Obesity Medicine Fellowship at Cleveland Clinic

Overview

This one-year fellowship which is co-supported by the Bariatric and Metabolic Institute (BMI) and Endocrine and Metabolism Institute (EMI) at the Cleveland Clinic is designed for recent graduates of training programs within internal medicine, family medicine or pediatrics or current clinical medicine subspecialty fellows (e.g. endocrinology, gastroenterology, nutrition) who wish to obtain advanced training focused in the area of Obesity Medicine.

This fellowship has been designed to provide trainees with expertise and clinical experience in the emerging field of Obesity Medicine, with a primary focus on the evaluation and management of patients with obesity. Fellows will learn how to treat obesity with nutritional, behavioral, pharmacological and surgical interventions, as well as how to screen and manage obesity complications effectively.

Trainees will spend the majority of time at the core sites (BMI and EMI) which together are one of the largest most complete interdisciplinary obesity centers in the country with more than 5000 annual obesity medicine patient visits, including telemedicine and shared medical appointments, and more than 750 annual bariatric and metabolic surgeries. The fellow will primarily work in an interdisciplinary setting with a team of clinical providers, including more than 30 psychologists, registered dietitian nutritionists, exercise physiologists, advanced practice providers, bariatric surgeons, bariatric endoscopists and five ABOM-certified obesity medicine physicians. In addition, the fellow will be exposed to clinical rotations in the complementary fields of clinical nutrition, sleep medicine, pediatric obesity and lifestyle medicine.

By the end of the training year, fellows will have a good understanding of the science of body weight regulation, current clinical obesity care guidelines, and research being conducted to advance knowledge in this field. In addition, fellows will be able to assess a patient with obesity using body composition and utilize standard and innovative approaches to the treatment of obesity, including novel combination therapies in obesity medicine, bariatric endoscopy and metabolic and bariatric surgery. Trainees will be able to complete a full pre-operative evaluation for patients with indications for surgery and provide comprehensive post-operative medical and nutritional care for these surgical patients.

Furthermore, we expect the fellow to participate in clinical and research activities throughout their training, including active clinical trials of new and emerging therapies conducted at the Cleveland Clinic, as well as prospective and retrospective studies. We anticipate that trainees who complete this fellowship program will be prepared to pursue clinical and academic careers focused in obesity medicine and to become competent teachers of obesity medicine and future leaders in this emerging discipline.

The strength of this program is the combination of the robust clinical exposure to multiple obesity subtypes in diverse patient population and the clinical expertise of numerous clinicians and clinical investigators in interdisciplinary obesity clinics across the Cleveland Clinic. We believe an OM fellow will have a well-rounded clinical case exposure as well as a structured, productive mentorship. Our faculty are clearly all committed to the disease of obesity and invested in this fellowship. And, most importantly, we work well together as a team and like to have fun.

Program Structure

Bariatric and Metabolic Institute (BMI)

This is a large interdisciplinary clinic at Main Campus focused on the management and treatment of obesity, including monotherapy and combination interventions with lifestyle, pharmacological and surgical therapeutic options. The environment at the BMI provides a well-rounded clinical experience, from managing patients with severe class III obesity (BMI>60) and complex bariatric surgical patients with heart failure or chronic venous thromboembolisms to bipolar patients with medication-induced weight gain and patients in need of an organ transplant or other non-bariatric surgery. The fellow will work closely with an interprofessional team consisting of behavioral psychologists, registered dietitian nutritionists, exercise physiologists and bariatric surgeons.  At the BMI, the fellow will develop and maintain their own clinical continuity clinic of both obesity medicine and bariatric surgical patients.

Primary Faculty at the BMI are listed below.

• W. Scott Butsch, MD, MSc. ABOM diplomate – Program Director, Obesity Medicine.
• Derrick Cetin, DO, ABOM diplomate – Obesity Medicine.
• David Creel, PhD, MS – Clinical Psychology, Exercise Physiology.
• Erin Rossi, RDN – Clinical Nutrition.
• Karen Schulz, RN, MSN CBN – Clinical Nurse Specialist.
• Rickesha Wilson, MD – Bariatric Surgery.
• Ricard Corcelles, MD – Bariatric Surgery.
• Roberto Simons-Linares MD MSc – Bariatric Endoscopy, GI (DDSI).

Endocrinology and Metabolism Institute (EMI)

The fellow will become familiar with diagnosis, management and treatment of the obesity subtypes and its endocrinological complications as well as the obesity-centric approach for the treatment of diabetes mellitus. The interdisciplinary endocrine subspecialty outpatient clinics at the Main Campus and the Diabetes Center focus on the management and treatment of obesity and diabetes using lifestyle, pharmacological interventions and a multidisciplinary team. The trainee will rotate in subspecialty endocrine clinics and will become familiar with multiple endocrine diseases associated with weight gain and obesity that included but not limited to thyroid disease, PCOS, lipodystrophies, and pituitary and hypothalamic pathology. The fellow will become familiar with virtual and face-to-face shared medical appointments and individual appointments.

Primary faculty at this site are listed below.

• Marcio Griebeler, MD, ABOM diplomate – Associate Program Director, Obesity Medicine, Endocrinology, Director of the Diabesity Center and Obesity Initiatives.
• Bartolome Burguera MD, PhD – Institute Chair, Endocrinology and Metabolism Institute (EMI), Obesity Medicine, Endocrinology.
• Oscar Morey-Vargas MD, ABOM diplomate – Staff, Obesity Medicine, Endocrinology.
• Ula Abed, MD – Staff, Obesity Medicine, Endocrinology.

Clinical Rotations

Pediatric Obesity: Roy Kim, MD, ABOM diplomate
The majority of exposure to pediatric obesity medicine will be in the Be Well Kids Clinic, within pediatric endocrinology at the Cleveland Clinic Children’s Hospital, located at the Main Campus. This is a longitudinal rotation in an interdisciplinary clinic, which sees young patients between the years of 2 and 17 and focuses on the management of children with obesity, utilizing monotherapy and combination therapy with lifestyle-based therapies and obesity pharmacotherapy. In addition to the management of general pediatric obesity, the fellow will become familiar with neuroendocrine diseases associated with weight gain (including hypothalamic injury and pituitary disorders), monogenetic and syndromic obesity, and an obesity-centric approach to diabetes.

Sleep Medicine: Jessica Vensel Rundo, MD MSc
The sleep medicine rotation will take place in the sleep medicine clinics and laboratory at the Main Campus. The sleep medicine clinic is an outpatient experience which will expose the fellow to new and established patients with a variety of sleep disorders, most frequently, sleep related breathing disorders (i.e. obstructive sleep apnea), insomnia, central hypersomnias, parasomnias, and sleep related movement disorders (i.e. restless legs syndrome).

Lifestyle Medicine: Sandra Darling, MD
The Lifestyle medicine elective is a rotation at the Wellness Institute. This is a longitudinal rotation in an interdisciplinary clinic, which will occur throughout the academic year, where the obesity medicine fellow will be exposed to the practice of an interdisciplinary lifestyle medicine team consisting of a physician, professional chef, registered dietitian, behavioral health specialist and yoga therapist. The fellow will be exposed to lifestyle medicine and its related programs, which focus on stress management, physical activity, nutrition, and psychology. Several teaching methods are utilized for subgroups of patients, including shared medical appointments, culinary medicine (with cooking classes in a test kitchen) and health coaching.

Clinical Nutrition: Don Kirby, MD
The majority of exposure to clinical nutrition will be in the Center for Gut Rehabilitation and Transplantation, within Digestive Disease and Surgery Institute, located at the Main Campus. This is a longitudinal rotation in an interdisciplinary clinic, which will occur throughout the academic year, where the obesity medicine fellow will be exposed to a variety of patients with nutritional conditions e.g. malnutrition and malabsorption in both the inpatient and outpatient settings. In addition to the management of general nutrition disorders, the fellow will become familiar with gastrointestinal diseases and surgical procedures associated with malabsorption, use of oral rehydration solutions, enteral and parenteral nutrition.

Didactic Learning and Educational Conferences

The BMI and EMI provide the ideal environment for learning as all of its faculty members are committed to the field of obesity. Several primary and secondary faculty involved in the obesity medicine fellowship have served in leadership roles within professional societies and peer reviewed journals, have advanced the field of obesity through scientific achievements (as Principal Investigators of NIDDK-funded and NIH funded research) through clinical innovation, and through leadership roles in obesity education and advocacy.

The academic didactic learning and educational conferences in the BMI, EMI and Cleveland Clinic are integral to the fellow’s education and clinical experience. Annual educational conferences attended by trainees will give the fellow an opportunity to network, speak, create and develop educational workshops and present research. Travel funds are provided for the trainee to attend one annual professional conference. Several national professional society conferences e.g. Obesity Week™, CME courses e.g. Blackburn Course in Obesity Medicine at Harvard, Cleveland Clinic-Pennington Biomedical Research Center Diabetes, Obesity, and Cardiovascular Disease Summit (DOCS) as well as with Cleveland Clinic Abu Dhabi DOCS will be available to attend.

Trainees will have opportunities to share experiences and participate in clinical and research activities with faculty and other post graduate obesity trainees in a variety of educational settings. The obesity medicine fellow will join two existing post graduate training programs in obesity within the BMI, a clinical/health psychology postdoctoral fellowship in bariatrics (one fellow per year) and a bariatric and minimally invasive surgical fellowship (2 fellows per year), in addition to endocrinology fellows (2 per year).

• Obesity Medicine Multidisciplinary Rounds (monthly, alternating days): Required meeting. BMI clinical staff discuss selected complex cases at the BMI and formulate diagnostic and treatment team recommendations.
• Obesity Fellows Rounds (weekly, Wednesdays 7:00-8:00 a.m.): Required and closed meeting for BMI obesity trainees (including the clinical health psychology postdoctoral fellow, bariatric and minimally invasive surgical fellows and the obesity medicine fellow) and associated program directors and faculty. Topics discussed include core competencies in obesity and bariatric surgery, career development, advocacy and community outreach.
• Obesity Research Meeting (monthly, alternating days): Fellows are exposed to ongoing research activities within the obesity medicine community at the Cleveland Clinic (BMI, EMI, as well as within the newly formed Enterprise Weight Management Center).
• Metabolic and Obesity Multidisciplinary Club (bimonthly, 2nd Tuesday, 5:00 p.m.): Required meeting. Directed by Drs. Griebeler, Butsch and Kashyap. Obesity medicine faculty at BMI and EMI and obesity and endocrine trainee will present a recently published article or a case presentation.
• Obesity LIVE (monthly): Required meeting. Virtual clinical case conference hosted by Drs. Butsch and Simons-Linares. Cases in obesity medicine, bariatric endoscopy and metabolic and bariatric surgery are presented and relevant discussion with obesity specialists in other academic institutions area.
• Endocrinology Grand Rounds (Monday, weekly): Clinical lecture presented by a Cleveland Clinic EMI staff or visiting physician with topics related to Endocrinology, Diabetes and Metabolism. Attendance from all obesity medicine trainees is required.

Research

Obesity medicine fellows are given research opportunities and responsibilities after several initial meetings with the program director. Each trainee meets with the program director during their first month to discuss research opportunities and is assigned an appropriate mentor. The fellow is expected to learn to design and conduct research in the area of obesity medicine; the research experience is expected to occupy >20% of the fellow's time. Our fellows are provided with protected time and support needed to complete projects and the expectation is that the experience will lead to authorship of a publication or presentation at a national meeting. Fellows will meet monthly with their clinical mentors to review clinical curriculum addressed as well as to aid in designing and implementation of research project. Fellows are expected to produce at least one review paper and one research paper per year. All Obesity fellows are required to take the Investigator Human Subject Research Education course offered by Cleveland Clinic in addition to CITI and HIPAA, online education courses.

Clinical research setting: At the BMI and EMI, out-patient beds are available for clinical research studies performed by its members.

Current research topics:

• Shared Medical Appointments in the Treatment of Obesity.
• Anti-obesity Medications Interventions with Shared Medical Appointments.
• Obesity-centric Approach for the Management of Diabetes.
• Virtual Visits with Phentermine.
• Prescribing trends with Anti-Obesity Medications.
• Combination therapies in obesity care.
• Late phase clinical trials with emerging anti-obesity medications.
• Outcomes in Metabolic and Bariatric Surgery.