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REP 12: WHOSE JOB IS IT ANYWAY?

Gail Dechman

 

Physiotherapists play established roles in women’s health, including pelvic floor training, and we also provide rehabilitation for animals. However, most of us don’t believe we have a role to play in managing obesity. Perhaps it’s time to ask why that is.

The Big Idea

Physiotherapists define themselves as movement specialists. People with obesity need to lose weight to improve mobility and function, and exercise is an important part of effective weight management. In 2012, You and colleagues published the results of a CPA member survey demonstrating that most respondents (over 95%) felt they had a role to play in treating conditions associated with obesity but far fewer believed that assessing adiposity was part of our role.

How can we treat a condition if we don’t assess the driving factors? Physiotherapists are perfectly positioned to provide the integrated, patient-centered care essential for managing obesity and its co-morbidities.

My take on things…

The latest information from Statistics Canada states that over 60% of Canadians are overweight or obese. It has also been predicted that by 2019 more than half the provinces in Canada will have more people who are overweight or obese than those who are normal weight. Obesity is one of the most important causes of chronic disease and it is estimated to cost the country between 4.6 and 7.1 billion dollars annually. Those are your tax dollars!

“But I think that no matter how smart,
people usually see what they’re already looking for, that’s all.”
Veronica RothAllegiant

Many respondents in You’s survey cited lack of knowledge about how to assess body fat and weight management as important barriers to providing care for people with obesity. We are smart, well-educated health professionals who have, or could easily develop, the skills to use activity as part of a weight management program. Is bias stopping us? Weight bias and stigma are common. Presentations from the Canadian Obesity Summit 2011 (video) and the Rudd Center for Food Policy and Obesity at Yale University (video) describe the phenomenon and specifically discuss issues related to health professionals.

The survey by You and colleagues also noted that many physiotherapists find treating people with obesity unsuccessful and unrewarding because these patients don’t adhere to treatment programs. We know that many of our patients don’t follow their home exercise programs and improve anyway, likely as a result of the natural healing process. Unfortunately, there is no natural healing process for people with obesity, therefore creating effective exercise programs is critical to weight management success. We need to understand that adopting an exercise program, even one to address a basic orthopedic problem, involves behaviour change. As we know, using behaviour change techniques when we develop exercise programs is likely to improve adherence and overall success. Dr. Michael Vallis, director of the Behaviour Change Institute, does a great job on his website explaining how the principles of behaviour change can be applied to weight management.

“The fear of change can keep you from walking into
some of the greatest things life offers.”
Buky Ojelabi

If we understand our biases and believe that people with obesity deserve quality health care, and we also adopt behaviour change techniques, all that’s left to developing exercise programs to address weight management is the exercises themselves. That shouldn’t be so difficult! After all, physiotherapists are exercise specialists.

there is no natural healing process for people with obesity, therefore creating effective exercise programs is critical to weight management

Some of my colleagues tell me that they are reluctant to work with people who are obese because it’s scary. We provide aerobic, strength and balance exercises to improve mobility and function in people with neurological impairments. These patients often have undiagnosed cardiovascular disease and might have a heart attack during our treatment. Consider a patient with poor balance who falls and injures themselves. Isn’t that scary? Our training prepares us for those challenges, and as a result we are more comfortable with them. Is it simply a matter of including more content on exercise for people with obesity in our physiotherapy curricula then?

Providing activity and exercise programs for people with obesity requires creativity on our part. Our practices should be free of bias and accessible to all. There are lots of intriguing adaptations that can make exercise fun and effective. The Canadian Obesity Network and Dr. Arya Sharma’s website and blog are excellent resources on obesity and its management. This special issue of the Journal of Obesity presents guidance on many aspects of exercise for people with obesity.

Being overweight and obese has serious health consequences. The current trend in obesity management has us moving away from focusing on weight loss and redirecting attention on health consequences. The role of exercise in helping patients achieve that goal is obvious. If you agree with that, I think the role of the physiotherapist for this population is also obvious.

“Imagination is the beginning of creation.”
George Bernard Shaw

Adapting exercise to make it safe, effective and doable is part of the challenge and fun of working with people with obesity. Check Betty Dietsch’s aerobic drumming program  in her Palm Beach studio and this education program at the Canadian Obesity Summit 2015 which is coming up in April.

Discuss

Do you think physiotherapists should be involved in weight management for people who are obese? If so, what role should we play? If so, what’s stopping you? What needs to change to make that happen?

Chime in using the comments box below, or via the CPA Facebook page or on Twitter (hashtag  #30Reps).

About Gail Dechman

Dr. Gail Dechman is an assistant professor at the School of Physiotherapy and the School of Health and Human Performance at Dalhousie University. She is a research affiliate in the Division of Respirology at the QEII Hospital. Dr. Dechman received her BSc in Physiotherapy from Queen’s University and a PhD in Physiology from McGill University. She has worked with people with chronic pulmonary disease for more than 30 years and as a result has developed an appreciation for the complexities of exercise testing and prescription. Over the past 15 years her clinical and research interests have expanded to include the use of exercise as a tool in chronic disease management, including obesity.

Dr. Dechman has research collaborations with, and sits on the Advisory Board of, Partners for Healthier Weight, a behaviourly based weight management program in Halifax. She also has research collaborations with the bariatric surgery program at the QE II Hospital.

Featured image by imagesource.com.

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