During the past two years of my clinical experience I have come upon many different conditions: osteoarthritis, cardiovascular and pulmonary disease, diabetes, hypertension and chronic low back pain – to only name a few. One of the recurring factors in all of these patients was that most of them were overweight or obese.
It is a well known fact that obesity has significant co-morbidities and may affect many other health related conditions. It affects not only the physical, but also the mental and psychological aspect of humans, as an obese individual might struggle with low self esteem, or suffer from depression (Haslam & James, 2005). It affects their lives in all aspects.
The increased BMI of most of these patients is the leading cause and facilitator for the health condition they suffer from now. Due to the sedentary lifestyle (Seidell et al., 2007) that normally accompanies obesity, the patients face secondary complications such as cardiovascular diseases, they are more prone to heart attacks, pulmonary complications (Haslam & James, 2005) and according to Sowers & Karvonen-Gutierrez (2010) is one of the leading causes of osteoarthritis in the knee and wrist.
So far my main treatment aim was to increase their level of physical activity in their daily lives. This will undoubtedly improve their overall health – cardiovascular and pulmonary endurance, muscle strength and endurance, decrease chronic pain levels as well as decrease the main problem of obesity (Seidell et al., 2007) which will have many more health benefits. However it is unrealistic to expect them to accomplish this in a framework of five to six weeks (the amount of time we spend at a particular clinical block).
Looking at obesity and its affect on other underlying conditions that the patients may suffer from, if you can lower the amount of access body weight – or fat, to be blunt – this will improve those conditions (Lau et al., 2007). Is it fair then to suggest to these patients to come back in a few months time after they have lost x amount of weight? Is it ethical to tell a patient that there is nothing you can do for them unless they make a drastic change to their current lifestyle?
Besides proscribing a home exercise program, exercise classes, education and refferals to a dietitian, what more can we as Physiotherapists do to fight obesity? The fact of the matter is that no matter how many times you put on a hot pack, or how many joint mobilizations you do, if they do not lose weight their problems will probably not go away.
References:
- Lau, D. C. W., Douketis, J. D., Morrison, K. M., Hramiak, I. M., Sharma, A.M., Ur, E. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ, 176(9), S1-S13. Doi: 10.1503/cmaj.061409
- Haslam, D. W., James, W. P. (2005). Obesity. Lancet (Review). 366 (9492): 1197–209. Doi: 10.1016/S0140-6736(05)67483-1
- Seidell, J. C., Nooyens, A. J., Visscher, T. L. S. (2007). Cost-effective measures to prevent obesity: epidemiological basis and
appropriate target groups. Proceedings of the Nutrition Society, 64(1), 1-5. Doi: 10.1079/PNS2004402 - Sowers, M. R., Karvonen-Gutierrez, C. A. (2010). The evolving role of obesity in knee osteoarthritis. Current Opinion in Rheumatology, 22(5), 533-537. Doi: 10.1097/BOR.0b013e32833b4682
3 thoughts on “Obesity and the ethics around that”
Hi Theron.
Thank you for your thoughts on obesity related to clinical practise. This is something many of us as health care providers struggle with to help obese patients to be fully functional and pain free. However I have a few suggestions:
Paragraph 1:
Sentence 2: Consider restructuring this sentence to ” One of the recurring factors in most of these patients were that most of them were either overweight or obese. ”
Paragraph 2:
I agree with you that obesity has a lot of comorbidities and that this can have a major impact on their health status. I would just suggest that you find evidence about why obesity causes comorbidities and the types of comorbidities to support this claim and to make your argument even stronger.
Paragraph 3:
Consider rephrasing sentence 1 to make it more formal. ” The increase BMI of these patients is the leading cause of their health condition they suffer from now.”
Sentence 2: Restructure this sentence to let the text flow more easily. I suggest changing it to ” Due to the sedentary lifestyle of obese patients, they face secondary complications such as cardiovascular disease, pulmonary complications and they are more prone to heart attacks.” Also consider getting rvidence for this statement at it will make your text more reliable. Then after that start with a new sentence. ” According to Schroeder(2011) this is the leading cause of osteoarthritis in the knee and wrist.” Just clarrify what this cause is as it is a bit unclear. Also include this reference in you reference list.
Paragraph 4:
Include evidence for your statement in sentence 2 on own the physical activities will improve their overall health.
Paragraph 5:
How will losing excess body weight benefit a patient who has a health condition? Also what type of conditions are you talking about? If you can answer the questions for the readers it will help them to understand the text in more depth.
You first question in this paragraph is one that I have asked myself before. Is it fair to send them back to home and ask them to lose weight before coming back for treatment?. I personally think that it can be fair in certain circumstances. If you send the patient back to lose weight you would have to refer them to a dietician and provide them with an exercise programme that will assist them. Even though it you do this the patient may still be overweight so what else can you do from your side?
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Evidence is important in this writing piece so try to research literature there is on what physiotherapists can do for obese/overweight patients. This will definitely make the writing more formal and make your argument more stronger.
Overall I like that you chose this topic as this is something we struggle with at our clinical placements due to the limited time. If you can find a sustainable solution for patients it will make not only your live easier but theirs as well.
Hi Theron.
I liked the idea of focusing on obesity but then linking it to the manner we address patients and their conditions. Its something we all face at some point and don’t always handle in the best way, forgetting that we are talking to a human being with other external and internal factors that may be contributing as well.
As a suggestion I would say maybe zone in a little more on the ethics and how we can address issues such as obesity and the importance of weight loss in a respectable and professional manner. For example the steps we can take such as explaining the medical side of it all to our patients or referring them so that they can make informed decisions. I would like to see the questions you posed at the end answered in some way. Could be interesting.
Overall the flow is good and easy to understand. In paragraph 2 it should be affects or may affect”….and affect many other health related conditions.” No other grammar errors that i can see.
Don’t forget the reference list, and maybe a few more recent articles to support your statements and examples.
Thanks. Hope this helps.
Hi Theron,
Found it interesting how you managed to link an unhealthy lifestyle with that of a ethical dilemma. Here are a few suggestions that I think could strengthen your argument/stance throughout this piece.
For the rest of your piece, I suggest you rephrase some of the sentences so that it is more formal and that of academic writing. This would strengthen your viewpoint. Saying this, you ask a few questions – it could be interesting to see what the literature says regarding this ethical dilemma?
Try start your piece with an idea or fact that will grab your readers attention. Maybe stats on how many people suffer from obesity in the world, and then closing it down to South Africa. This will help your reader understand the extent of the problem relative to the world. It could be interesting to compare a developing country with a non-developing country to see what the root of the problem is causing the issue we are facing.
In paragraph 2, you make a few claims – but there is no reference to support this. Try add recent literature to back up what you are trying to convey to your readers.
Overall, a interesting piece that has a logical flow to it, but adding more references to support your claims would benefit the piece tremendously. You also need to add a reference list at the end.