The Emerging Role of the Physiotherapist in the Current Obesity Epidemic

Introduction

            “Global terrorism is a real threat, but poses far less risk than obesity”
          				(Gostin, 2008)

Obesity is a leading preventable cause of death and disease worldwide (Finucane et al. 2011). Since 1980, the prevalence of obesity worldwide has more than doubled (Finucane et al. 2011). The rapid increase in the number of obese people in the UK is a major challenge, as over half of the UK adult population could be obese by 2050 (Tackling Obesities – Future Choice, 2007). Research estimates that without a major shift in society’s attitude towards food and exercise and a change in individuals’ lifestyles, overweight and obesity costs in the NHS are projected to double to £10 billion per year by 2050. Substantial costs to society and business are also alarming being estimated to reach £49.9 billion per year (Government Office for Science, 2007).

Obesity co-morbidities such as stroke, diabetes and heart disease are major public health issues within the UK. Figure 1 demonstrates health risks associated with obesity. The current problem includes the implications that obese patients have on secondary care for example, surgery and postoperative recovery. In addition, health and safety issues in the acute care of obese patients and the need for bariatric equipment, impact on the increasing costs in the NHS.

The enormity of the problem has been recognized by the government with research and guidelines emerging in an attempt to help tackle this threatening epidemic. The National Institute for Health and Clinical Excellence guidelines (NICE, 2006) on obesity advocated a multidisciplinary team (MDT) approach. The guidelines recommend that interventions are made up of different components, including strategies to increase physical activity and promote healthier eating. A more up-to-date publication of the Scottish Intercollegiate Guidelines Network (SIGN, 2010) support this with the recommendation that health professionals undertake dietary and physical interventions, including behavioural, pharmacological and bariatric surgery for managing obesity.

However, how do you think this type of holistic patient-centred care can 
best be delivered? 

Should you as a physiotherapist undertake the responsibility 
to provide dietary and behavioural interventions?

Or should all members of the MDT focus exclusively on their own 
fields of expertise?

The Chartered Society of Physiotherapy (CSP) recognises that the prevention and management of obesity requires an aggressive and comprehensive approach that addresses the complex and multifaceted issues. However, to date there is confusion of the current role of the physiotherapist within the prevention and management of obesity, and physiotherapists have had a low profile in managing this condition as it is traditionally seen in terms of overeating. There is a great need for emphasis on the importance of exercise, activity and lifestyle as it is often not the focus in dietician led weight management programs. The Health Survey for England (2007) identified that 68-69% of adults either underestimated the amount of physical activity required to derive health benefits or were unaware of the recommendations. This area of expertise falls within the physiotherapist domain and it is crucial for physiotherapists to be at the centre of not only the management of obesity but in prevention and maintaining weight loss.