Obesity is the result of genetic, behavioral, environmental, physiological, social and cultural factors that result in an imbalance between energy intake (food) and energy expenditure (exercise) over an extended period of time promoting excessive fat deposition.

Obesity has become an increasingly common condition that problematically places those affected at an elevated risk for a broad range of acute/chronic health conditions including but not limited to hypertension, type-2 diabetes, coronary artery disease, stroke, sleep apnea, muscular-skeletal difficulties, hyper lipidemia, and several forms of cancer.1,2,3 In addition, obesity is also believed to contribute to the development and manifestation of various psychological conditions and mental health problems (i.e., anxiety, depression, stigmatization, etc.).

Occupational therapy is the art and science of enabling engagement in everyday living through occupation. In addition, the profession enables highly trained individuals to promote and develop the health and well-being of others. As a form of prevention and intervention, occupational therapists assist people with physical, psychological, and environmental conditions through education and the use of assistive devices designed to improve their quality of life.

The role of occupational therapy in bariatric

Occupational therapy practitioners can help individuals with obesity change their lifestyle, engage in meaningful activities, and manage their weight (AOTA, 2013). Practitioners focus on health promotion, disease prevention, remediation, adaptation, and maintenance (AOTA, 2013). Occupational therapy practitioners can provide services to individuals receiving specialized bariatric care, or to individuals with other medical conditions who have obesity as a secondary diagnosis, to enhance their functional abilities in the following areas.

Activities of daily living (ADLs) such as bathing, dressing, and toileting, with particular attention to areas requiring sufficient reach and flexibility (e.g., washing and drying the buttocks, back, and feet).

Activity tolerance, by grading functional tasks to progressively increase physical endurance.

Safe household and community mobility, including transferring in and out of a car, using public transportation if relevant, maneuvering safely in limited spaces, using mobility devices (e.g., electric scooter, walker, or wheelchair), and adapting vehicles (e.g., seat belt extender) (Forhan & Gill, 2013).

 Energy conservation and work simplification to facilitate performance of daily activities at home, work, and/or in the community, particularly when respiratory insufficiency is a co-morbid condition (AOTA, 2013).

Instruction in body mechanics for the client and/or caregiver to maintain safety for both during physical activities and transfers.

Monitoring and maintaining skin integrity to maintain optimal health and prevent wounds, especially when co-morbid conditions are present.

Providing strategies, including adaptive equipment and methods to facilitate performance of instrumental ADLs (IADLs) such as cleaning, doing laundry, cooking, and caring for children.

Home modifications to promote activity participation, improved environmental access, and safety (e.g., recommend DME appropriate for the client’s weight and size; have appropriate seating choices) (AOTA, 2013).

Routines related to planning for healthier choices, food selection and shopping, meal preparation, mealtimes, and daily health management tasks.

 Relaxation and sleep routines or positioning to increase comfort and facilitate restorative sleep periods.

Wellness groups for individuals and their families, facilitating health promotion through lifestyle change and engaging in supportive interpersonal relationships.

Education and coping strategies for how to effectively manage pain, stress, and anxiety during daily activities, especially in social contexts.

Addressing sexual health including sexual expression, communication, positioning, and intimacy.

Community participation, including identifying businesses and social gatherings that the individual feels comfortable accessing, in order to increase or maintain social and leisure activities.

Task and environmental modifications to increase activity demands and energy expenditure safely and appropriately for improved weight management or to maintain participation in valued and meaningful roles and occupations at the individual’s current weight, during all household, leisure, educational, work, and community activities

Occupational therapy practitioners may provide bariatric intervention throughout the continuum of care in hospitals, rehabilitation facilities, outpatient clinics, community centers, and home health environments. They may also provide services in specialty bariatric clinics or centers.

Occupational therapy practitioners bring a functional perspective to bariatric intervention, an area of practice that has historically emphasized the client’s medical deficiencies. Occupational therapy practitioners are trained to address occupational issues affected by obesity through interventions supporting health promotion and disease prevention, in addition to established roles in ADLs and IADLs (AOTA, 2013). Through education, customized intervention, and adaptive strategies, practitioners can use occupation as a tool for promoting healthy habits, routines, and overall lifestyles for clients who are obese.

The focus on occupational performance that is meaningful to individual clients, as well as the knowledge of the psychosocial impact of obesity on all aspects of daily life, are critical elements in the delivery of occupational therapy services that benefit this population.