Physical Therapists Serve Growing Demand to Treat Childhood Obesity
Physical therapists, particularly those who specialize in pediatrics, have an increasingly important role to play in combating childhood obesity.
Since more than a third of the children and adolescents in the United States are obese, there has been an increase in the number of healthy weight clinics in pediatric hospitals, said Maggie O’Neil, an associate professor in the Department of Physical Therapy and Rehabilitation Sciences at Drexel University in Philadelphia.
These clinics employ a team of specialists, such as nutritionists, dieticians, and gastroenterologists, to work holistically with children — and the children’s parents — in changing behaviors that lead to weight gain.
One of those behaviors strongly associated with obesity is lack of physical activity. That's where physical therapists come in. They are experts in movement, they're focused on enabling a patient's functional mobility, and they're dedicated to improving health through physical activity.
The Importance of Family-Centered Care
Pediatric physical therapists are skilled in working with children and families, according to O'Neil. This makes them uniquely qualified to create a treatment program that is child-specific, goal-oriented for the child and the family, and designed to motivate physical activity.
Involving the family in a child’s treatment is crucial, O'Neil said, especially since factors such as the child’s surrounding environment and community may contribute to their obesity. For example, is there a park or a recreation center or a baseball field where the child can be physically active? Are there areas with fast food restaurants that should be avoided?
“We try to help the families find healthy resources in their community for activity and nutrition while making sure the exercise program meets the child's needs,” she said. Pediatric physical therapists will also help parents determine what activities the child can do safely, how often, and at what intensity.
APTA Guidelines for Treating Childhood Obesity
The role of physical therapists in treating childhood obesity became prominent recently when the American Physical Therapy Association (APTA) published recommendations in its Physical Therapy journal in June 2016. It also issued a press release on the topic that same month.
These recommendations, based on clinical recommendations from the Belgian Physical Therapy Association, target physical therapists in private practice and home care settings who may not have the resources, tools, or clinical practice experience in pediatric obesity.
The guidelines explain that children can suffer from a number of health problems related to obesity, including respiratory disorders, diabetes, high blood pressure, asthma, orthopedic injuries, and chronic pain. They may also experience social and psychological impacts.
Therefore, the guidelines for physical therapists unfamiliar with treating young patients who are obese, include some of the following suggestions:
- Screen for medication prescriptions, e.g., insulin or anti-asthmatic medication
- Measure and monitor a child's height and weight
- Measure and monitor waist and hip circumference
- Evaluate body composition
- Measure heart rate, blood pressure and respiratory rate
- Examine psychosocial barriers that would deter exercise
- Prescribe strength training for muscle weakness
O'Neil said these recommendations are spot-on. She also pointed out that they are par for the course for a pediatric physical therapist.
"Quite frankly, as physical therapists, we are trained to make sure we use appropriate outcome measures to determine the effectiveness of the treatment intervention," she said. "So things like muscle strength and endurance, aerobic performance and capacity, bone alignment and child pain levels are all possible outcomes to be included when examining the effectiveness of a treatment program."
O'Neil noted that physical therapists who specialize in pediatrics should be the primary choice for treatment interventions of children with obesity, because they've studied child development, can modify treatment plans to the child's developmental needs, and involve the family in the child's treatment.
"When it comes to children, a family-centered approach -- including the family in the intervention -- is critical, and pediatric physical therapists are trained for that," she said.