Obesity Medicine
Body of Knowledge

We communicate the body of knowledge for obesity medicine to the current and future obesity medicine physician workforce

Developing the Body of Knowledge

A practice analysis defines the content and breadth of a field of medicine, which is conducted periodically to remain up to date given the evolving nature of science and clinical practice. In Fall 2024, the American Board of Obesity Medicine published the results of an updated practice analysis and new content outline that defines the body of knowledge for obesity medicine.

This information is key for ABOM-certified physicians practicing obesity medicine, as current diplomates can use this resource to ensure that their clinical practice remains up to date with obesity medicine knowledge and skills.

Defining the Scope of Obesity Medicine

The body of knowledge is presented in the form of a content outline that is organized into the three primary duties of an obesity medicine physician: Evaluating, Examining & Diagnosing Patients, Treating Patients with Obesity, and Practicing Obesity Medicine with Professionalism. Under each of these duties, there are multiple tasks key to the practice of obesity medicine.

The information below may be helpful to physicians preparing for the obesity medicine certification exam, as it provides an easily accessible overview of the knowledge and skills necessary for an obesity medicine physician. Candidates should be sure to review the entire ABOM content outline for a comprehensive outline of the body of knowledge for the field. 

A. Evaluating, Examining & Diagnosing Patients

B. Treating Patients with Obesity

C. Practicing Obesity Medicine with Professionalism

A. Evaluating, Examining & Diagnosing Patients

A1. Weight History

  • Age of onset of abnormal weight gain or obesity
  • Weight trajectory
  • Normal and abnormal growth patterns in childhood
  • Contributors to weight change throughout the life course
  • Outcomes and adverse effects of prior weight-loss approaches including self-directed changes, structured programs, and healthcare professional directed treatments
  • Family history of obesity and obesity-related diseases and complications
  • Inheritance patterns suggestive of underlying syndromic or monogenetic obesity

    A2. Nutrition History

    • Current dietary intake and quality
    • Prior dietary patterns
    • Food intolerances, allergies, and preferences
    • Barriers to nutritional changes
    • Nutritional knowledge, including nutrition labeling on foods

      A3. Eating Behavior History

      • Age-appropriate healthy and unhealthy eating behaviors, including parent feeding styles
      • Appetite, food noise and hunger signals
      • Occasions of and triggers for overeating and non-homeostatic eating
      • Disordered patterns of eating, including emotional eating and stress eating
      • Evaluate and diagnose binge eating disorder
      • Evaluate and diagnose night eating syndrome
      • Clinical findings of other eating disorders (e.g., anorexia, bulimia, sleep-related eating disorder)

      A4. Physical Activity History

      • Current structured and unstructured physical activities, including assessment of frequency, intensity, time, type, and enjoyment
      • Prior physical activity regimens
      • Sedentary time
      • Exercise safety, including cardiorespiratory fitness, functional status, and balance
      • Barriers to physical activity changes
      • Physical activity knowledge

        A5. Sleep History

        • Age-appropriate sleep requirements and normal sleep patterns
        • Sleep duration, quality, and patterns
        • Sleep hygiene
        • Shift work
        • Circadian rhythm dysfunction

        A6. Medication & Supplement History

        • Prior and current use of FDA-approved obesity medications
        • Prior and current use of weight-promoting medications
        • Prior and current use of medications that may reduce weight
        • Over-the-counter medications, supplements, and vitamins that may influence weight status
        • Barriers to medication adherence and persistence

        A7. Neuropsychiatric History

        • Current depressive symptoms, history of depression
        • Current anxiety symptoms, history of anxiety
        • Current attention-deficit/hyperactivity disorder (ADHD) symptoms, history of ADHD
        • Clinical findings of other mental health conditions, history of other mental health conditions
        • Clinical findings of body image disorders or concerns (e.g., body dysmorphia)
        • Clinical findings of cognitive impairment
        • History of developmental delays

        A8. Social History & Social Determinants of Health

        • Family and cultural influences on health, including family/household structure
        • Educational attainment
        • Financial resources including insurance status
        • Occupational influences on health
        • Food and nutritional insecurity
        • Environmental characteristics that may impact food access and physical activity
        • Stress including stress management techniques
        • Stigmatizing experiences (e.g., discrimination, bullying), including instances of weight stigmatization
        • Adverse childhood experiences and psychosocial trauma as an adult (e.g., violence, abuse)
        • Prior and current use of tobacco, alcohol, marijuana, and illicit substances

         

          A9. History of Weight-Related Metabolic & Biomechanical Complications

          • Metabolic/endocrine conditions (e.g., insulin resistance, type 2 diabetes mellitus, metabolic syndrome, hypothyroidism, gestational diabetes)
          • Cardiovascular conditions (e.g., coronary artery disease, stroke, heart failure, dyslipidemia, hypertension, atrial fibrillation)
          • Gastrointestinal conditions (e.g., metabolic dysfunction-associated steatotic liver disease, gastroesophageal reflux disease, cholelithiasis, irritable bowel syndrome, hernias)
          • Musculoskeletal conditions (e.g., osteoarthritis, slipped capital femoral epiphysis, Blount’s disease, degenerative joint disease)
          • Pulmonary conditions (e.g., obstructive sleep apnea, obesity hypoventilation syndrome, asthma)
          • Neurologic or ophthalmologic conditions (e.g., idiopathic intracranial hypertension, migraines)
          • Renal or urologic conditions (e.g., focal segmental glomerulosclerosis, stress incontinence)
          • Gynecologic or reproductive conditions (e.g., premature/delayed puberty, menstrual cycle irregularities, polycystic ovarian syndrome, infertility, male hypogonadism, uterine fibroids)
          • Dermatological conditions (e.g., acanthosis, hidradenitis suppurativa, cellulitis, venous stasis)
          • Cancer (e.g., breast, ovarian, endometrial, esophageal, gastric, pancreatic, colon, prostate)

            A10. Diagnose Weight-Related Metabolic & Biomechanical Complications

            • Evaluate and diagnose prediabetes and type 2 diabetes mellitus
            • Evaluate and diagnose dyslipidemia
            • Evaluate and diagnose metabolic syndrome
            • Evaluate and diagnose essential hypertension
            • Evaluate and diagnose polycystic ovarian syndrome
            • Clinical findings of atherosclerotic cardiovascular disease
            • Clinical findings of heart failure
            • Clinical findings of arrhythmia
            • Clinical findings of metabolic dysfunction-associated steatotic liver disease
            • Clinical findings of gastroesophageal reflex disease
            • Clinical findings of osteoarthritis, slipped capital femoral epiphysis, Blount’s disease, and degenerative joint disease
            • Clinical findings of asthma
            • Clinical findings of obstructive sleep apnea
            • Clinical findings of idiopathic intracranial hypertension
            • Clinical findings of premature and delayed puberty
            • Clinical findings of lymphedema
            • Age-appropriate cancer screening tests

                A11. Diagnose Secondary Causes of Weight Gain or Obesity

                • Evaluate and diagnose thyroid dysfunction
                • Evaluate and diagnose menopause
                • Evaluate and diagnose hypercortisolemia
                • Evaluate and diagnose lipodystrophy
                • Evaluate and diagnose lipedema
                • Evaluate and diagnose other adipose tissue disorders (e.g., Dercum’s disease, familial multiple lipomatosis, Madelung’s disease)
                • Clinical findings of hypogonadism
                • Clinical findings of growth hormone deficiency
                • Clinical findings of insulinoma
                • Clinical findings of hypothalamic obesity

                A12. Diagnose Genetic or Syndromic Causes of Obesity

                • Evaluate and diagnose leptin and leptin receptor deficiencies
                • Evaluate and diagnose MC4R deficiency
                • Evaluate and diagnose POMC and PCSK1 deficiencies
                • Evaluate and diagnose Prader-Willi syndrome
                • Evaluate and diagnose Bardet-Biedl syndrome
                • Evaluate and diagnose Fragile X syndrome
                • Clinical findings of Albright’s Hereditary Osteodystrophy
                • Clinical findings of Wilson-Turner syndrome
                • Clinical findings of rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome
                • Clinical findings of Alström syndrome
                • Clinical findings of other genetic, monogenic and syndromic forms of obesity

                A13. Diagnose Obesity & Characterize Its Severity

                • Strengths and limitations of anthropometric measurements, including weight, height, waist circumference, and neck circumference, and related calculated measures including body mass index and waist-to-height ratio
                • Type and regional distribution of adipose tissue (e.g., white adipose tissue, visceral fat)
                • Body composition and body composition analysis, including reliability, indications, and contraindications for testing
                • Energy expenditure and energy expenditure testing, including reliability, indications, and contraindications for testing
                • Severity, disease prognosis and risk stratification using the Edmonton Obesity Staging System
                • Sarcopenic obesity
                • Adipocyte biology
                • Adaptive thermogenesis

                  B. Treating Patients with Obesity

                  B1. Discuss Obesity as a Complex Chronic Disease

                  • Physiology of weight regulation
                  • Neuroenterohormonal mechanisms regulating appetite, weight status, and energy metabolism
                  • Metabolic adaptation to weight reduction
                  • Theories of body weight regulation (e.g., set point theory)
                  • Established and emerging factors influencing weight regulation and obesity (e.g., microbiome, epigenetics, endocrine disruptors, viruses, inflammation, maternal obesity)
                  • Common misconceptions and biases about obesity and its treatments
                  • Expectations for treatment including targets, timeframes, and outcomes
                  • Age-appropriate weight reduction goals to achieve specific health benefits
                  • Age-appropriate weight trajectory for safe body mass index reduction

                    B2. Behavior Modification Counseling

                    • Stages of behavior change
                    • Readiness for change in patient or family members
                    • Goal setting
                    • Basic behavioral strategies (e.g., stimulus control, cognitive restructuring, mindfulness)
                    • Self-monitoring (e.g., self-weighing, journaling, smartphone applications, wearable devices)
                    • Sleep hygiene
                    • Stress management
                    • Changes in the home environment (e.g., family support, undermining, shopping patterns) and work/school environment (e.g., social support, undermining, food availability)
                    • Indications for cognitive behavioral therapy or other behavioral therapies

                        B3. Nutrition Counseling

                        • Composition of foods (e.g., ultra-processed foods, sweets, carbohydrates)
                        • Composition of beverages (e.g., caffeine, sodas, fruit juices, sugary drinks, sweet tea, alcohol)
                        • Dietary quality (e.g., sugar-sweetened beverages, ultra-processed food)
                        • Government-recommended dietary patterns and strategies (e.g., DASH, Mediterranean, vegetarian, My Plate)
                        • Macronutrient and micronutrient composition recommendations in weight-related complications including type 2 diabetes mellitus, dyslipidemia, hypertension and metabolic dysfunction-associated steatotic liver disease
                        • Indications, contraindications, benefits, and risks of different dietary strategies (e.g., low-calorie, very-low-calorie, low-carbohydrate, protein-sparing modified fast, ketogenic, intermittent fasting, time-restricted eating)
                        • Age- and sex-appropriate calorie targets for weight reduction and weight maintenance
                        • Age- and sex-appropriate caloric intake and portion sizes
                        • Recommendations regarding early childhood eating patterns (e.g., breastfeeding, introduction of solid foods, water/juice intake)
                        • Meal planning
                        • Meal replacements
                        • Manage patients on very-low-calorie diets and ketogenic diets

                          B4. Physical Activity Counseling

                          • Basic exercise physiology (e.g., biomechanics, kinesiology)
                          • Non-exercise activity thermogenesis
                          • Global benefits of physical activity (e.g., sleep, stress, cardiovascular, anxiety, depression)
                          • Role of physical activity in weight reduction and weight maintenance
                          • Aerobic exercise, strength training and balance/flexibility training
                          • Unstructured physical activities
                          • Classifications of physical activity intensity
                          • Metabolic impacts of different types and intensities of physical activity
                          • Age-appropriate physical activity, exercise and sedentary time recommendations

                          B5. Prescribe Obesity Medications

                          • Use of obesity medication in long-term comprehensive treatment
                          • Age-appropriate eligibility criteria for obesity medication per clinical practice guidelines
                          • Mechanisms of action, indications and contraindications of FDA-approved obesity medications and off-label medications for weight reduction
                          • Expected outcomes, benefits, risks, and adverse effects of obesity medications and weight-reducing medications
                          • Drug-drug, drug-herbal, and drug-nutrient interactions with obesity medications and weight-reducing medications
                          • Costs and insurance coverage for obesity medications
                          • Risks and adverse effects of herbal and other supplements for weight reduction

                            B6. Bariatric Devices & Non-Surgical Procedures

                            • Use of devices and non-surgical procedures in long-term comprehensive treatment
                            • Age-appropriate eligibility for devices and other non-surgical procedures per clinical practice guidelines
                            • Mechanisms of action, indications and contraindications for devices and other non-surgical procedures
                            • Expected outcomes, benefits, risks, and complications for devices and other non-surgical procedures
                            • Costs and insurance coverage for devices and other non-surgical procedures
                            • Best practices for pre- and post-procedural management after device or non-surgical procedures

                              B7. Metabolic & Bariatric Surgery

                              • Use of metabolic-bariatric surgery in long-term comprehensive treatment
                              • Age-appropriate eligibility for metabolic-bariatric surgery per clinical practice guidelines
                              • Mechanisms of action, indications and contraindications for metabolic-bariatric surgical procedures
                              • Expected outcomes, benefits, risks, and complications for metabolic-bariatric surgery
                              • Costs and insurance coverage for metabolic-bariatric surgery
                              • Best practices for pre-, peri- and post-operative management for metabolic-bariatric surgery
                              • Post-operative nutritional management including vitamin and mineral deficiencies
                              • Post-operative management of weight recurrence
                              • Hypoglycemia after metabolic-bariatric surgery, including etiology, risk factors, diagnostic approach, and management
                              • Conditions requiring revisional surgeries or procedures
                              • Types and long-term complications of historical metabolic-bariatric surgical procedures

                                B8. Tailor Treatment for Special Populations with Obesity

                                • Manage medication-induced weight gain
                                • Manage genetic or syndromic obesity
                                • Manage thyroid dysfunction
                                • Manage secondary obesity
                                • Individuals of childbearing potential including contraception and treatment approach during pregnancy or lactation
                                • Complex patients such as older adults, individuals with multiple long-term conditions (multi-morbidity), patients before and after transplant surgery, patients with type 1 diabetes mellitus, patients with cancer, patients with serious mental illness, patients requiring weight reduction in preparation for non-bariatric surgery, patients with limited mobility (e.g., wheelchair, bedbound), and patients under substantial care of caregivers (e.g., autism, severe cognitive impairment)
                                • Age-appropriate primary, secondary, and tertiary prevention strategies for obesity

                                      B9. Manage Weight-Related Conditions

                                      • Manage prediabetes and type 2 diabetes mellitus, including risk counseling, nutrition, physical activity, medication management, medication titration, and metabolic-bariatric surgery
                                      • Manage dyslipidemia including risk counseling, nutrition, physical activity, and medication management
                                      • Manage essential hypertension including risk counseling, nutrition, physical activity, medication management, and medication titration
                                      • Manage metabolic dysfunction-associated steatotic liver disease including risk counseling, nutrition, physical activity, and medication management in collaboration with hepatology
                                      • Manage gastroesophageal reflux disease including risk counseling, nutrition, physical activity, medication management, and metabolic-bariatric surgery in collaboration with gastroenterology
                                      • Manage obesity-related musculoskeletal conditions including risk counseling, physical activity, and medication management
                                      • Manage asthma including risk counseling, physical activity, and medication management
                                      • Manage idiopathic intracranial hypertension including risk counseling, nutrition, physical activity, and medication management in collaboration with neurology and ophthalmology
                                      • Manage polycystic ovarian syndrome including risk counseling, nutrition, physical activity, and medication management in collaboration with gynecology
                                      • Manage binge eating disorder including behavioral strategies and medication management in collaboration with psychology
                                      • Manage night eating syndrome including behavioral strategies and medication management in collaboration with psychology
                                      • Manage depressive symptoms including behavioral strategies and medication management
                                      • Manage anxiety symptoms including behavioral strategies and medication management
                                      • Manage attention-deficit/hyperactivity disorder including behavioral strategies and medication management

                                              B10. Formulate an Effective Treatment Plan

                                              • Different counseling approaches (e.g., motivational interviewing, 5A’s, shared decision-making)
                                              • Combination therapies (e.g., intensive lifestyle modification plus pharmacotherapy)
                                              • Clinical practices guidelines for the treatment of obesity in adults
                                              • Clinical practices guidelines for the treatment of obesity in children and adolescents
                                              • Understanding use of energy expenditure measures to direct treatment plan
                                              • Understanding of cultural and ethnic differences related to obesity
                                              • Core components and findings of landmark behavioral interventions (e.g., Diabetes Prevention Program, Look AHEAD)
                                              • Social service programs (e.g., SNAP, WIC)
                                              • Evidence on effective and safe group and commercial weight-loss programs
                                              • Treatments that have been proven ineffective, unsafe or are unregulated

                                                B11. Manage the Obesity Treatment Plan Long-Term

                                                • Relationship between outcomes with follow-up frequency and chronicity
                                                • Manage behavior modification plan in response to treatment
                                                • Manage nutrition plan in response to treatment
                                                • Manage physical activity plan in response to treatment
                                                • Manage medication plan in response to treatment
                                                • Manage weight plateau
                                                • Manage weight recurrence
                                                • Evidence-based strategies for weight maintenance after weight reduction

                                                C. Practicing Obesity Medicine with Professionalism

                                                C1. Maintain Professional Competence in Obesity Medicine

                                                • Requirements for maintaining active certification in primary medical specialty and ABOM certification
                                                • Participate in continuing medical education on obesity
                                                • Epidemiologic studies of obesity to understand changes in prevalence and inequities over time
                                                • New and emerging scientific evidence on obesity
                                                • Basic knowledge of research study designs and statistical methods
                                                • Contribute to the field of obesity medicine through scholarship, research, teaching, or volunteering

                                                  C2. Manage the Obesity Medicine Clinical Practice

                                                  • Elements of a respectful practice environment and equipment that accommodates all patients
                                                  • Train staff on respectful treatment of patients with obesity
                                                  • Multidisciplinary and interprofessional nature of obesity care
                                                  • Typical operational policies and protocols associated with an obesity medicine practice including templates, schedules, clinical workflows, follow-up care
                                                  • State and federal laws on controlled substances
                                                  • State policy on obesity medications
                                                  • State policy on off-label medication prescribing
                                                  • Reimbursements, billing and coding
                                                  • Insurance coverage of treatment options
                                                  • Prior authorizations and appeals for medications, procedures and surgeries
                                                  • Cost effectiveness of treatment strategies
                                                  • Basic knowledge of quality improvement strategies

                                                      C3. Reduce Weight Bias & Stigma

                                                      • Explicit and implicit weight bias, weight stigma, and internalized weight bias
                                                      • Effects of weight bias and stigma on patients with obesity
                                                      • Weight bias in education, workplace and health system settings
                                                      • Patient-centered communication principles
                                                      • Strategies to mitigate weight bias and stigma
                                                      • Mitigation strategies for internalized weight bias

                                                        C4. Advocate for Patients with Obesity within the Health System

                                                        • Knowledge gaps in obesity care among trainees, staff and other healthcare professionals
                                                        • Educate trainees, staff and other healthcare professionals on obesity and obesity medicine
                                                        • Knowledge gaps on obesity and obesity medicine among health system leaders and management
                                                        • Policies and resources that improve the healthcare experience for patients with obesity

                                                        C5. Raise Public Awareness of Obesity

                                                        • Impacts of obesity in the workplace including healthcare costs, absenteeism, and benefits to cover obesity treatments
                                                        • Effectiveness and limits of evidence-based public health interventions for obesity
                                                        • Inequities in access and receipt of obesity treatments
                                                        • Raise awareness and advocate on a community, local, state or national level

                                                        The ABOM Content Outline is protected by copyright by the American Board of Obesity Medicine (ABOM). The information presented above is done so with the permission of ABOM.