Enabling Participation in Activities of Daily Living for People Living with Obesity
- Asking patients about how they view their ability to manage daily activities including personal care, mobility and interactions with the built and social environment will provide valuable information about facilitators and barriers to engagement in daily activities, including treatment recommendations. This can help healthcare professionals (HCPs) to tailor interventions for obesity treatment and management.
- Places and spaces where healthcare service delivery occurs can be made physically accessible, equipped and respectful for use by persons living with obesity so that patients can access the full range of primary care services, including assessment and treatment. Consideration of the accessible features surrounding the clinic space, including access to parking, public transport and door widths to accommodate mobility equipment, are also needed.
- It is important to recognise that people living with obesity may have experienced stigmatising interactions within healthcare services, which may contribute to increased anxiety around attendance. Discussing and agreeing on expectations at the outset of assessments can be helpful in improving individual comfort within the healthcare environment.
- Appropriate equipment should be made available with recognition of structural dimensions, composition and safe working load. Attendance can be affected by these challenges and consideration should be given in relation to rescheduling or an alternative virtual appointment.
- Injury prevention, which includes falls risk reduction, is possible via the inclusion of rehabilitation to improve postural control, balance and lower extremity strength. The Falls Efficacy Scale1 is a psychometrically sound measure that determines an individual’s concern about their risk of falling while performing activities of daily living (ADL) that involve walking or moving about.
- Patients who report significant challenges with participation in ADL living may benefit from a referral for occupational therapy and/or physiotherapy.
- Try to identify patient-specific barriers to ADL participation, including musculoskeletal pain, falls history/balance impairment, sleep or cardiorespiratory dysregulation, bowel/bladder dysfunction, reduced exercise tolerance and social/environmental challenges to determine appropriate referral pathways.
- HCPs should look at the integrity of the patients’ skin and condition of any wounds in order to identify any areas of concern, such as pressure points, skin breakdown or signs of infection2. HCPs should determine if lymphoedema-like swelling is present and discuss referral to an appropriate service for compression therapy, including made-to-measure flat-knit garments3. Lymphoedema-like swelling is associated with reduced mobility, physical activity levels and poorer physical function in people living with obesity with a body mass index > 40kg/m2 4. This can have an impact on functional mobility and on a person’s ability to manage personal and domestic ADL5.
- HCPs should ask patients about their ability to manage domestic ADL, i.e., laundry, groceries, etc., and make appropriate referral.
- We recommend that healthcare professionals (HCPs) ask patients living with obesity if they have concerns about managing self-care activities, such as bathing, getting dressed, bowel and/or bladder management, skin and/or wound care, foot care (Level 3, Grade C)6.
- We recommend that HCPs assess falls risk in people living with obesity as this could interfere with their ability and interest in participating in physical activity (Level 3, Grade C)7.
- The restricted range of motion, balance, mobility, and levels of pain that some individuals living with obesity experience can impact the ability to complete self-care activities, such as bathing, getting dressed, bowel and/or bladder management, skin and or wound care and foot care, grocery shopping and meal preparation. Issues in this area may require adaptation of self-care activities and/or the use of assistive devices, such as dressing aids, a long-handled reacher, long-handled sponges, bath benches, grab bars and mobility aids6.
- Some individuals living with obesity experience issues with mobility and are at risk for slips, trips and/or falls. This could interfere with the ability and interest in participating in physical activity. Be sure to let your healthcare professional (HCP) know if you have had a fall or are fearful of falling as you go about your day-today activities7. Obesity is linked to other barriers too, such as pain, trouble sleeping or breathing, bowel and bladder continence, being comfortable and feeling safe when active, physical challenges at home and in personal relationships. Discussing these with your HCP can help them support you and gain access to specialist services as needed.
- Obesity is also linked with an increased risk of skin issues and lower limb swelling that can result in redness, blisters, rashes, and open wounds that are resistant to healing. Individuals with obesity should routinely monitor their skin and condition of any wounds to identify any areas of concern, such as pressure points, skin breakdown or signs of infection. Assessing skin integrity both pre- and post-weight loss is important. Utilising a mirror may help with viewing areas that are difficult to access. Particular attention should be paid to areas of excess skin folds post-weight loss2. People living with obesity and lymphoedema-like swelling should discuss management strategies or referral to specialist services.
- Your HCPs’ offices and clinical care spaces should be physically accessible and equipped so that all patients, including those living with obesity, can access the full range of primary care services, including assessment and treatment. Let your HCP know if there are barriers that prevent you from fully participating in and accessing care. This includes access to parking or public transport, elevators, stairs, seating, doorways, washroom accessibility, etc. Advocate to have barriers addressed and spaces modified.
- Consideration should be given to your needs and abilities to manage domestic activities of daily living, i.e., laundry, groceries, etc., and seek referral if necessary.
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