The Casual Narratives for Obesity in Low Income Families

Original Editors - Ben Carter, Maire Nic Amhlaoibh, Niamh McCormack, Emma Roche, Sinead Collins, Lucy Manico and Daniel Thomas as part of Queen Margaret University's Current and Emerging Roles in Physiotherapy Practice Project

Meridian Contributors - Admin, Kim Jackson, Lucinda hampton, Maire Nic Amhlaoibh, Niamh McCormack, Ben Carter, Vidya Acharya, Judith Lane, Emma Roche, Kate Oakes, Sinead Collins, Daniel Thomas, George Prudden, Tony Lowe and Lucy Manico

Introduction [edit | edit source]

Co-ordinate to the WHO in 2016 1.9 billion people were overweight, 600 million of these were obese and alarmingly 41 million children nether the historic period of 5 were overweight or obese (childhood obesity) ^[1]

The table beneath shows environmental factors that create a part in causing obesity.^[2]

Increasing energy intake	Decreasing energy expenditure
↑ Portion sizes ↑ Snacking and loss of regular meals ↑ Energy dense food ↑ Affluence	↑ Machine ownership; ↓ Walking to school/work ↑ Automation; ↓ manual labour ↓ Sports in schools ↑ Fourth dimension spent playing video games and watching TV ↑ Central heating

Evaluation [edit | edit source]

A standard screening tool for obesity is the measurement of body mass alphabetize (BMI). See here

Waist to hip ratio should be measured, in men more than than 1:1 and women more than than 0:8 is considered pregnant. Encounter here

Further evaluation studies similar skinfold thickness, bioelectric impedance assay, CT, MRI, DEXA, water displacement, and air densitometry studies can be done^[3]. See here

Handling/Direction [edit | edit source]

Obesity causes multiple comorbid and chronic medical conditions, and physicians should accept a multiprong approach in the direction of obesity. Practitioners should individualize treatment, care for underlying secondary causes of obesity, and focus on managing or controlling associated comorbid conditions. Direction should include dietary modification, behavioural interventions eg exercise, medications, and surgical intervention if needed.

• Dietary modification should be individualized with close monitoring of regular weight loss. Low-calorie diets are recommended. Low calorie could exist carbohydrate or fat restricted. A low-carbohydrate nutrition can produce greater weight loss in the get-go months compared to a low-fatty nutrition. The patient'due south adherence to their diet should frequently be emphasized.
• Behaviour Interventions: Obese patients to be referred for intensive behaviour interventions. Several psychotherapeutic interventions are available which includes motivational interviewing, cognitive behaviour therapy, and interpersonal psychotherapy. Behaviour interventions are more effective when they are combined with nutrition and energy expenditure modification (i.e., exercise)
• Medications: Antiobesity medications tin be used for BMI greater than or equal to 30 or BMI greater than or
• Surgery: Indications for surgery are a BMI greater or equal to 40 or a BMI of 35 or greater with severe comorbid conditions. The patient should be compliant with post-surgery lifestyle changes, function visits, and exercise programs. Patients should take an extensive preoperative evaluation of surgical risks.^[3]

Physiotherapy [edit | edit source]

Physiotherapists tin play a role in educating customer re weight loss and assessing and planning an practice program. The programme of practice focuses on energy expenditure modification through practise.

• Utilizing exercise as a means of reducing obesity (i.e., reducing fat mass) has benefits beyond the reduction of fat mass. Fitness is associated with more than desirable clinical outcomes in many instances, eg decreasing metabolic disease, cardiovascular disease, Alzheimer illness risk, inflammation.
• Encourage patients to make a list of personal reasons to adopt an agile lifestyle. Prepare short-term goals. Goal setting has been shown to be effective in focusing the attention of participants toward behaviour alter.
• Patients must exist cleared by their healthcare provider for whatsoever comorbid conditions by history and physical examination to maximize patient safety. Examples include the Physical Action Readiness Questionnaire (PAR-Q) and Wellness/Fitness Facility Preparticipation Screening Questionnaire.

Practice recommendations

Minimum of 150 to 300 minutes of moderate physical activity per week or 75 to 150 minutes of vigorous physical activity weekly is essential to forestall weight regain, increase weight loss and ameliorate fettle. However, for individuals who wish to lose weight, at least 200 to 300 minutes of moderate to vigorous physical activity each week is recommended to encourage long-term weight loss.

1. The recommendation for inactive individuals is "start low and get slow" by starting with lower intensity activities and gradually increasing the frequency and duration of the activeness.
2. It is a adept idea to spread out aerobic activeness over the week, versus all the time in ane day.
3. Employ appropriate gear and sports equipment and chose safe environments.
4. Accommodate exercises equally necessary to subtract orthopedic chance or is non-convalescent (if applicable). This can include cycling or hydrotherapy instead of running if an individual has arthritis. If individuals are non ambulatory or may take to modify practise due to special circumstances, the practice guidelines nevertheless apply. However, the patient can get artistic to find ways to reach them, such equally utilizing limbs that are more ambulatory than others (e.g., moving artillery faster in order to become the heart charge per unit up if legs are not able to be used, upper torso ergometer, etc.)
5. Anaerobic training can exist implemented and may even increase muscle mass. Anaerobic do has not been shown to be constructive in altering energy expenditure or absolute weight loss. Notwithstanding, if the goal of the patient is to increase muscle mass, and then anaerobic exercise is highly encouraged. Furthermore, in order to increase musculus mass, each musculus group should be exercised at a minimum of ten sets per calendar week, with one fix consisting of 8 to 10 reps. Besides, ensure proper form to avoid injuries. Individuals who are non ambulatory or may accept express movement are still able to participate in an anaerobic do. Individuals must ensure proper form but can modify exercises as needed, such equally upper torso but exercises, lower torso just exercises, using a neutral grip, keeping stable movements, etc.)^[4]

Our Unique Skills [edit | edit source]

Some of the skills possessed by physiotherapists that make them qualified to deal with the growing obese population are:

• Anatomy (important to know nigh strengthening exercises to let the musculoskeletal system to cope with the extra demands placed on them by overweight individuals)
• Physiology (important to know nearly changes to heart rate, claret pressure, etc.) and Exercise Physiology (important to create and implement practice programs)
• Cardiovascular/Cardiopulmonary systems (important to know virtually changes to breathing patterns, apneas, cardiovascular disease.)
• Biopsychosocial Model (important to know nigh environmental factors, cultural factors, social factors, etc., that pb to the development of this condition)
• Physiotherapists may take large contact time with obese people, therefore they can potentially make a big touch on.
• Physiotherapists also accept good knowledge of secondary complexity such as – hypertension, diabetes, osteoarthritis and complex profound physiological changes.

Physiotherapists are recognized as able to prescribe exercise programs targeted at an private'southward specific problems, all the same, the precise boundaries of a physiotherapists remit when dealing with obesity tin be hard to define. Therefore physiotherapists should exist enlightened of significant bug that volition crave referral to the relevant professionals such as:

• Psychology/cognitive-behavioral approaches (psychologist)
• Nutrition/caloric management (nutritionist)

Self Management of Obesity [edit | edit source]

Many approaches have been assessed to back up self-management, ranging from passive approaches such equally information sharing at ane finish of the spectrum to agile behavioural change interventions at the other. Self-management support can exist conceptualised past dividing interventions into those that focus on building knowledge and skills (such every bit healthy eating habits) versus those that target self-efficacy.

Providing Data

• Written data - Written information materials to support self-direction are common and include guidebooks and printed educational materials. Written motivational leaflets or letters help people experience more willing to raise concerns and discuss their symptoms^[five] but whether such written information results in behaviour change is debatable^{[half dozen]}.
  Electronic information sources - Audiovisual engineering science, computers, Internet and the mass media tin can also exist utilised in the delivery of cocky-management information.
  

Planning and Goal Setting

• Planning and goal setting ofttimes take the grade of care plans; these are a written document designed by service users and healthcare professionals, which address bug, treatments/interventions, review schedules and targets.
  Care plans often include both goal setting and development plans with the aim of achieving the set goals.

References [edit | edit source]

1. ↑ Globe Health Organization. Obesity and overweight factsheet. Bachelor: https://world wide web.who.int/en/news-room/fact-sheets/item/obesity-and-overweight[Accessed fourteen.11.2021] ↑
2. ↑ Boon N.A., Colledge Due north.R., Walker B.R. and Hunter J.A.A. 2006. Davidson's Principles and Practices of Medicine, Affiliate 5. 20th Edition. Elsevier publishing.
3. ↑ ^{3.0 3.1} Panuganti KK, Nguyen 1000, Kshirsagar RK, Doerr C. Obesity (Nursing).Available:https://world wide web.statpearls.com/articlelibrary/viewarticle/26060/ (accessed 14.xi.2021)
4. ↑ Niemiro GM, Rewane A, Algotar AM. Exercise and fitness event on obesity. Available:https://world wide web.ncbi.nlm.nih.gov/books/NBK539893/ (accessed 14.11.2021)
5. ↑ Glasgow, N. J., Ponsonby, A.L., Yates, R., Beilby, J. & Dugdale, P. 2003. Proactive Asthma Intendance in Childhood: General Practice Based Randomised Control Trial. British Medical Journal. 327 (659).
6. ↑ Little, P., Dorward, 1000., Warner, G., Moore, M., Stephens, K., Senior, J. & Kendrick, T. 2004. Randomised Control Trial of the Effect of Leaflets to Empower Patients in Consultations in Master Care. British Medical Periodical. 328, pp. 441-iv.

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