Childhood Obesity: Part 4

Physical Therapists: What should we know? What can we do?

This post is more a very quick review of the literature.  Physical therapists, as professionals, have a duty to help prevent and treat childhood obesity.  However, the laws governing our profession vary slightly state to state; therefore, the amount and type of outreach we can do varies.  Nevertheless, childhood obesity is an issue that affects us all and one which we should all be up to date on the literature. 

“The Role of Physical Therapists in Pediatric Health Promotion and Obesity Prevention: Comparison of Attitudes”

·      PTs are professionals of choice for educating others on health promotion/obesity prevention/physical activity

·      PTs can help to train teachers and parents to help youth incorporate physical activity approaches for obesity management

·      PTs must move beyond the traditional role of health care practitioner

·      Complexity of obesity/overweight epidemic necessitates that we work together with multidisciplinary professionals to address the many facets of this problem

·      As a community, we need to change societal and environmental supports that directly influence behavioral lifestyles

·      It is becoming more evident by the day that it is not only vital to our long-term health to prevent disease, but also our country cannot continue to finance health care without an attention to the critical benefits of preventative measures

Nervik et al.  “The Relationship Between Body Mass Index and Gross Motor Development in Children Aged 3 to 5 Years” Pediatr Phys Ther 2011;23:144–148

·      PTs are health care professionals who are experts in the field of gross motor development and practitioners who assist in efforts of health promotion and prevention

·      PTs should have a role in preventing and treating childhood obesity by providing intervention or consultation in the following areas: motor skills, physical activity, and/or obesity education.

·      In a sample of 3- to 5-year-old pre–school-aged children, high BMIs were associated with low gross motor skills, indicating that children who are overweight/obese are more likely to score in the below-average category while lean children score in the average category

·      PTs can educate and inform insurance companies and legislators about obesity research and the associations between BMI, motor skills, and activity levels

·      PTs can develop gross motor and physical activity programs for school, community, and individual use as both rehabilitative and preventative measures

·      Research: needed! Larger sample sizes, larger numbers in each BMI category, examining motor skills of children in all categories of weight, including underweight, look at physical activity levels and SES

Nunez-Gaunaurd et al. “Motor Proficiency, Strength, Endurance and Physical Activity Among Middle School Children Who are Healthy, Overweight, and Obese”  Pediatr Phys Ther 2013;25:130–138

·      Children with overweight or obesity may have poorer aerobic fitness, decreased trunk and LE strength, and poorer fundamental movement skills (than peers who are leaner)

·      PTs need to recognize children with obesity may have poorer motor skills which may relate to lower levels of physical activity and aerobic fitness

·      PTs screen for:

-       Detect motor deficiencies

-       Substitution of sedentary behaviors for physical activity

-       Decreased perceived physical competence in fundamental mvt skills

-       Heavier weight

·      PTs should:

-       Provide age and culturally appropriate activities that challenge motor skills

-       Build self-adequacy for physical activity in early childhood

-       Include family-based approach to care

·      PTs be aware of:        

-       The BOT-2 is a product-oriented assessment tool and may be limited in identifying the specific components of children’s motor skills associated with obesity that should be the focus for improvement

-       Should use a process-oriented test (Test of Gross Motor Development) that breaks down skills (such as the run and broad jump) into specific observable components that can be taught and practiced – potentially more clinically useful

à Ulrich DA. Test of Gross Motor Development. 2nd ed. Austin, TX: Pro-ED Inc; 2000.

***Please note, this is not a complete review of the literature regarding PTs role in preventing and managing childhood obesity.  PTs have an extraordinary opportunity and challenge in preventing and managing obesity, but we have the skills and knowledge to make an impact on this important issue.