Obesity: Staging and Assessment

• Obesity is a complex, chronic disease.
• Characterized by abnormal or excessive body fat that impairs health.
• Alberta recognizes obesity as a chronic disease.
• Causes of obesity are complex, involving societal, psychological, biological, and environmental factors.
• Patient A, B, and C have a BMI of 32 kg/m^2, assessed by DEXA scan.
• BMI does not measure body composition or fat distribution.
• Other ways to assess health risk beyond BMI include waist circumference.
• Increased cardiovascular risk for women: 80-87 cm.
• High risk for women: >88 cm.
• Increased cardiovascular risk for men: 94-101 cm.
• High risk for men: >102 cm.
• Edmonton Obesity Staging System (EOSS) is a functional and disease-related staging system for obesity.

Edmonton Obesity Staging System

• Stage 0: No risk factors, physical symptoms, psychopathology, functional limitations, or impairment of well-being.
• Stage 1: Presence of sub-clinical risk factors, mild physical symptoms/psychopathology/limitations/impairment.
• Stage 2: Established chronic disease, moderate limitations/impairment.
• Stage 3: Established end-organ damage, significant psychopathology/functional limitations/impairment.
• Stage 4: Severe disabilities, severe psychopathology/limitation/impairment.
• Recognizing obesity as a chronic disease is vital.
• Lifestyle changes yield a 5-10% body weight reduction.
• Pharmacotherapy and lifestyle changes produce a 10-15% body weight reduction.
• Bariatric surgery and lifestyle changes result in a 20-30% body weight reduction.

Canadians with Severe Obesity (2011 Survey):

• 75% have suffered for >10 years.
• 30% reported having spent their entire life suffering.
• 25% tried so many times to lose weight that they have lost count.
• 25% tried between 6 and 20 times to lose weight.
• Weight bias and stigma are negative perceptions directed toward individuals perceived to have excess weight.
• Over 40% of adults report experiencing weight bias and stigma daily.
• ⅓ of physicians listed obesity as a condition they responded to negatively.
• Health professionals/trainees attribute obesity to laziness, non-compliance, being unintelligent/less honest.
• Psychologists link it to more psychopathology and poorer prognosis.
• 69% of female patients report weight bias during encounters with health professionals.

Impact of Weight Bias on Patient Care:

• Decreased expectations of the patient.
• Increased aggressiveness toward the patient.
• Neglecting to explore all causes of health concerns.
• Attributing complaints/concerns to body weight.
• Lack of respect for autonomy and individual differences.
• Applying a one-size-fits-all approach to care.
• Decreasing the length of time spent with the patient.
• Discomfort while spending time with a patient who has obesity.
• Offering fewer interventions or preventative screening.
• Stigma impacts patient behavior, internalizing experiences, reducing engagement in lifestyle changes.

Strategies to Reduce Weight Bias and Improve Care:

• Reflecting on personal biases and beliefs.
• Avoid working with obese patients.
• Engaging in conversations amongst colleagues.

Plan Ahead in Clinic Settings:

• Have equipment that accommodates patients with obesity.
• Provide supportive seating for rest.
• Eliminate reading material promoting fad diets or negative images.
• Know the dimensions of doorways, weight capacity of equipment/furniture, elevator location.

Factors Beyond BMI:

• Why does this person have obesity?
• How is obesity affecting this person?
• What is the best treatment plan?
• Occupational performance is impacted by obesity.

Impact of Obesity on Participation:

• Challenges playing with children or grandchildren came up the most.
• Body functions/structures affected encompass strength, ROM, visceral fat distribution, endurance, comorbidities.
• Participation/life roles involve caregiving roles, social stigma, and exclusion from sports.
• Activity limitations include public events, ADLs, leisure, lecture halls, classrooms, and shopping centers.
• Personal factors: socioeconomic status, gender, age, education, social network affect participation.
• Environmental factors: restricted access to places and spaces, social attitudes towards disability affect participation.

OT in Obesity Management:

• Promote engagement in daily occupations.
• Enable strengths and address barriers.
• Address physical, cognitive, and affective factors that impact participation.
• Promote environments to support client goals.
• Coach and collaborate to build skills in goal setting, problem-solving, and self-management.
• Support advocacy for funding, equipment, and evidence-based treatments to improve health/occupational engagement.

Equipment Considerations:

• Patient comfort and size
• Size and dimensions
• Weight capacity
• Environment
• Cost and accessibility
• Seating and back support
• Mobility- self propulsion
• Transportation
• Adjustability
• Measurement considerations: body shapes, sitting position and weight dist, having the right tools.
• Mobility devices include canes, walkers, w/c, and powered mobility.
• Be mindful if powered mobility encouraging sedentary behaviour.

Aids:

• Dressing aids like sock aids/coiled laces are helpful for reaching limitations.
• Bath seats, grab bars, and detachable shower heads for bathing.
• Raised toilet seats, commodes, bidet seats for toileting.
• Ask the patient what they usually do to manage; come up with a solution.

Education and Skill Building:

• Skin care
• Physical activity
• Energy conservation
• Positioning
• Time management
• Stress management
• Home safety
• Community resources
• People with obesity are at high risk for skin breakdown.
• Excessive skin folds and perspiration lead to skin conditions.
• Medical comorbidities and compromised circulation contribute to skin problems.
• Challenges reaching areas to clean and lack of knowledge contribute to skin issues.

Managing Skin Care:

• Ask the client what works for them
• Frequent repositioning -checking and cleaning skin
• Encourage loose fitting, lighter weight clothing
• Moisturize frequently
• Support garments as needed