Supporting patient weight loss management through physiotherapy

In 2022, the World Health Organization (WHO) published a report revealing that the UK ranked fourth for having the most overweight and obese adults in the European region. What’s more, the NHS disclosed that, between 2019 and 2020, there were just over 1 million hospital admissions in England where obesity was a factor. The WHO added that across the region, obesity is likely to be directly responsible for at least 200,000 new cancer cases annually.

A holistic approach is necessary to address rising obesity rates in the country. To combat widening waistlines and the illnesses linked to obesity, patients must also be educated on interconnected health indicators. If you have been with us since the start, you would remember one of our first articles published on here already stressed the need for tackling healthcare under the lens of a unified theory. The Unified Theory of Healthcare emphasises that symptoms are often interlinked and that medical responses should be multi-dimensional. This theory can help patients seek better care and empower healthcare professionals to provide holistic care.

Approaching weight loss management holistically

Sleep deprivation and its impact on physical health is a great example of the interconnected nature of illnesses. Research findings show that there is a 50% increased risk of developing obesity among sleep-deprived individuals. In many cases, patients underestimate the complex interplay of factors that lead to obesity, as most people assume that obesity can be blamed purely on a poor diet. In truth, we know that obesity can be the result of genetics, an individual’s environment, medications, stress, emotional factors, poor sleep - to name but a few factors.

Just as the causes of obesity are multi-dimensional, so too should the treatment approach be. As physiotherapists, we see many patients on their weight loss journey. Our role in that journey is to provide them with the utmost care and support.

As such, one of your physio interview questions may explore this very topic: How can physiotherapists help support patients’ weight loss management?

Helping patients through appropriate physical activity

This is the easy part to remember. Time and again, studies have shown physical activity and exercise to be pillars in the management of obesity. However, the development of obesity is associated with decreased habitual fitness and limited mobility. As such, physiotherapists should begin by conducting a thorough assessment of the patient’s medical history, current fitness level, and weight loss goals. Appropriate collateral information from the patient's GP should be obtained re: any risk to physical activity. Think about outcome measures and questionnaires too, such as Physical Activity Readiness Questionnaire (PAR-Q).

Tailor an exercise programme according to the patient’s needs, prioritising strength training to increase metabolism and build muscle mass. Then add in low-impact aerobic exercises to improve cardiovascular health. Part of giving holistic support also involves teaching stress management strategies and encouraging patients to integrate more physical activities into their daily lives (the classic "get off the bus a stop earlier and walk" bit of advice is still relevant!).

Regular physical activity has benefits beyond the reduction of fat mass, and can start a cascade of positive clinical outcomes, eg decreasing the risk of metabolic disease, cardiovascular disease, Alzheimer, amongst many others.   

Know your exercise recommendations! To obtain “substantial health benefits,” adults should do at least 150 to 300 minutes a week of moderate-intensity physical activity or 75 to 150 minutes a week of vigorous physical activity.  For people looking to lose weight in the long term, this has been shown to be even more, at least 200 to 300 minutes weekly.

Ensuring patients have coordinated care and good management strategies in place

Adherence to new physical activity habits over time poses a challenge for many patients managing obesity. Offer guidance and education on what patients can do to stay on track. Self-management strategies range from information sharing to active behavioural change interventions. Physiotherapists can point patients toward resources like weight loss programmes. For this, patients can search for keywords like weight loss groups near me online. Teach them to find a trusted platform that gives them access to expert tips from trainers, nutritionists, and dieticians. Platforms that connect patients with a supportive network will also encourage them to stay motivated and find greater success.

Similarly, the NHS offers weight management pathways which your patients might fit the criteria for. Depending on a patient’s needs, the NHS has multi-tiered options. Tier 3 weight management services can includes Psychologists / psychotherapists, weight management advisers, specialist dieticians / nutritionists, and bariatricians. This is usually a 12-week programme followed by regular support for up to 2 years and patients must be referred by their GP and meet certain criteria to access the programme. If patients are thinking about weight loss surgery, they have to be informed that they will need to complete 6-12 months of a tier 3 programme, and show evidence of behaviour and lifestyle changes.  

Helping patients manage obesity-related chronic pain

Persistent pain is common in individuals with obesity. This association can be attributed to increased biomechanical load, changes in the gut microbiome, low-grade inflammation, and lifestyle factors. In such cases, integrating weight reduction techniques within chronic pain management leads to better outcomes for reducing pain and disability.

As physiotherapists, we have a unique skillset which allow us to help patients with weight management, be it from our anatomical knowledge, our knowledge of physiology and exercise physiology, as well as our understanding of cardiovascular and cardiopulmonary health. However, it is our multifactorial, biopsychosocial approach to treatment which ties all this together and which allow us to help patients with the complex symptoms, comorbidities and persitent pain that comes with obesity. As physios, we also usually have the most contact time with our patients, and can make a big impact through consistent treatment, intervention and education. However, it is important to always recognise your own scope of practice, and know when to refer on to a psychologist, nutritionist or other specialist.

The key to successful weight loss is combining appropriate physical activity, sustainable diet adaptations, and having the appropriate, ongoing support to help tackle the many factors contributing to it. By taking a holistic and tailored approach to each patient’s needs, physiotherapists can play an essential role in helping patients achieve sustainable results.

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