The Role of the Physio in Preventing Obesity

I recently spent some time with a local weight management service, it was a great to see physios making a real difference to people’s lives. I was interested to hear that people don’t meet the referral criteria for the service unless they have a BMI of 35 + comorbidities, or a BMI of 40 without comorbidities (...show me someone with a BMI of 40 without co-morbidities!). By the time someone has a BMI of 35 (this roughly equates to a weight of 17 ½ stone for someone who is 5’ 10’’) they are in serious trouble and common sense would suggest that preventing this situation is better for the individual and more cost effective than trying to deal with it further down the line.

This made me think about the huge number of people with a BMI of 25-35, overweight and fast heading towards obesity, gradually accumulating risk factors over the years, what are we doing as physios to be proactive about this? We seem to be carving a nice role for ourselves in obesity management services but I don't know how much activity there is in pro-active, preventative action and it is concerning that someone could be considered Obese Class II but still not be eligable for referral to their local weight management service.

So what could we be doing? 

We see patients who are overweight all the time!  We could integrate discussion about weight into our standard assessment process, be it during acute stroke rehab, in fracture clinic or LBP classes . Broaching the question of weight with patients can be daunting but we are great communicators and if it’s raised in a sensitive, timely way it can create an opportunity for change and there are some useful resources available to help with this.   I'm not advocating quizzing everyone about their weight but if we were to ask people “How do you feel about your weight?” or “Is your weight something you would like to change?” then we are opening a dialogue, if the patient is happy and isn’t interested in changing their weight then we move on. As ever, a standard approach is unlikely to work, we need to take cues from patients and tailor our approach accordingly.  A recent US study suggests that care needs to be taken with language, it found that the terms that were rated as most desirable were "weight, unhealthy weight", the terms that were rated most motivating to lose weight were "unhealthy weight, overweight" and the terms that were rated as most undesirable, stigmatising and blaming were "morbidly obese, fat, obese". 

We could also integrate routine weight monitoring into physio sessions, it takes 2 minutes and it allows us to have discussions about the risks associated with weight gain and the benefits of physical activity and nutrition. It also sends a message to the patient that we consider weight management to be important.

We could signpost patients to other services, not just NHS Obesity services with limited referral criteria but also to commercial ventures aimed at maintaining a healthy weight.  There's Slimming World, Weight Watchers, gym-based weight management programmes as well as the exercise classes that we regularly recomend for patients.  My local GP practice hosts WeightWatchers sessions, should we be doing this too?

Or there could be a role for developing you own service targeting people at risk of obesity.  We have expertise in longterm conditions, behaviour change and physical activity, we often have colleagues in Dietetics, Nutrition & Psychology with whom we could collaborate, we have facilities in our departments & gyms and we have a large throughput of patients many of whom would like to change their weight.

Maybe it is time to embrace our role in preventing obesity as well as in managing it?