Overcoming Obesity Stigma

Can OTs help combat the stigma of living with obesity by improving individuals’ ability to participate in activities of daily living?

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

that, while not directly relating to patients living with obesity, an individual who is provided with the skills or equipment to independently achieve their ADLs feels greater self-esteem. Perhaps this approach could help alleviate the internalised stigma that people living with obesity face? The intervention of an OT may also address the community-based aspect of living with obesity, including participation in outdoor activities and engaging in leisure. Publications from the American Occupational Therapy Association support several different approaches in the management of obesity in children, and they report that common findings in post-occupation based interventions for children show that a client-centred, occupational therapy-based approach to living with obesity can offer individuals the framework to support their engagement with meaningful and satisfying occupations.