Occupational therapy is breaking into bariatric care, an area where we have been under utilized despite being well prepared to address the needs of the patient population. Interested? Read on to get those first steps underway!
Understanding the Bariatric Population
The field of bariatrics focuses on the causes of, prevention of and treatment of patients with obesity. The percentage of adult Americans that qualify as obese is nearing half as of 2018, contributing to a rise in public awareness about bariatrics.
As practitioners, we are well aware that obesity is more than an excess of fat, and is associated with higher risk for serious medical complications including heart attack, stroke, high blood pressure and some cancers. Patients living with obesity are challenged in many areas of life — some of which may not be as obvious to us as clinicians.
Before breaking into bariatrics, we want to stress the importance of recognizing the bias and stigma associated with being an overweight person. Understanding the lived experience of your patients will improve your ability to form a therapeutic relationship, create stronger plans of care & better improve carryover for goal achievement.
It has been shown that weight-related bias affects an overweight persons’ ability to procure goods and services at the same quality and access level as thin Americans. Weight bias in healthcare is an issue that has recently come back into the spotlight as people share experiences of having their medical issues ignored or entirely blamed on weight alone. This discrimination is not limited to primary care providers, as unfortunately occupational therapists like you and I have been found to carry implicit bias about weight. Bias against overweight people has been shown to exist at the student level as well, suggesting it is not a behavior learned on-the-job or through work culture and a much further reaching issue.
Thankfully, there are tools available online to help identify our implicit biases & facilitate correction. Take Harvard’s Project Implicit test here (be sure to select the ‘weight’ focus), Stop Weight Bias Organization’s weight bias quiz here, and check out other assessment and informational tools available from the University of Connecticut’s bias tool kit here.
Understanding the Occupational Therapy Role
Now that you have background on obesity and tools to identify any harmful biases against the bariatric population, lets dive a little deeper into the role of occupational therapists serving these patients!
AOTA’s Bariatric fact sheet states that OT practitioners should focus on health promotion, disease prevention, adaptation, modification and remediation with this population. Patients may require assistance for ADLs at baseline; it will be important to do a thorough evaluation and identify barriers to independence. Is your patient limited by in-home mobility? Can your patient successfully navigate getting in and out of the tub or shower? Does stamina, balance or safety limit them in completing any tasks?
Graded tasks will be important for increasing activity tolerance. An entire showering routine done in standing may be too physically taxing and too challenging for balance initially, for example. Encouraging your patient to complete one portion of showering, let’s say hair washing, in standing to start and then finishing the activity while seated is a great way to grade the activity safely and still be challenging.
Education on coping mechanisms for stress management will be very important–especially for your surgical bariatric patients. For patients that are battling food addictions, it will be important to learn to identify stressors and triggers and how to effectively navigate them.
Independence with health management will be a wide focus while working with these patients as well. A 2021 study found that lymphedema was present in over 50% of bariatric patients. With this in mind, occupational therapy should include education and techniques for preservation of skin integrity and wound care – which are incredibly important for bariatric patients. This, alongside the creation and promotion of a skin management routine will decrease the risk of your patient being derailed by a wound or infection.
Living well and self-advocacy are also key areas to be aware of – a person living in a larger body has many roadblocks to navigate, not least access to travel, medical compassion and understanding, insurance coverage, and psychosocial challenges. As an OT, we promote all around health and quality of life, and it is important to include empowerment as part of our plan. This may require self education and working with support groups and anti-fat bias networks, and presenting information relevant to whole health promotion to your client.
The role of Occupational Therapy in the sensitive and emerging field of bariatric care is a valuable one- and we can be at the forefront of helpful, practical health promotion across the spectrum.
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