Scoping Review of Obesity-Related Nutrition Educational Interventions for Medical Students, Residents and Fellows - a Handful of Paradoxes?

Background: To our knowledge, no study assessed the published obesity-related nutrition educational interventions (ONEI) delivered to medical students, residents or fellows. The current scoping review undertook this task. Methods: We searched PubMed, Web of Science and EMBASE databases. Original articles of ONEI delivered to medical students, residents or fellows were included. The ONEIs’ goals, content, teaching and learning characteristics, health professionals involved, duration of the intervention, trainees, target populations, evaluation methods, and outcomes were scrutinized. Extracted data were categorized, condensed, and mapped to identify gaps. Results: Thirty six ONEI were included, mostly (88.8%) from North America. Physicians were the instructors in less than half the ONEI (44.4%), followed by dietitians (30.5%). Most ONEI (75%) were for medical students, 25% for residents, and none for fellows. The majority of ONEI (83.3%) were for adult patients with obesity (PWO), whereas 16.7% focused on childhood obesity. ONEIs’ overarching goals were to improve nutrition knowledge, skills and confidence in assessment, counseling, intervention, and attitudes towards PWO. The teaching and learning methods included face-to-face traditional lectures, oral presentations, case-based scenarios, interactive group discussions, simulated and standardized patient interactions and role play activities. Technology-based education modalities were also utilized such as online videos, web-based and computer-based learning. Other interventions involved culinary classes to deepen trainees’ understanding of nutrition and health. A range of evaluation tools was used to appraise effectiveness including pre- and post-surveys, multiple-choice questions, observed structured clinical examinations, learning essays and narrative reflections. The ONEI resulted in significant improvements in knowledge, competencies, confidence, nutrition assessment, counseling, weight management, and promoting healthy lifestyle. Positive improvements were also noted in communication skills, attitudes toward PWO, and in the trainees’ own personal behaviors. Conclusion: Obesity-related nutrition education does not appear to be sufficiently prioritized across the medical education continuum. The review also identified five paradoxes: (1) a slow developing evidence base of obesity-related nutrition education in the face of a fast-paced obesity epidemic; (2) only a minority of physician instructors participate in nutrition education, despite their complementary role to dietitians and the well-recognized benefits of collaborative nutrition training; (3) a low representation of ONEI outside of North America despite the global prevalence of obesity; (4) a dearth of ONEI delivered to residents, and none identified for fellows, despite the roles of these young physicians in delivering care to PWO. In addition, (5) ONEI targeting childhood obesity remain insufficiently emphasized, despite its significant long-term health consequences. These ‘mismatches’ suggest the necessity for efforts to enhance the obesity-related nutrition education for young physicians-in-training.