Sadly, it seems we cannot escape the fact that many physiotherapists now believe that part of the answer to the problems now facing the profession can be resolved, at least in part, by telling people to lose weight, stop smoking, and get more exercise.
The need to feel part of the move towards population-based primary health care has induced many traditional and orthodox health professionals to scratch their heads and ask what their social function will be in the future.
It seems reasonably clear that traditional sources of work, like the specialist care that once took place in large hospitals, and the routine self-limiting, acute musculoskeletal disorders that made up significant amounts of private practice work, are in terminal decline.
But based on the opinions of ‘Leading physiotherapists from the UK, Canada and Australia’ who ‘led a symposium at the IFOMPT conference in Glasgow’ recently, the answer lies in merely ‘getting patients active’ (link).
Non-specific physical activity may well be an important response to the growing concerns around lifestyle disorders, but surely we should be asking whether it requires someone with an expensive three- or four-year training and years of experience with complex co-morbidity to tell someone to lose weight and get more exercise?
Surely the future of the profession lies in more complex health issues than this?
But then perhaps this desire to move into the occupy the mundane end of public health care speaks more to our inability to imagine where the funding will come from for the kind of work that we really should be doing?
I wonder if you’d consider that helping to enable individuals to loose weight and get more exercise (if they want to) may be reasonable goals towards prevention and maybe even management of the dire conditions that you describe. I’d suggest that it’s not what people are told or indeed what they do but how they do it that’s a more salient point to be addressed by such a symposium. This may be a better use for all that edumacation… For individuals who already find it tough being enabled to achieve more activity with less physical effort may be a better suggestion to start with? 🙂
I’d suggest that it requires a lot more than as you say a 3 or 4 years of training and years of experience to address what is a rising global phenomenon. Obesity is a far more complex issue that most medical practitioners and clinicians alike feel grossly inadequate in their approach to helping people who present with same to their practice. From a manipulative physiotherapists perspective I’ve often wondered in the big scheme of things how much am I really making a difference in someone’s life by doing any kind of manipulative technique when obesity and other co-morbidities are life threatening and significantly impacting on one’s life experience. Physiotherapy should truly encompass the full biopsychosocial model in adjusted proportions – not 99% bio. I’d like to think that as physio’s we are eminently placed to take a leadership position in this space to where possible, help people help themselves. Even better, can we embrace the wellness space instead of the sickness model and influence health policy in order to effect legislative change. This is a useful post that Dave has posted and should get us all thinking. Obesity is far more than a personal behavioural problem that isn’t at all helped by saying ‘exercise more and go on a diet’ – that approach sets people up for failure, just my thoughts.
Thanks Ricky. Great comments.
Just to be clear, I’m not arguing that physiotherapists should leave this work to other people, only that it doesn’t take a 3 or 4 year degree and all that experience to tell people to lose weight and get more exercise.
Unfortunately this uncritical rhetoric is very common in physiotherapy at the moment.
There are clients/patients who have multiple co-morbidities for whom simple well meaning exercise advice could be very dangerous. They need proper assessment and carefully thought through interventions. Its these people I think will benefit most from physiotherapy.
I would also support what you say about a more embodied approach to care. I don’t personally hold with the biopsychosocial model. It seems to me to be a biomedically-driven attempt at holism. It’s too focused on the psychology of behaviour – an approach with very little evidence of efficacy, and pays almost no attention to the social determinants of health, which are much more significant determinants of access to good quality food, clean air and safe walking areas, and access to high quality support services; all vital in helping people remain fit and healthy, regardless of body size.
I think we need to take a close critical look at how we are joining in with the body-shaming that seems to be customary now when anyone talks about body size. We live in what must be the most weight-obsessed time and as people who work with bodies a lot, we must be very careful about whose side we’re on in this fight.