Study selection
A total of 1,657 records were identified from three databases (PubMed, CINAHL Plus, and ERIC). After deduplication (n = 371 duplicates), 1,286 titles and abstracts were screened, resulting in 143 full-text papers being assessed for eligibility. During full-text review, 121 papers were excluded, resulting in 22 papers for inclusion in the final review (Fig. 1) [42].
Profile of included studies
Table 1 presents a comprehensive synthesis of all included papers [12, 16, 17, 22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40], highlighting key differences and similarities across study designs, educational interventions (if applicable), target groups for education and mechanisms to assess learning outcome achievement or competency achievement. The studies were primarily conducted in the USA, Canada, United Kingdom and Australia, with the majority focusing on obesity-related HCP curricula in higher education institutions. Heterogeneity in the study designs was present among included studies, comprising pre-post education intervention evaluations (using sequential mixed-methods approaches in some papers) [12, 23, 26,27,28,29, 31, 32, 34, 37, 38, 40], (cluster) randomised controlled trials [25, 33], consensus-building approaches (including proposition papers for setting up frameworks) [16, 17, 22, 36], qualitative analyses [35, 39] and cross-sectional studies [24, 30]. Four included papers proposed frameworks for competency development or provided practice guidelines without direct intervention [16, 17, 22, 36]. Of interest, two papers were more comprehensive with one being focused on reaching consensus on a required set of obesity competencies for medical and nursing professionals [16], and another one on adapting these to build a competency framework which would serve a broader range of HCPs [17]. While most studies [12, 23,24,25,26,27,28,29, 31,32,33,34,35, 38, 40] aimed to assess the impact of novel obesity-related education interventions on knowledge, competence and attitudes, others [30, 37, 39] mainly focused on exploring the learning experience and job preparedness. Content and modalities of education interventions (if any) were heterogeneous and included didactic lectures [23, 29, 32, 38], online modules [25, 27, 33,34,35, 40], flipped-classrooms [26], role-playing exercises [23, 33, 40], hands-on workshops [24, 29, 32, 33, 35, 38, 40] and interprofessional training programmes [12, 28, 31]. Target groups ranged from undergraduate/graduate HCP students [23, 24, 26, 28, 30, 31, 33, 35,36,37,38,39,40] to practicing HCPs (continuing professional development) [12, 16, 17, 22, 25, 27, 29, 32, 34, 36]. The cross-study variability in targeted HCPs, including physiotherapists [25], nurses [16, 24, 38], dietitians [31], pharmacists [28, 31, 40], radiographers [39] and physicians [16, 23, 26, 29, 30, 32,33,34,35,36,37,38], point toward the relevance of obesity-related competencies across disciplines. Reported mechanisms to evaluate learning outcome achievement or accomplishment of HCP competencies mainly comprised subjective measures (including self-reported assessments and reflection assignments) [12, 25, 27,28,29,30,31,32, 34, 35, 38, 40], while a minority of studies included objective measures (including structured clinical examinations; practical or theoretical exams) [24, 26] or both [23, 33]. The studies of Olson et al. [35] and Thanh Le et al. [39] used qualitative thematic analysis of written feedback or following focus groups, respectively (Table 1).
Competencies
Multiple obesity competencies were identified, spanning eleven key domains: Obesity Background, Clinical Assessment, Clinical Management, Evidence-Based Practice, Communication, Professionalism/ethical standards, Patient Centred Care, Advocacy/influencing Policy, HCP Education, Public Health/Health promotion and Health systems. Within these eleven domains, forty-one subdomains were identified and are also outlined in Table 2, and with details of all reported competencies in Appendix Table 4. The most frequently reported competencies fell within the domains of Clinical Assessment and Clinical Management, suggesting these are heavily emphasized domains in clinical education. Clinical assessment encompassed both physical and subjective assessment competencies, alongside diagnostics (e.g., selecting and interpreting appropriate laboratory tests). Assessing lifestyle behaviours and readiness for change were among the subjective assessment competencies. Other assessment competencies related to identification of risk factors and comorbidities. Physical assessment competencies included assessment of weight status (e.g., body mass index) and overall physical examination of the person living with obesity. Clinical Management encompassed nine subdomains (e.g., clinical reasoning, exercise/physical activity, diet, behaviour change/motivational interviewing, and patient education), with frequent mentions of interprofessional care to manage obesity and its comorbidities, reinforcing the need for multidisciplinary strategies (Table 2).
Other frequently reported competencies related to application of a wide range of background knowledge, ranging from understanding of obesity as a chronic disease, with related comorbidities, to determinants of obesity, staging of obesity and knowledge of lifestyle, pharmacological and surgical interventions, indicating a strong focus on foundation knowledge and stigma awareness. Patient-centred care competencies (e.g., shared decision making, cultural competence) and those relating to professionalism were also to the foreground, suggesting a shift towards emphasising inclusive, empathetic care models. Due to the frequent mention of communication related competencies across papers, a dedicated communication domain was generated, with three subdomains; Clinician-patient communication, Communication with communities/group and Communication with peers and other professionals, reflecting a broader understanding of competence in communication, beyond patient interaction. Competencies in the public health domain primarily related to health promotion for disease prevention or community health surveillance. In the health systems domain, competencies included obesity service development and enhancement and incorporating information technology infrastructure and e-health tools (e.g. smartphone applications and wearable devices) into healthcare. Demonstrating an understanding of the costs of obesity was also a recognised competence in this domain, highlighting the need for understanding of the broader health system context. Several papers also referred to competence in advocacy for people living with obesity, including advocating for better health services and policies which are free of bias and stigma [17]. Additionally, being competent in providing and availing of HCP obesity education was recognised across a number of papers, with specific reference to competence in mentoring staff. Finally, evidence-based practice competencies were identified, as they related to obesity healthcare.
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