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Research Reports: Suzanne Sack, Dianne Rigassio Radler, Kathleen K. Mairella, Riva Touger-Decker, and Hafiz Khan Physical Therapists' Attitudes, Knowledge, and Practice Approaches Regarding People Who Are Obese PHYS THER 2009; 0: ptj.20080280v1-0 [Abstract] [PDF]

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Beyond Individual-level Approaches Toward Obesity

Gary S Brooks   (7 August 2009)

Beyond Individual-level Approaches Toward Obesity 7 August 2009
Gary S Brooks, Academic PT faculty SUNY Upstate Medical University Send rapid response to journal: Re: Beyond Individual-level Approaches Toward Obesity brooksg{at}upstate.edu Gary S Brooks	I commend Sack and colleagues for studying physical therapists’ attitudes, knowledge, and practices related to obesity. Given the current concern regarding the obesity epidemic, this research is very timely. I would like to offer a different perspective on their findings and conclusions. The authors measured, among other things, physical therapists’ attitudes toward people with obesity. Respondents rated various characteristics, each of which had a positive as well as a negative anchor. Findings relating to these attitudes are presented in Table 5. The authors present means and standard deviations as well as proportions of negative, neutral, and positive responses to summarize ratings for each set of attributes. To their credit, the authors acknowledge that majorities of respondents indicated some negative attitudes toward people with obesity. However, their conclusion that “overall” physical therapist attitudes are neutral is based on the mean ratings. This conclusion is reflected in the discussion and is primarily emphasized in the abstract. In my opinion, examination of the percentages of respondents with negative attitudes leads to a different interpretation. For example, the authors report that more than 50% of the respondents tended toward attitudes that people with obesity are “noncompliant” or “weak willed,” and 40% of the respondents tended to indicate that people with obesity are “lazy” or “sloppy.” Assuming that this survey is representative, an alternative conclusion is that large segments of our profession hold negative attitudes toward people with obesity. Negative attitudes toward people with obesity may be fostered unintentionally by the way issues are framed. In surveying physical therapists’ opinions regarding causes of obesity, the authors listed 11 causal factors, all of which measure individual-level characteristics. Some causes are genetic or physiologic in nature, some are behavioral, but none touched upon community- or population-level factors. Emerging epidemiologic evidence strongly suggests that obesity rates are influenced by factors such as lack of availability and high cost of nutritious foods, easy access to and low cost of energy-dense fast food and processed food; and lack of safe and available opportunities for physical activity.1,2 These factors disproportionately affect economically disadvantaged communities where obesity rates often are highest.3 By neglecting to ask about community- and population-level factors, we ignore the social, economic, and political determinants of obesity. It follows then that we tend to place blame on individuals for their obesity. Similarly, the interventions listed in Table 7 all approach the problem on an individual level, overlooking community- and population-level interventions.4 Thus, when our patients and clients are unsuccessful in their efforts to reduce obesity, it is viewed solely as an individual failure without recognizing society’s failure to provide conditions that encourage healthy living. The causes of and solutions to obesity are multifactorial and include environmental as well as individual-level components. By including community- and population-level items on surveys pertaining to obesity, we gain a more comprehensive understanding of the problem, and in so doing, we may broaden physical therapists’ perspectives about obesity. Gary S. Brooks G.S. Brooks is Academic Physical Therapy Faculty, SUNY Upstate Medical University References 1 Hill JO, Peters J. Environmental contributions to the obesity epidemic. Science. 1998;280:1371–1374. 2 Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Millbank Q. 2009;87:123–154. 3 Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549–1555. 4 Kahn LK, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR. 2009;58(RR-7):1–29.