I was hesitant to write this blog. It’s a controversial and sensitive subject area for patients and practitioners alike, but I felt it needed to be addressed.
The question is, should osteopaths be utilising weight loss as another method of improving a patients health?
In my time at the BSO clinic I had the opportunity to observe many practitioners, with many patients. And whilst I don't intend to come across as calling anyone out(they were all excellent osteopaths in my opinion, and any patient would be lucky to see them for treatment) one thing I couldn’t help but notice was that so many of the long term patients that didn’t seem to get better were overweight. Obviously at the BSO clinic everyone treating is a student, so maybe its unfair criticism. But the fact is very few practitioners around(in the BSO or otherwise) will address the subject with their patients. And I think for patients where it’s relevant, addressing their weight is a huge part of resolving their symptoms. We do call ourselves holistic after all.
So, first things first. How do we decide if a patient is overweight? BMI would be the option many choose. Personally I think BMI is useless. If you were to measure the BMI of a bodybuilder or a forward in rugby they would class as overweight or obese, but these people are in some of the best physical condition you’re likely to see.
I think we try to complicate categorising and measuring a person’s weight. Observing a person will tell you all you need to know. If they clearly have a large amount of excess body fat, or are struggling to complete basic physical tasks without winding up out of breath, or even if they are just not active enough, addressing the issue will benefit them in the long run. Sometimes a person who is not overweight can be in worse levels of physical fitness than someone who is classed as obese.
So, what effect does a person’s bodyweight have on their presentation?
Excess weight increases the demand on the weight bearing joints of our body. Seems obvious right? But the fact is that with more weight being put through the joints, there is a larger potential for injury, accelerated degenerative change and a poorer capacity for recovery.
Excess weight in the abdomen area has a huge effect on the spine. The anterior weight pulls the lower back into extension. This is partly due to the pull of the weight there, but also as the body’s attempt to keep upright instead of tipping forward. Having a lower back in hyperlordosis(extension) pre disposes the joints in your lower back to injury and degeneration, puts you at risk of an condition called spondylolisthesis and reduces your mobility.
Excess body fat is also correlated to reduced cardiovascular capability. Whilst this is an issue in of itself, it also has a huge effect on the musculoskeletal system. Reduction in blood flow and as a result, reduced delivery of essential nutrients and removal of waste products to and from the muscles, joints and other tissues compromises their structural integrity, as well as hinders their recovery.
Obesity a causative factor for gout. pretty self explanatory, no one wants gout.
Reduced capability to exercise. Osteopaths LOVE encouraging patients to exercise and move. Obesity reduces the capacity for the patient to do this. The body is reliant on motion to keep healthy, without this motion muscles begin to atrophy, providing less support for joints, and cartilage in joints begins to degenerate as the motion in joints is required to provide it with nutrients. MOTION IS LOTION as you may have heard us say
This isn’t an exhaustive list, but it covers the basics.
Now, how do we go about beginning a conversation about weight loss?
This is probably the hardest part, it’s probable that the patient knows they are overweight and without doubt it will be a sensitive subject area. But the fact is that as an osteopath, it is your job and responsibility to inform them fully of what is occurring to cause their symptoms, and I think this is where it is best mentioned.
Asking a patient how they feel about their weight is the most respectful and non-judgemental way of opening a conversation about the subject that I know of, but mentioning other factors such as their amount of exercise or how healthily they eat is a good way to address the subject too.
The bottom line is that as an osteopath, you are doing everything you can to help this person. And most patients will know this and understand your point.
After opening a conversation about the subject the next step is to provide the patient with sound, evidence based advice about the best way to go about losing weight. I will be releasing another article about my advice on this within a few days of publishing this one, so keep an eye open for that!