Obesity and Physical Therapy
The late comedian Patrice O’Neal is now famous for saying, “My doctor has told me that if I don’t lose weight, it will kill me. That’s not motivation enough for me.” O’Neal had severe diabetes, which led to a stroke that killed him in November 2011 at the young age of 41.
Obesity can affect every system in the human body. In physical therapy we most commonly see obese patients who have complications associated with diabetes, arthritis and heart disease. There is a genetic component to each of these diseases, but for the most part, they are preventable. Diabetes, arthritis, and heart disease are non-communicable diseases. You don’t catch them from being in a room with someone who has them. You don’t get them from kissing or getting sneezed on.
The human condition is such that the possibility of being sick or dying is not enough to persuade most people to change the way they live. Most of us need to get a diagnosis from a professional or see someone close to us get sick or die to make significant changes in the way we manage our health. Diabetes, arthritis and heart disease are acquired subtly; you don’t just wake up with arthritis in all your joints one day. They take time to make their way into your life, usually without you even knowing. This can be a double-edged sword. If you choose to make a change, this can be a positive. Small tweaks in your diet and increases in your exercise volume can decrease your weight and improve your overall health. On the other hand, the slow creep of these obesity-related diseases allow people to rationalize doing nothing, with the excuse that they have plenty of time before it gets serious.
Obese patients usually see a Physical Therapist because the arthritis in their knee is so bad they can’t climb steps or the diabetic neuropathy in their feet is so painful that they barely walk any more. By this stage, these symptoms are very challenging for the PT to treat. Multiple medical issues coupled with a lack of mobility creates a complicated scenario. This patient has to get moving despite the pain.
Arthritis is caused by a constant wear and tear on a joint to the point of irritation and chronic inflammation. The inflammation leads to breakdown of cartilage and bone, causing pain and dysfunction. Obesity makes it nearly impossible to allow that joint to rest and heal. The patient’s de-conditioned state also makes it very challenging for them to get active enough to lose weight.
The complications associated with diabetes and heart disease are similar. A major element of healing is blood flow. Blood supplies oxygen to the body and oxygen fuels chemical interactions, including cell reproduction and growth. Healing is essentially growth of new, healthy cells and it can’t happen without ample blood supply. Heart disease prevents sufficient amounts of blood to be pumped throughout the body while diabetes affects the quality of that blood supply. Both diseases make it extremely challenging for the body to heal itself.
Movement and exercise are the key components of helping obese patients improve. A Physical Therapist is extremely aware of the risks and complications associated with obesity, arthritis, diabetes and heart disease. The major obstacle that most of these patients face is a fear that they are too overweight to exercise. This couldn’t be further from the truth. In fact, it’s necessary that they exercise. They just need to be guided by a professional.
Every patient is different and a PT will always do a thorough evaluation before designing a custom plan of care for each patient, but here is a typical program for someone who is experiencing complications related to obesity:
1. Pain control modalities if necessary
2. Cardiovascular exercise
3. Strengthening exercise
4. Balance training
5. Gait training
6. Aquatic exercise
7. Functional activity (ADL) training
8. General nutrition education and consult to nutritionist/dietician if necessary
Ask the Physical Therapists at WSPT how PT can help you manage Obesity and Obesity related conditions.