title: Can our residents carry the weight of the obesity crisis? A mixed methods study.
abstract: BACKGROUND
  Obesity is a worldwide problem and has reached epidemic proportions in the Middle East. Although physicians are in a unique position to counsel and treat their obese patients, little is known about healthcare provider management of obesity in this region of the world. The purpose of this study is to assess resident physician diagnosis and management of obese patients, and barriers to obesity management in the United Arab Emirates.
  
  
  METHODS
  We conducted a retrospective medical records review of an internal medicine resident clinic in an academic medical centre in the UAE. A focus group was then held with a convenience sample of 20 Internal Medicine residents. Questions were aimed at understanding barriers to obesity diagnosis and management. Focus group discussions were analysed using qualitative thematic analysis.
  
  
  RESULTS
  Of 155 patients seen in resident clinic in 2012 and 2013 (representing 766 patient encounters), 50 (32%) met the criteria for overweight, and 102 (66%) met the criteria for obesity. Despite the high prevalence, only 9% had documentation of BMI or obesity in their medical record. Six percent were offered diet or exercise advice, and 6% were referred to a dietician. Focus group results indicated residents had sufficient knowledge, but lacked training in obesity management and adequate time for counselling. Weight biases and feelings of incompetence may exist among our trainees.
  
  
  CONCLUSIONS
  Obesity is under-recognised and under-treated by our residents. The findings confirm that a significant gap exists between optimal obesity management recommendations and the current practices of our trainees.
authors.affiliation: Department of Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates; Johns Hopkins School of Education, Baltimore, MD, USA. Electronic address: hibrahi4@jhu.edu.
authors.forename: Halah
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Department of Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates.
authors.forename: Aydah Al
authors.initials: AA
authors.lastname: Awadhi
authors.affiliation: College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
authors.forename: Sami
authors.initials: S
authors.lastname: Shaban
authors.affiliation: Department of Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates.
authors.forename: Satish Chandrasekhar
authors.initials: SC
authors.lastname: Nair
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002983:Clinical Competence; D003131:Combined Modality Therapy; D057210:Delayed Diagnosis; D057286:Electronic Health Records; D058872:Epidemics; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D014479:United Arab Emirates / Q000453:epidemiology; D000078329:Workforce; D055815:Young Adult
keywords: Medical education; Middle East; Obesity; Residency