.
- Get back to the basics with compassion. The American Medical Association did not recognize obesity as a disease state that required treatment and prevention efforts until 2013. Obesity is a complex disease that goes beyond simple lack of knowledge and encompasses rather unmodifiable factors such as genetics and socioeconomic background. Therefore, treating patients with obesity requires a high degree of compassion and sympathy. The vast majority of obese patients live with obesity for years, as only 3% of individuals who undergo only lifestyle and dietary changes achieve their weight loss goals.
- Prepare for unique patient needs. Patients with large body habitus require special attention in clinics and procedures. A simple example is having a proper size cuff for blood pressure, dedicating adequate time for clinic visits, and managing goals and expectations. Ensuring periprocedural preparations are made, such as discussing with anesthesia teams prior to starting, having a plan for safely transferring from and to a stretcher, using the correct scope choice for colonoscopy, and expecting longer recovery after certain interventions.
- Maximize your learning opportunities. Because many fellowship programs lack a curriculum for obesity, it is important to familiarize yourself with the latest literature and maximize the learning opportunities outside of your institution. Multiple well-designed trials have been published this past year alone on the new GLP-1 and GIP receptor agonists. FDA approvals have been granted for two new agents since 2021, and more studies are underway for newer targets (such as triple G receptor agonists). Endo-bariatrics is a field that continues to grow, especially with gastric and duodenal-focused interventions. Data is key, and knowing more will make providing care and progress in the field easy.
- Connect with weight loss experts. Find who is doing weight loss treatments at your home institute. Sometimes, endocrinologists and nutrition physicians are the ones taking the lead. If so, approach them and try to use your electives in your second or third year to work in their clinics after asking for your program approval.
- Deepen your knowledge through networking. Join workshops and networking groups. ASGE usually conducts networking events for fellows at DDW. That is an ideal opportunity to meet experts and collaborate. Another option is to join the Association for Bariatric Endoscopy, a division of ASGE.
- Take the obesity boards. The requirements usually include different pathways: completing a continuing medical education course or doing a fellowship in obesity medicine. A few approved courses can be found on the American Board of Obesity Medicine website. This also helps with marketing your practice once you start.
- Get involved in research projects focusing on obesity. If your home institute lacks a mentor in this field, consider reaching out to others in the field. ASGE offers a mentorship program (Beyond the Scope) and other valuable resources to help you start a meaningful collaboration that enhances your early career. The application process for the ASGE Mentorship Program begins in June. Learn more.
Danny Issa, MD, UCLA Health, Los Angeles, CA, is an assistant professor of medicine at UCLA and a member of the ASGE
Membership Engagement Committee.