Occupational problems and barriers reported by individuals with obesity

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity-Is the Elephant in the Room Still the Biggest Challenge?

In this response to the Schwartz & Proffitt (2024) letter to the editor, Muntefering et al. (2023) agree that the profession has a duty to support the occupational participation of diverse individuals, including diverse body types, but also affirm that health management is an area of occupation within the practice framework.

Exploring the use of powered mobility devices and occupational participation for people with obesity

BACKGROUND

The increasing prevalence of obesity is a global issue with the World Health Organization estimating that more than 650 million adults are impacted by obesity. Those living with obesity are impacted by both physical and psychological issues. The physical consequences of living with obesity can lead to decreased mobility and reduced occupational participation. The aim of this research is to understand how the use of a powered mobility device influences occupational participation and quality of life from the perspective of people with obesity.

METHOD

Semi-structured qualitative interviews (n = 7) were undertaken with a phenomenological approach to gain an understanding of the lived experience of using a powered mobility device.

RESULTS

Thematic analysis occurred resulting in inter-connected themes that describe the positive experiences associated with using a powered mobility device: (1) autonomous mobility; (2) enhanced occupational participation; and (3) improved self-efficacy creates increased confidence in relation to participation. In addition, two themes emerged that were barriers to usage of powered mobility devices: (4) physical environmental barriers and (5) difficulty transporting the powered mobility device.

CONCLUSION

For those with obesity, a powered mobility device provided autonomous mobility allowing them to engage in an increased range of activities. This was hampered by physical environmental barriers and difficulties transporting the powered mobility device. Further research is required to verify the results of this study with a wider population and to explore the benefits and barriers to use of a powered mobility device in the home and community.

Occupational balance as a component in weight loss interventions

BACKGROUND

Obesity can limit occupational participation because of physical and mental barriers. Weight loss programmes emphasizing dietary and physical activity may lower body weight; however, mental barriers and sustainable weight loss seemed to be challenged. Weight loss influences daily patterns and structure of occupations and finding a balance in daily life during the weight loss process might improve sustainable weight loss.

AIM

To explore if and how health professionals conducting weight loss programmes in Danish municipalities address elements related to occupational balance in the daily life of citizens with obesity.

MATERIAL AND METHODS

Twenty individual interviews with health professionals from Danish municipalities were conducted and analysed.

RESULTS

(1) Helping participants find the time and energy to lose weight, (2) Emphasizing small steps for sustainable changes and (3) Utilizing the citizen's life experience for direction.

CONCLUSION

Elements of occupational balance might be addressed by the participants, however values and meaningfulness regarding occupations seem to be missing. Integrating occupational balance in weight loss programmes could enable health professionals to understand and address sustainable weight loss.

SIGNIFICANCE

Occupational therapists may be ideally suited to support citizens with obesity to sustain weight loss by supporting a balanced life focussing on meaningfulness and values in occupations.

Going Beyond Management and Maintenance: Occupational Therapy's Role in Primary Prevention for Adults at Risk of Obesity

There is a critical need to address the escalating obesity epidemic by examining new methods of care. Adult obesity has historically been addressed through management and maintenance once an individual is clinically diagnosed as obese. Research and practice demonstrate that significant weight loss can be difficult to achieve and even harder to maintain. Despite this, preventive interventions targeted toward adult obesity have been limited in many health care professions, including occupational therapy. As professionals who are skilled in supporting clients' holistic development of healthy habits and routines, occupational therapists are equipped to play a key role in moving health care practices away from a reactive model of care to a proactive one that emphasizes primary prevention. This column identifies how this issue is aligned with occupational therapy's domain and presents potential examples of interventions to support adult obesity prevention.

Occupational performance problems in people with depression and anxiety

BACKGROUND

Depression and anxiety often reduce people's ability to cope with everyday occupations. There is a lack of knowledge about such problems in people of working age with depression and anxiety.

AIM

To describe which problems people with depression or anxiety disorders experience when performing everyday occupations and which occupations are affected.

MATERIALS AND METHODS

Data based on the Canadian Occupational Performance Measure was used in this cross-sectional study. A total of 118 participants aged 18-65 years, with depression or anxiety, were recruited from primary healthcare and general mental healthcare services. The data were analysed with descriptive statistics and directed content analysis.

RESULTS

The participants rated a low level of occupational performance, and their satisfaction with performance even lower. They described a great number of problems with their everyday occupations. The most frequent problem areas concerned household management, socialization and personal care. Detailed descriptions of which type of problem they experienced during everyday occupations are included.

CONCLUSIONS

This study provides knowledge of which problems people with depression and anxiety disorders experience in everyday occupations within self-care, productivity, as well as leisure. Furthermore, they rate performance and satisfaction with performance of the five occupations they find the most important to change in everyday life.

Occupational performance issues in a longitudinal perspective in people with depression and/or anxiety on sick leave, returning to work or working

BACKGROUND

People with depression and anxiety disorder may experience occupational performance issues (OPIs). Further knowledge about these issues longitudinally and about potential differences between people is valuable.

AIM

To explore experienced OPIs longitudinally in a sample living with depression and/or anxiety disorder participating in occupational therapy and varying in terms of their work situation.

MATERIAL AND METHODS

The Canadian occupational performance measure (COPM) was completed by 54 participants with depression and/or anxiety at four measure-points from baseline to one-year after participation in occupational therapy. The participants constituted three groups: continuously on sick leave (SL), returned to work within a year and continuing working. Descriptive and non-parametric analysis was used.

RESULTS

Participants in all groups identified OPIs in all occupational areas in the COPM. All groups increased their occupational performance and satisfaction with their occupational performance in the area socialisation. Each group also made improvements in relation to other occupational areas, varying between the groups.

CONCLUSIONS

OPIs and improvements were identified among the participants regardless of them being on SL, returning to work or working.

SIGNIFICANCE

The diverse nature of OPIs and improvements in the clients indicate the relevance of occupational therapy.

A mixed-methods study on the effectiveness of a self-directed online education program on obesity and bariatric care for occupational therapy practitioners and students

BACKGROUND: Due to the rising rates of obesity in the United States, healthcare professionals will likely be seeing individuals from this population more frequently in service provision settings. OBJECTIVE: The purpose of this study was to examine the effectiveness of a self-directed online education program entitled BOOTH: Bariatrics, Obesity, and Occupational THerapy; How we can help. The educational program was directed to occupational therapy practitioners and occupational therapy students and designed to increase knowledge of obesity and bariatric care. METHODS: A convergent parallel mixed methods design was used in which the quantitative component was a one-group quasi-experiment with pre- and post-measurement. Surveys with Likert-style rating and open-ended questions were administered prior to the program and following completion. RESULTS: Paired samples t-testing revealed significant differences (p < 0.05) between pre- and post-program rated survey questions, which indicated an increase in perceived knowledge in the main topic areas. Qualitative data corroborated these findings, as most of the participants initially expressed concern about not being well-informed on obesity and bariatric care prior to taking the course. CONCLUSION: More education is needed on obesity and bariatric care for occupational therapy practitioners and occupational therapy students. An online education program was demonstrated to be an effective way of increasing knowledge on this important topic to reduce work-related injury.

Five Vital Components in an Occupational Therapy-Based Municipal Weight Loss Program Obtained Through Research Circles

INTRODUCTION

Currently 1.9 billion adults worldwide are estimated to be overweight or obese. Weight loss sustainability is difficult, and weight loss rehabilitation programs have been criticised for having an individualistic approach. It has been suggested that occupational therapists could be used as part of a transdisciplinary approach because of their holistic perspective. During the development of an occupational therapy- based weight loss program five components arose as essential from earlier interviews with health professionals and citizens with obesity: diet, physical activities, social relations, habits and balancing everyday life. Before developing the program, we needed a clearer picture of which strategies should support the five components. The aim of this study was to obtain a description of strategies related to the five components that could support weight loss to become part of everyday life of people with obesity.

METHODS

This study took a participatory design by using research circle (RC) methodology. Two RC groups were created, one with occupational therapists and one with citizens with obesity. Researchers participated in both RC groups. Data was obtained through democratic principles. The two RC groups met four times over a period of 4 months. Qualitative content analysis was conducted.

RESULTS

Five themes arose: (1) Diet-Find the line between either-or, (2) Physical activity-Break the comfort zone, (3) Social relations-Stand strong together, (4) Habits-Focus on possibilities instead of bad habits, and (5) Balancing everyday life-Handling life's bumps.

CONCLUSION

The strategies for a weight loss program including the five components should include awareness of senses and activity patterns surrounding meals, taking one step at a time when focusing of physical activities and be conscious of values, include family and friends in the program to find common ground and self-confidence and use re-placement activities. We suggest that the component of balancing everyday life should be seen as an overall component as all strategies are related to finding meaning and variation in activities which is part of an ongoing weight loss process.

Preferred Content in Occupational Therapy-Based Weight Loss Interventions: A Survey

Despite decades of attempts from doctors and dietitians to break the obesity curve, obesity rates are increasing in Denmark. To counteract this, municipal occupational therapy-based interventions are in development as part of the Danish Obesity Intervention Trial (DO: IT). The objective was to survey Danish adults on preferred content in an occupational therapy municipal weight loss intervention and determine if preferences differed by gender and age. A 21-item questionnaire was developed to explore preferences related to diet, physical activity, occupational balance, habits, and social relations. In all, 429 respondents were included. Chi-square statistics were performed to determine if preferences differed by gender and age. A total of 15 of the 21 items indicated gender-based differences in preferences. Two items indicated age-based differences. Notably, compared to men, women indicated significantly more interest in content relating to habit formation and occupational balance. Gender-based differences should be considered when developing a weight loss intervention.

Working with clients of higher weight in Australia: Findings from a national survey exploring occupational therapy practice

INTRODUCTION

Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight.

METHODS

A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis.

RESULTS

Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma.

CONCLUSION

Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.

Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study

BACKGROUND

People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants' health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D).

METHODS

This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables.

RESULTS

The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (- 2.33, 95% CI: - 3.10 to - 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = - 0.34, 95% CI: - 0.65 to - 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = - 0.02, 95% CI: - 0.04 to 0.001) and work absence (B = - 0.01, 95% CI: - 0.02 to - 0.002). The regression model explained 71.8% of the HRQoL variance.

CONCLUSION

The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended.

TRIAL REGISTRATION

Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374 , registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=.

Development of the impact of weight on daily activities questionnaire: A patient-reported outcome measure

While patient-reported outcome measures are available to evaluate health-related quality of life and functioning in obesity, existing measures do not evaluate the impact of excess weight and weight loss on the ability to perform regularly occurring daily activities. Three iterative sets of qualitative interviews were conducted in two countries (United States, n = 23; United Kingdom, n = 23) with individuals with body mass index ≥30 kg/m² to inform development of the Impact of Weight on Daily Activities Questionnaire (IWDAQ) for use in clinical trials to evaluate daily activity limitations associated with excess weight. Candidate concepts were selected based on the literature, expert opinion, and previously conducted qualitative research, after which the draft IWDAQ was developed and tested. Interviews included a brief concept elicitation phase, followed by cognitive debriefing during which the IWDAQ was refined based upon participants' feedback. The IWDAQ uses a novel, adaptive questionnaire design, such that clinical trial participants choose the three IWDAQ activities they would most like to improve with weight loss and rate the degree of limitation in each of these activities at baseline. By allowing individuals participating in trials to identify and monitor changes in the activities they most want to see improve with weight loss, the 19-item IWDAQ has the potential to detect the benefits of weight-loss treatment that individuals with obesity value most.

Stigma perceived by overweight women

OBJECTIVE

to understand the experience of discrimination perceived by overweight women.

METHODS

a qualitative research conducted at an outpatient clinic in Salvador, Bahia, where eleven women were interviewed. The interviews were transcribed and submitted to thematic content analysis.

RESULTS

the analysis of the statements expressed three categories: Suffering discrimination in different social contexts: denounced disrespect, hostility, veiled and/or explicit exclusion, prejudice, injustice and insults lived in public transport, at work, in the family environment, in social events and commercial establishments; Experiencing negative feelings about discrimination: revealed inferiority, sadness, shame, fear, anger, frustration, low esteem and discouragement faced by women; Reacting to discrimination: expressed isolation of marital intimacy and social encounters, removal from work, concealment of body and feelings and even illness of women.

FINAL CONSIDERATIONS

the discrimination experienced in various settings has caused suffering, embarrassment, negative feelings, shame, isolation and loss in women's lives.

The motivation and opportunities for weight loss related to the everyday life of people with obesity: A qualitative analysis within the DO:IT study

BACKGROUND

Unsuccessful weight loss or weight loss maintenance is due to different barriers and physical limitations related to participation in everyday life. It will, therefore, be relevant to investigate the field from an occupational therapy perspective, since occupational therapists are uniquely trained in focussing on people's resources, meaningfulness and participation in everyday life.

AIM

The aim was to explore what motivates people to lose weight from an OT perspective and which opportunities people with obesity experience in their everyday lives to achieve and maintain lost weight.

MATERIAL AND METHODS

A descriptive phenomenological study including 21 semi-structured individual interviews was conducted as part of the DO:IT study.

RESULTS

The data analysis led to the identification of three main themes: The influence of external circumstances on the desire for weight loss; use of time in everyday life; and changes in habits, routines and structure.

CONCLUSION

People who are overweight or obese are motivated to lose weight because of health issues and feeling more comfortable with their body. The opportunities for weight loss lie in creating habits, routines and structuring everyday life activities to facilitate a healthier lifestyle.

SIGNIFICANCE

The findings indicate that an occupational therapist should be part of weight-loss interventions.

Community-based participatory research to promote healthy lifestyles among Latino immigrant families with youth with disabilities

BACKGROUND/AIMS

Community-based participatory research (CBPR) is an optimal approach that brings together community stakeholders, researchers and practitioners in an effort to understand and address social issues and health disparities experienced by vulnerable populations. Latino immigrant families in the United States with youth and young families with disabilities have experienced a number of barriers in gaining positive health outcomes. These families face challenges in maintaining a healthy lifestyle, placing them at high risk for obesity, diabetes, and other chronic health conditions. The purpose of this study was to develop a healthy lifestyles intervention in collaboration with Latino immigrant families with youth and young adults with disabilities using a CBPR approach, and to examine the impact of the intervention from participants' perspectives.

METHODS

Grounded in the principles of CBPR, we developed a partnership with community stakeholders to create a healthy lifestyles intervention aimed at meeting the needs of Latino families in the United States. During and following implementation of the intervention, we conducted focus groups with 12 intervention participants to examine the impact of the intervention.

RESULTS

Participants identified the intervention program as meeting a need in the community and reported specific positive aspects related to health behaviors, social learning, inclusion, community participation, and peer advocacy.

DISCUSSION

CBPR healthy lifestyle interventions are relevant to the needs of Latino immigrant families with youth and young adults with disabilities. Health professionals should involve community residents in the design of healthy lifestyles programming to ensure strategies for change are relevant and relatable.