Beyond the scales: physiotherapists’ impact on obesity

Obesity is a relapsing, complex and multifactorial disease influenced by a multitude of factors that extend beyond the basic narrative of ‘eat less, move more’. It is a major contributor to increased mortality and morbidity, affecting individuals’ quality of life, mental health and activity participation.

The Foresight System Map, developed by the UK government’s Foresight Programme, provides an in-depth visualisation of these interconnecting influences of obesity, categorising them into seven thematic groups: food consumption, food production, individual activity, activity environment, individual psychology, biology and societal. This map demonstrates the complexity of obesity, illustrating how genetics, environment, and behaviour interplay to influence body weight.

Currently in the UK there are a number of approaches to obesity management which are outlined below: 

• Universal interventions
  These interventions focus on population wide strategies to promote healthy lifestyles and prevent obesity for example public health campaigns and initiatives aimed at encouraging healthy eating and physical activity.
• Lifestyle interventions 
  For individuals living with overweight or obesity. This involves structured, multicomponent weight management programmes which are typically 12 weeks long and delivered in community settings by health coaches or healthcare professionals. 
• Specialist weight management services
  Individuals living with obesity who require more intensive support could be referred to an intervention with specialist multidisciplinary team provision. This level involves healthcare professionals, including dietitians, psychologists, physiotherapists and medical professionals providing lifestyle interventions from six to 24 months. 
• Surgical Interventions
  For individuals living with complex obesity (BMI ≥40 kg/m² or ≥35 kg/m² with comorbidities) who have not achieved significant weight loss through non-surgical methods. Bariatric surgery includes procedures such as gastric bypass and sleeve gastrectomy are offered, accompanied by long term follow up and support.
• Pharmacotherapy (medications)
  For individuals who struggle to achieve or maintain weight loss through diet and exercise alone, medications can be used to support the management of obesity. 

Addressing weight stigma

Weight stigma, characterised by negative attitudes and discrimination towards individuals based on their weight, poses significant barriers to effective obesity management. Microaggressions, subtle slights or insults can profoundly affect individuals living with obesity, exacerbating feelings of shame, reducing self-esteem, and discouraging engagement in health-promoting behaviours. 

The language we use matters. Shifting from blame to compassion is not just ethical but essential for creating meaningful and effective healthy weight management interventions which are collaborative.

Blaming individuals for their weight disregards the complex aetiology of obesity and perpetuates stigma. It is imperative to foster a supportive and empathetic healthcare environment that recognises the multifactorial nature of obesity. 

Addressing weight stigma involves training healthcare professionals to use person-first language and develop interventions that prioritise health and well-being overweight loss alone.

Physiotherapy and exercise

Physiotherapists play a crucial role in the multidisciplinary approach to obesity management. Given the high prevalence of obesity, most physiotherapists will encounter patients living with this condition. The profession is well placed to support healthy weight loss from active weight management interventions. It is well known during weight loss fat-free mass also reduces. There is a potential risk of sarcopenia, which is characterised by reduced muscle mass coupled with diminished functional capacity. 

Therefore, understanding the role of physiotherapy in this space is essential to enhance better patient care and health outcomes: 

1. Assessment and tailored treatment plans
   Physios are skilled in assessing body composition, physical function and fitness to develop individualised exercise and treatment plans that cater to the needs and limitations of people living with obesity. We consider co-morbidities, joint health, mobility and cardiovascular fitness when planning and tailoring their interventions. Due to the risk of skeletal muscle loss in weight loss, physiotherapists could support this mitigation which is within their professional scope.
2. Promoting physical activity
   Physios encourage safe and sustainable physical activity, helping patients overcome barriers to exercise. This involves setting realistic goals, addressing physical discomfort, and fostering a positive relationship with physical activity. We are also well placed to discuss the importance of reducing sedentary time. 
3. Education and behavioural change support
   Increasing patients’ knowledge and propensity to act on the benefits of physical activity, providing ongoing behavioural change support and eliciting motivation are key components of the physiotherapist’s role. This includes underpinning treatment with behaviour change theory and techniques to facilitate people to perform physical activity, exercise and healthy behaviours. 
4. Collaboration with multidisciplinary teams
   Physiotherapists collaborate with other healthcare professionals to ensure a comprehensive approach to obesity management, integrating physiotherapy with dietary, psychological and medical interventions. 
    

Developing a network 

In 2020, three specialist bariatric and weight management physiotherapists, Anna Young, Jen Smith and Heather Pursey, established a network to support physiotherapists working in obesity and metabolic services.

Last year, a working party was formed to continue the development and formalisation of the network. This group has been actively engaging with stakeholders to shape the network’s future direction, set clear aims and objectives, and enhance its impact. 

The re-launch of the network is planned for March with a webinar series outlining the role of physiotherapy in weight management.

Along with myself, the working party for the network includes senior specialist healthy living physiotherapist Richard Myers-Ingram, specialist bariatric physiotherapist Corinne Pepper, clinical specialist physiotherapist Jo Pockney, and specialist weight management physiotherapists Lynn Humpleby and Jonathan Curry.

Physiotherapeutic interventions for obesity management are relatively new. Our outcomes across the UK are favourable yet remain uncoordinated, often reliant on talented physiotherapists fortuitously exposed to equally enthusiastic fellow professionals. 

Therefore, physiotherapy’s potential to affect policy and knowledge generation remains unexploited. The development of a network for physiotherapists working in obesity and metabolic services aims first to champion our role by creating a community of practice, and then to design realistic strategies to enhance the role and evaluate whether this can improve the knowledge, skills, and influence of physios; and improve outcomes for people living with obesity. 

The aim is to bring members together to provide peer support and mentorship, share best practices and latest research; progress towards recognition as a CSP professional network, influence policy and practice locally and nationally; advocate for physiotherapy input within this field and to develop physiotherapy specific treatment guidelines. 

We encourage all interested members to join our network and contribute to this important work. 

The future of obesity management is exciting. Innovation, creative thinking and the application of research into practice are just a few of the key elements in the evolving field.

Together, we can improve care for patients living with obesity and promote the value of physiotherapy in weight management. Email: physio.npoms@gmail.com; X/Twitter: @PhysioNpoms.