The Role of the Physio in Obesity Management

Nice guidelines on the management of obesity were publishes recently and the CSP expressed disappointment that the role of the physio wasn't specifically mentioned.  Obesity is such a complex issue that it requires multilevel, multidisciplinary & multiagency approaches.  Approaches that are tailored to the individual and that involves family and carers.  Behaviour change in any situation is difficult but in this highly complex situation there are so many barriers to change that we need to pull out all the stops in terms of wrap-around interventions.  This infographic shows the complexity of the causes of obesity (if you can't see it clearly, see the Public Health England website).

 

In my experience many physios don’t feel equipped to tackle obesity, it might not have featured in their training, they might not have been on a course but I firmly believe that we are particularly well placed to lead action on obesity for a number of reasons.

1. We are used to working with complex patients, we are not phased by long lists of medication and complex comorbidities, our broad clinical experience equips us to be problem solvers and to tailor our interventions to the individual.
2. By the same token, we are not risk averse, rehab is all about graded exposure to risk and physios are great at recognising risk and balancing risk.  One thing we absolutely have to keep in mind is that, with obesity, there is risk inherent in doing nothing!  There are some great risk stratification tools available to help plan exercise interventions with complex client groups.
3. We are the exercise experts, it’s our bread and butter and there is a lot to suggest that it will become even more central to what we do.  We need to send out a clear message that we are competent and confident in this key area of physiotherapy practice.
4. Physios are awesome communicators, we spend our days connecting with people and we are lucky enough to spend sufficient time with patients to develop meaningful therapeutic relationships.
5. We have a huge amount of practical expertise in behaviour change,  we spend our days trying to get people to do stuff that they don’t really want to do, we have lots of tricks up our sleeve and we  know intuitively how to select an appropriate approach for an individual.
6. We don’t judge, we understand enough about obesity to know that it isn’t simply a decision to overeat, it is far, far more complex than this and as the infographic above shows, there are many contributory factors. You don’t often meet obese people with  good quality of life, we don't judge, we show compassion because we care!

We do have a unique skill mix that lends itself to working to manage obesity, I can see that it is a natural fit for our profession and I hope that we will continue to establish ourselves as leaders in this area.  I do however think that we have a role that is at least as important in the prevention of obesity and I don't see much activity in this area.  More in the next blog post!

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