Overcoming
Obesity Stigma Can OTs help combat the stigma of living with obesity by improving individuals’ ability to participate in activities of daily living?
O
ne in every four people in the UK live with obesity, and are therefore at an elevated risk of developing a number of chronic illnesses, which include diabetes and cardiovascular disease. This is discussed frequently; any overweight or obese person who has ever set foot inside a doctor’s surgery for anything from an ingrown toenail to a broken leg has been informed of this. Society keeps people who live with obesity well-informed of the increased dangers that come with the condition; of course, the vast majority of these warnings come from a place of absolute care and concern. What is often less discussed is the stigma that comes with living with obesity. According to the World Health Organisation, almost one in four (19%) obese people have experienced stigma relating to their weight, and that number rises significantly to 38% of people who live with severe obesity. Obesity stigma is both internalised and externalised: people living with obesity may find themselves experiencing stigma from health professionals, the media, friends and family, and most worrisome, themselves. With this stigma comes a social impact on people who live with obesity: even if the individual does lose weight, they still encounter negative comments regarding their weight, per writings by Norwegian OT Björg Thordardottir, who noted that the social stigma that comes alongside living with obesity results in less participation in meaningful occupations. Indeed, in research by Dr Rebecca Puhl and Dr Kelly Brownell, they noted that “it has been said that obese persons are the last acceptable targets of discrimination” - the same study reported that 28% of teachers said that “becoming obese is the worst thing that can happen to a person”, while 24% of nurses said they were “repulsed” by obese people. Is there a role occupational therapy can play in helping 40
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people living with obesity, especially in the challenge of working through internalised stigma? Research by Randi Nossum et al in the Scandinavian Journal of Occupational Therapy sought to explore what barriers may be in place for people living with severe obesity from the perspective of an occupational therapist; they noted, that, while a majority of OTs do not consider weight management as an area of professional practice, there were still aspects of occupational performance where occupational therapists could assist. For example, the 63 individuals these researchers spoke to reported a number of problems where an OT’s intervention could absolutely improve their quality of life. They reported that: “The occupational problems individuals with obesity most frequently prioritised comprised playing with (grand)children, purchasing clothes, implementing regular meals and going to the swimming pool, while the barriers they most frequently described were dyspnea, musculoskeletal disorders, narrow chairs and seats, fear of glances and comments from others, and social anxiety.” With the help of an occupational therapist, the above activities of daily living could be reintroduced into the individual’s life, which could serve to improve their participation in said ADLs. Interventions by OTs may both encourage and allow people living with obesity to achieve independence where this is not already the case, through the introduction of assistive devices, meal preparation, and energy management strategies. If a person living with obesity finds themselves in a situation where they are struggling with dressing themselves independently, or bathing safely, who better to assess and provide assistance or solutions than an occupational therapist? Studies which examine the relationship between the effects of an individual’s ability to perform activities of daily living and their self-worth, such as those by C E Blair in 1999 and Anderson et al in 1992 show
