Medical Education

The Role of Occupational Therapy in Obesity Management

Keith Z. Brewster, Ph.D. (Cand.), M.A., Hon. B.A., School of Health and Exercise Sciences, University of British Columbia, Ke-
lowna, British Columbia, Canada
Behdin Nowrouzi, PhD, MPH, MSc. OT. OT. Reg. (Ont.), Centre for Research in Occupational Health and Safety, Laurentian Univer-
sity, Sudbury, Ontario, Canada
Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
Laura C. Davis, BHK, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada

intricate interplay of biopsychosocial factors – most notably

Abstract genetics, poor diet, and/or sedentary behaviour – are be-
Obesity has become a significant and wide-ranging lieved to contribute to the development and maintenance of
health and social epidemic occurring in both de- the condition.6
veloped and developing nations and across all age
Defined as a body mass index (BMI) score of 30 kg/m2
cohorts. Occupational therapists provide interven-
and above, obesity has reached epidemic/pandemic status in
tions to individuals, groups, and populations in or-
many countries throughout the developed and developing
der to effect change, optimize health, and improve
world.7 Globally, over 1.4 billion people are considered over-
quality of life. Accordingly, occupational therapy
weight (BMI ≥ 25 kg/m2) or obese and obesity has become
services are often integral in addressing obesity-
related illnesses and subsequent limitations while the fifth leading cause of death worldwide, in large part due
managing weight through attention to lifestyle, to increased risk of various significant comorbidities (i.e., car-
and the promotion of healthy, active lifestyles. The diovascular disease, diabetes, various cancers).8,9 Within the
purpose of this position paper is explain to persons obesity spectrum, the rate of morbid obesity (BMI ≥40 kg/
within and outside of the profession the role of oc- m2) is growing most rapidly and across all age cohorts. Equal-
cupational therapists, and/or occupational therapy, ly troubling is that approximately one-third of North Ameri-
in obesity management, from an individual and can children 6 to 19 years of age are considered overweight
population perspective. or obese (defined as being at or above the 85th percentile of
the sex-specific BMI-for-age growth chart), putting them at
risk for a variety of the aforementioned health risk and con-
cerns.10, 11 In Canada, approximately one in four Canadians
are clinically obese, creating significant challenges for the Ca-

O
besity has become an increasingly common condi- nadian health care system.12
tion that problematically places those affected at an In 2008, the economic impact of obesity in Canada was es-
elevated risk for a broad range of acute/chronic timated to be $7.1 billion, up 19% from 2000.12 As a result
health conditions including but not limited to hypertension, of the numerous health complications within the clinically
type-2 diabetes, coronary artery disease, stroke, sleep apnea, obese population, the average health care costs now exceed
muscular-skeletal difficulties, hyperlipidemia, and several $10,000 per patient per year. Given the severity of the disease
forms of cancer.1,2,3 In addition, obesity is also believed to and significance of the economic and health care burdens in-
contribute to the development and manifestation of various volved a need for intervention at both clinical and population
psychological conditions and mental health problems (i.e., levels is paramount.1,13,14
anxiety, depression, stigmatization, etc.). As such, obesity is Accordingly, various strategies, ranging from health pro-
now considered a multi-factorial chronic disease itself, associ- motion initiatives, improvements in education, and increased
ated with a myriad physiological, psychological, and quality of funding for bariatric surgery have been proposed and/or ad-
life deficits.4,5 Like many other chronic diseases, the etiology opted to some degree16. However, given the multi-factorial
of obesity cannot be linked to one primary cause. Rather, an nature of obesity, a multi-factorial approach should also be
utilized in managing obesity. Specifically, in order to effec-
tively manage obesity at an individual or population level, a
multi-disciplinary approach, comprised of allied health care
Corresponding Author:
Keith Z. Brewster practitioners and specialists, is essential in order to attain op-
Email: [email protected] timal results for individuals living with obesity. Of particular

UTMJ • Volume 91, Number 1, June 2014 33

 Medical
 Education

The Role of Occupational Therapy in Obesity Management

interest and intrigue is the role of the occupational therapist rounds, the client is the focus of the occupational therapy.
in various aspects of obesity management. The OT’s relationship with each client is to bring their knowl-
Occupational therapy is the art and science of enabling edge and expertise to help increase the client’s occupational
engagement in everyday living through occupation. In addi- performance and allow the client to make informed decision.
tion, the profession enables highly trained individuals to pro- Moreover, a therapist is often critical in placing the values of
mote and develop the health and well-being of others.16 As a meaningful occupations and considering assessments that in-
form of prevention and intervention, occupational therapists crease function and a client’s occupational performance. Us-
assist people with physical, psychological, and environmental ing different assessment processes that measure occupational
conditions through education and the use of assistive devices performance issues and components, the therapist gathers
designed to improve their quality of life.17 In terms of obesity, evidence to select a treatment plan that would fit that client’s
overall treatment/management options may include educa- unique needs.
tion, counseling, rehabilitation, lifestyle modification, phar- The functional, social and medical sequalae of obesity are
macotherapy, and/or bariatric surgery.18 consistent with other chronic conditions that result in dis-
Given the context of obesity and its current treatment ability.24 With the current prevalence of obesity and the role
modalities, obesity management is of great interest to the oc- that occupational therapy plays in the management of chron-
cupational therapist. Occupational therapists (OT) consider ic conditions, OTs come into contact with obese persons in
obesity within the chronic disease/illness paradigm or as a their clinical practice on a regular basis.16 People with obesity
health condition across the obesity spectrum (stage 1-4 or should have access to evidence-based, interprofessional and
class I-III).16 Class I obesity is defined as a BMI (kg/m2) be- collaborative health services throughout their lifespan16.
tween 30.0-34.99, class II obesity as a BIM between 35.0-39.99 Occupational therapists are ideally situated to provide care
and class III as a BMI ≥ 40.00. Occupational therapists are to people with obesity. Healthy occupations, in the framework
trained to provide vital insight into enabling participation in of obesity prevention, refers to participation in physical ac-
physical activity, developing functional environments, main- tivity and the intake of a nutritionally balanced diet.25 This
taining independence and addressing societal challenges necessitates skills and access to participate in physical activity
posed by physical limitation, including obesity.19 As such, in- and healthy food choices. In the context of obesity treatment,
dividuals living with obesity are likely to benefit from the ser- healthy occupations include, in addition to physical activity
vices of an occupational therapist. and healthy eating, access to services that meet the biopsycho-
Through advocacy, occupational therapists promote client social needs of persons with obesity.25,26
services to address obesity. These may include goal setting Obesity is a chronic disease for which treatment options in-
activities, health promotion undertakings, job site analysis, clude lifestyle modification, pharmacotherapy, and surgery.27
equipment adaptation and support with activities of daily liv- OTs are pivotal contributors to a health care team for persons
ing. Furthermore, therapists are ideally situated to address with obesity, as in other areas of chronic disease prevention
the stigma related to obesity through research, education, and management.16 OTs need to be informed of current
and self-reflective practice.16 For instance, therapists may evidence based practices and should be leaders in terms of
liaise between an employer and employee in order to mini- enabling clients, groups and communities to engage in mean-
mize the stigma associated with obesity and facilitate a timely ingful activities that will enhance or improve their health.
return to work when applicable. The therapist plays a pivot- Clients with obesity are at risk for occupational deprivation
al role in the return to work process and meeting both the in the areas of self-care, leisure and productivity. Therefore,
needs of the worker and the employer. Facilitating improved persons at risk of developing obesity or persons with obesity
communication and setting realistic goals will help foster a would benefit from access to occupational therapy services.16
collegial atmosphere and decrease workplace absenteeism. Obesity is a multifactorial condition that for some clients is
Obese individuals frequently experience bias, stigmatization a temporary state. However, for other individuals, obesity is a
and discrimination due to weight.20,21 Weight bias refers to chronic condition that will require occupational therapists to
“the inclination to form unreasonable judgments based on work closely with individuals to develop client-centered goals
a person’s weight”.22 Stigmatization refers to a generalized that improve their occupational performance. Obesity and
devaluation and social exclusion of individuals as a result of weight bias are growing issues in Canadian society and must
deviance in particular attributes, like being overweight.23 be regarded as serious problems. This stigmatization has seri-
As part of a multidisciplinary team, the role of the oc- ous socio-economic, health and psychological consequences
cupational therapist includes working closely with clients/ for obese individuals. Now that the types and prevalence of
patients in developing, designing and implement client- weight bias have been identified, the focus must move toward
centered goals. Like other allied health professions, occu- identifying how to rectify this societal issue. The mechanism
pational therapists focus on client-centered approaches to underlying the stigma must be identified so that effective in-
practice. Whether during assessments, treatments or at team tervention strategies can be developed and implemented. In

34 UTMJ • Volume 91, Number 1, June 2014

 Medical Education
The Role of Occupational Therapy in Obesity Management

order to develop policy that addresses the stigmatization of 9. Swanson, T. W., Tang, B. Q., Rusnak, C. H., Schaeffer, D. F., & Amson, B. J.
A five year Canadian laparoscopic adjustable gastric band experience. AJS,
obesity in the workplace and to better understand weight bias 199, 690–694 (2012).
and its underlying mechanisms more field research is neces- 10. American Association of Occupational Therapists. Position Paper: Occupa-
sary. As a public health issues, there is a need to educate the tional Therapy and Obesity. Retrieved October 28, 2013, from http://ajot.
aotapress.net/content/61/6/701.full.pdf (2007).
public and employers on the topics of obesity and weight bias 11. Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis,
in order to raise awareness of this pervasive issue. The contin- P. A., Ringham, R. M., et al. Psychiatric disorders among bariatric surgery
candidates:relationship to obesity and functional health status. Am J Psy-
ued development of preventative strategies targeting weight chiat. 164, 328–374, (2007).
stigmatization and stigma management in the workplace and 12. Canadian Institute for Health Information, “Discharge Abstract Database.”
http://www.cihi.ca//CIHI-ext–portal/ pdf/internet/DAD EXECUTIVE
other institutions is necessary. Finally, there is also a need to
SUM 09 10 EN (2011).
advocate change in current legislation in order to prohibit 13. Burke, L. & Wang, J. Treatment Strategies for Overweight and Obesity. J
discrimination and protect obese individuals from weight re- Nurs. 43, 368-375 (2011).
14 . Padwal, R. S., Pajewski, N. M., Allison, D. B., & Sharma, A. M. Using the
lated discrimination. Edmonton obesity staging system to predict mortality in a population-
representative cohort of people with overweight and obesity. CMAJ. 183,
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15. Christou, N. & Efthimious, E. Bariatric Surgery Waiting Times in Canada.
Acknowledgements Can J Surg. 52, 229-234 (2009).
We the authors thank the University of British Columbia, 16. Canadian Association of Occupational Therapists. CAOT Position State-
ment Obesity and Healthy Occupation. Retrieved October 28, 2013, from
Laurentian University, Northern Ontario School of Medicine, http://www.caot.ca/default.asp?pageid=3894 (2010).
Canadian Institute of Healthy Research, Mitacs Inc., and the 17. Colman, W. (1992). Maintaining Autonomy: The Struggle Between Occupa-
tional Therapy and Physical Medicine. Am J Occup Ther. 46, 63-70 (1992).
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for their support. guidelines on the management and prevention of obesity in adults and
children, CMAJ. 176, 1-120 (2007).
19. Pierre, N., Pollack, N., & Farfard, P. Health policies and trends for selected
target groups in Canada: an overview report for the Canadian Association
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