dominique williams md, mph
Why did you pursue obesity medicine certification?
In 2013 after earning an MPH in nutrition, I felt as though I needed to continue to expand my knowledge of the treatment of obesity, especially in adolescents. Children and adolescents suffering from obesity are afflicted with diseases typically associated with adults. As medical director of a multidisciplinary pediatric weight management program, it is important to stay up-to-date on the many facets and sequelae of obesity, including treatment options. Board certification in obesity medicine offered new colleagues, new resources, and a new awareness and understanding of the evidence base.
Many doctors have told us about the “aha” moment that stimulated their interest in obesity medicine. Do you have an obesity medicine “aha” moment that sticks out in your memory?
My “aha” moment for nutrition and medicine occurred when I was an undergraduate student. I changed my “premed” major from biology to nutrition. I thought med school would lay a great foundation in basic and clinical sciences but nutritional science would be a great complement. I never thought my career would be centered on obesity medicine. After completing my pediatric residency, I worked in a large general peds practice for about 7 years – much of that time was also spent working part-time with our children’s hospital weight management program. Eventually, I decided to leave private practice so that I could dedicate my career to treating children and adolescents with obesity. I don’t recall an “aha” moment. The more I worked with these children, the more passionate I became about being their advocate and provider.
How do you currently incorporate your obesity medicine training into your practice?
I work full time as medical director of a multidisciplinary pediatric weight management program within the health system of the state’s only free-standing children’s hospital. My team includes a nurse practitioner and behavior specialist, registered dietitians, exercise specialists, a nurse manager, and outreach coordinator. The medical clinic is the centerpiece of the program but we also offer group fitness and lifestyle classes. I work side-by-side with my teammates in clinic. We meet weekly for a team meeting to review the patients. My obesity medicine training provides a different perspective for the treatment of our older, high acuity patients. It helps to reframe discussions with families, colleagues, and teammates. Treatment plans and care coordination are heavily influenced by training in obesity medicine. For example, how we counsel families on topics such as self-monitoring, contingency management, and problem-solving; or the use of pharmacotherapy to address abnormal food seeking behaviors or other complications of obesity.
Why do you believe obesity medicine certification is valuable?
The emerging research and evidence base are invaluable to the treatment of obesity. Certification offers information, training, and resources that reflect the complex nature of this disease. Certification emphasizes the importance of delivering compassionate care to patients. The confidence and knowledge that come from certification not only enrich the dialogue with colleagues but also improves my skills as an advocate for children and adolescents with obesity.
What is the biggest challenge you face in your practice?
There are a couple of challenges that come to mind. One of the biggest challenges is “convincing” other medical providers to avoid using disgust, fear, and disdain as a way to “motivate” patients to lose weight and improve their health. Similarly, it is an ongoing challenge to foster self-efficacy and confidence in young patients who sometimes feel defeated and discarded by the words and actions of others. Often the challenging and frustrating behaviors of our pediatric patients are appropriate for their age and stage of development. The challenge is motivating patients without frightening them; holding them accountable without being overly restrictive; educating and enlightening without the perception of condescension. It is an interesting and delicate dance!
What has been your greatest achievement so far?
My greatest achievement comes whenever a patient achieves a milestone and says “it wasn’t as hard as I thought it was.” And he/she follows it up with “I am so proud of myself.”
What do you wish other physicians knew about treating obesity?
Treating obesity is not easy, patients are not lazy. Obesity is not caused by lack of willpower or discipline. I wish physicians would ask permission before they tell their patients what they “need to do” to get better. I wish other physicians would avoid the trap of thinking that patients with obesity have a knowledge deficit and just need to be told what to do. Some physicians should abandon the notion that “tough love” should be reserved for “those kids” while patience and acceptance are extended to others whose diseases have more subtle physical manifestations.
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