The White Elephant in the Clinic
The metaphorical idiom ‘the white elephant in the room’ has never been truer than when working with the obese patient who has a number of medical and orthopedic problems. When it comes to the underlying causes of problems that patients encounter, obesity is a major contributor, yet we’re afraid to address this issue with our patients. Why is this the norm rather than the exception?
We know that many research articles written on obesity and osteoarthritis of the weight bearing joints demonstrate the significant increased correlation in osteoarthritis (OA) with those that have a higher body mass index (BMI) compared with those with a lower BMI. Research on OA of the hip, knee and even the hands has shown a significant correlation in obesity and the BMI.
We also know that interventions incorporating both exercise and diet in a population with OA of the knees demonstrate weight loss of as little as 5% of an individual’s initial body weight is more effective than exercise alone. Subjects in this study showed significant increase in function and reduction in pain.
Additionally, we know that the amount of reduction in body weight of those that have knee OA is directly correlated with decreased cartilage degeneration over a 4 year period from previous published research.
However, these orthopedic issues pale in comparison with some of the other medical problems related to obesity including hypertension, diabetes, and cancer, to name a few. The very real improvement in these diseases, as well as other diseases not mentioned through modest weight loss, would lead us all to believe addressing obesity with your patient should be a priority. The American College of Rheumatology recommends weight loss for adults with hip or knee osteoarthritis and overweight or obesity, which can improve function and mobility while reducing pain and disability.
Your response to this article might be that “as a physical therapist that’s not my area” or “that’s really not something I know about”. My rebuttal would be “why not us?”. The APTA now clearly states its commitment to this topic and has demonstrated this priority by providing a nutrition webpage on its website stating "nutrition" is part of the professional scope of practice for physical therapists. The APTA Nutrition webpage has also offered several excellent websites as resources for the physical therapist, including www.nutritionfacts.org and www.eatright.org.
Offering information to your patient on how an elevated BMI is correlated to osteoarthritis of the weight bearing joints and then helping them set some realistic weight loss goals of 5-10% of their current body weight should be a part of the initial evaluation process. Physical therapists should encourage their patients to eat more fruits and vegetables and avoid inflammatory refined carbohydrates by directing them to governmental websites
With all the available tools that we have as professionals which are "public knowledge", making lame statements like "this is not my area" or "I don’t know anything about that topic", represents a sad commentary for professional healthcare clinicians addressing this most important problem with our patients. This truly demonstrates a lack of effort as the "White Elephant in the Clinic" needs to be addressed, not avoided.