Managing BMI to Improve Pre & Post Surgical Outcomes

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MANAGING A PATIENT’S BMI can reduce pain and improve outcomes pre & post surgically.
Physical therapists can treat patients for their pain (potentially related to their obesity) and can provide can provide general population information to patients regarding healthy eating, healthy recipes, general daily activity.


HOW OBESITY AFFECTS A PATIENT:

  • Although genes play an important role in the regulation of body weight, the World Health Organization Consultation on Obesity concluded that behavioral and environmental factors (ie, sedentary lifestyles combined with excess energy intake) are primarily responsible for the dramatic increase in obesity during the past 2 decades (4)
  • Excess in mass imposes abnormal mechanics on body movements. (3)
  • Higher prevalence of hip OA “caused not only by age but also by an increasing number of people who are overweight or obese.”(1)
  • The use of BMI to assess weight-related health risk has gained international acceptance because of the associations between BMI and adiposity, BMI and disease risk, and BMI and mortality. (4)
  • Overweight is defined by a BMI of ≥25.0 kg/m2, and obesity is defined by a BMI of ≥30.0 kg/m2, regardless of gender. (4)

 

POSTIVE EFFECTS OF EXERCISE ON OBESITY:

  • Combining exercise with weight loss produces more effects on function and pain than either alone. (1)
  • Exercise generally does not produce considerable weight loss when used independently, but is a very important adjunct to a weight-reducing diet because it increases energy expenditure, enhances loss of adipose tissue, and improved dietary adherence. (4)
  • Weight losses of 5% to 10% of initial body weight produce health benefits and are deemed by many healthcare practitioners to represent a clinical success. Long-term success, however, is dependent on maintenance of a 10% weight loss for at least 1 year. (4)

 

BENEFITS OF PHYSICAL THERAPY FOR:

BACK PAIN CAUSED BY OBESITY

  • Low back pain [that] may be a consequence of obesity itself… could possibly be prevented by weight loss and specific spine exercises. (3)

OA OF THE HIP AND/OR KNEE CAUSED IN PART BY OBESITY

  • Improvement in self-reported physical function in participants who had hip OA and were overweight or obese after 8 months when they followed a program of exercise in combination with weight loss. (1)

SPECTRUM OF CARE INCLUDES:

Physical Therapists can treat patients for their pain (potentially related to their obesity) with a proper MD/DO referral and can provide can provide general population information to patients regarding healthy eating, healthy recipes, general daily activity.

  1. We do not provide weight loss services.
  2. We can provide referral to a nutritionist or registered dietician, but are not able to offer nutritional advise specific to each patient.
  3. We can provide general education to all patients regarding healthy eating, healthy recipes, general daily activity
  4. All patients must have written permission from their PCP or a cardiologist that they are appropriate for a program to address functional de-conditioning.

Written by: Kelly Wilson, PT, SPT, University Physical Therapy  – West Blacksburg, VA (www.universityptonline.com)

References:

  1. Paans, N et al “Effect of Exercise and Weight Loss in People Who Have Hip Osteoarthritis and Are Overweight or Obese: A Prospective Cohort Study. Physical Therapy. Vol 93 No 2. February 2013.
  2. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011; 14:4-9.
  3. Cimolin V et al. Effects of obesity and chronic low back pain on gait. J NeuroEng Rehab. 2011, 8:55.
  4. Racette SB et al. Obesity: overview of prevalence, etiology, and treatment. Phys Ther. 2003; 83:276-288.