Managing obesity: do physiotherapists have a role?
Last month the UK’s National Institute for Health and Care Excellence (NICE) released a new guideline aimed at preventing adults (aged 18 and over) from becoming overweight or obese and the provision of lifestyle weight management programmes for adults who are overweight or obese.
The guideline emphasises the need for coordinated weight management programmes with an integrated and person-centred approach. It is comprehensive and focuses on topics such as healthy food options in public places to weight management for people with comorbidities, that often have fewer options to exercise.
With exercise and movement the keystone of the scope of physiotherapy practice physiotherapists have a role to play in the prevention and management of obesity.
Close contact time means physiotherapists are well placed to deliver some of the key the actions and interventions outlined in the guideline. The CSP’s Physiotherapy Works: Obesity suggests a treatment plan for an obese patient may comprise:
- Provision of personalised lifestyle advice;
- Prescription, supervision, and progression of appropriate physical activity;
- Management of associated conditions such as arthritis, back pain, and other musculoskeletal and chronic conditions, such as heart disease
- Co-ordination of comprehensive and sustainable programmes of management in collaboration with service users, other health and social care professionals, and community services.
According to Public Health England’s Adult obesity slide set, around a quarter of adults in England are obese (BMI >30), and 42% of men and 33% of women aged 16 or older are overweight (BMI >25).
Although overweight and obesity exist in all population groups, obesity is associated with social disadvantage and ethnicity.
Being overweight or obese can lead to chronic and severe medical conditions. Life expectancy is reduced by an average of 2–4 years for people with a BMI of 30–35, and 8–10 years for those with a BMI of 40–50.
Obesity is expensive; individuals with a BMI >35 cost twice as much in healthcare costs than individuals with a BMI
The wider societal cost of overweight and obesity in England was estimated at £15.8 billion per year in 2007 and is projected to reach £49.9 billion in 2050.
Obese individuals often have complex bio-psychosocial barriers to physical activity participation. Physiotherapists are uniquely positioned to facilitate physical activity required for weight management in these patients due to their sound grounding in a range of relevant areas. They autonomously and effectively deliver high quality, personalised exercise and lifestyle interventions to prevent and address barriers to physical activity participation, promoting physical and mental health and wellbeing, and enabling obese people to move and function as well as possible.
The case studies and recommendations provided help in setting up sustainable weight management programmes.
Are these comprehensive guidelines helpful for your day to day management of overweight patients?
> From: NICE et al., NICE Guideline QS111 (2016) . All rights reserved to National Institute for Health and Care Excellence. Click here for the Pubmed summary.