By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN
Traditional physical therapy (PT) does an amazing job at treating dysfunction, pain, and problems. Preventative care and wellness, such as weight loss, was once taboo and often ignored by many physical therapists. However, today's Doctors of Physical Therapy (DPTs) are truly embracing more holistic treatments like nutrition, mindfulness, and sleep habits. Having physical therapy patients lose weight can help reduce inflammation, prevent health issues, and may improve PT outcomes. But what about stopping the weight gain in the first place? Weight gain prevention is vitally important, as it is much more difficult to lose the weight than it is to gain it. Given such interest in these topics, our team found it relevant to consider a recent study looking at weight gain and arthritis -- let's make the case for more PTs to start talking about patients preventing weight.
A recent study has demonstrated that individuals with normal body mass index (BMI) in the early adult and mid-life periods have significantly lower chances of developing arthritis (OA) than those with a higher BMI. Specially, the article estimates that nearly a quarter of arthritis cases in the US, corresponding to 2.7 million people, are attributable to excess weight. The researchers used data from the National Health and Nutrition Examination Survey (NHANES) on adults 40-69 years old, to categorize individuals based on the changes in their body mass indices (BMI) from early adulthood to midlife, and analyzed the association between these BMI trajectories and the risk of developing an arthritis condition within 10 years. Of the 13,669 participants in the study, 3,603 developed OA condition. Compared with those who had a BMI in the "normal" range in both early adulthood and middle age, those who went from the "normal" range to the "overweight" or "obese" ranges, those who went from the "overweight" range to the "obese" range, and those whose BMIs were in the "obese" range at both points were all significantly more likely to develop OA.
The most striking finding was that the lead authors posited that weight loss was not the answer. They commented that weight loss could represent a viable way to reduce arthritis risk at the individual level but found that the best solution at the population level would be to prevent weight gain in the first place. Population level interventions tend to have a larger impact than individual interventions; however, I argue that if our professional organization, the American Physical Therapy Association (APTA), would unite us PTs to collectively take action for weight gain prevention through sound exercise and nutrition that we would have a bigger, population-level type impact.
As movement specialists, PTs know that exercise is important to functioning, health, and weight loss. Exercise is vitally important for controlling stress, maintaining lean muscle mass (which is important metabolically), and reducing threats to pain. Many physical therapists know how to prescribe exercise, and they should also be tracking their clients' exercise outside of the clinic. One of the best ways of doing this is through the use of fitness trackers. For a great review on Fitness Trackers, check out the Consumer Advocate's top fitness trackers: these are easy devices to help PTs motivate and track their client's exercise outside of the clinic.
However, the data does not stack up for using exercise alone for weight loss or weight maintenance. In our courses we highlight how weight loss is best achieved over the long run with changes in nutrition, as well as other lifestyle factors (stress control, social interactions, etc). Moreover, preventing creeping weight gain has been linked to the quality of person's diet, not just merely their physical activity level. As such, we as DPTs need to be intervening in childhood and early adulthood through educating patients on what a healthy diet looks like. I can appreciate we have so much to discuss, treat, and document as clinicians -- but addressing nutrition is the key to keeping patients out of our clinic for OA for years to come.
If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!
Learn about the Top 5 Functional Foods to Fight Inflammation and Pain in Physical Therapy.
Keywords: nutrition, continuing education, weight loss, PT, physical therapy, weight gain, APTA, medbridge, diet