CAOT Position Statement
Obesity and Healthy Occupation (2010)

It is the position of the Canadian Association of Occupational Therapists (CAOT) that people with obesity should have access to evidence-based, interprofessional and collaborative health services throughout their lifespan. Occupational therapists have the skills, knowledge and expertise to contribute to practice, policy, research and education in the areas of obesity prevention, treatment, and management. Occupational therapy is an essential component of interprofessional services that promote health and well-being through engagement in meaningful and health-building occupations.

Recommendations for occupational therapists

  1. Occupational therapists consider obesity within the chronic disease/ illness paradigm or as a health condition across the obesity spectrum (stage 1-4 or class I-III) (Health Canada, 2003) and the lifespan.
  2. Occupational therapists advocate for services to address obesity.
  3. Occupational therapists address stigma related to obesity through research, education, and reflective practice.
  4. Occupational therapists build capacity and design services related to the prevention, treatment, and management of obesity in professional education.

CAOT Initiatives

  1. Develop and disseminate evidence related to the understanding of health status, cultural, social, and political issues related to obesity and opportunities for occupation focused on prevention, treatment, and management of obesity.
  2. Develop and disseminate evidence related to the impact of occupational therapy services for people with obesity.
  3. Identify strategies to facilitate access to occupational therapy services that will provide opportunities for engagement in meaningful and health-building occupations for people with obesity.
  4. Advocate for the occupational therapy representation in areas of obesity research, policy, advocacy, and healthcare teams.
  5. Facilitate collaboration among occupational therapists to increase the profile of the profession in the area of obesity intervention, research, policy, and advocacy.
  6. Collaborate with other disciplines in the areas of research, policy development, education and clinical practice related to the prevention, treatment and management of obesity.

Background

 

  1. Meaningful and health-building occupations, in the context of obesity prevention, refer to participation in physical activity and the intake of a nutritionally balanced diet. This requires skills and access to participate in physical activity and healthy food choices.  In the context of obesity treatment, occupations promoting health include, in addition to physical activity and healthy eating, access to services that meet the bio-psychosocial needs of persons with obesity. Hammell Whalley (2004) advocated for supporting clients in living their lives while they are trying to manage their weight. Hammell Whalley referred to the work of Hasselkus (2002) to support a theoretical framework in which occupation is a source of found meaning and also a contributor to meaning in a person's life. From this view of occupation, occupational therapists should consider the occupations recommended in most health promotion messages that seek to reduce obesity. Those occupations include controlled, balanced eating and physical activity. The literature in the area of weight management and obesity prevention does not speculate on the way in which these occupations contribute to meaning in a person's life; rather, the literature specifically addresses the reduction of consequences of obesity that are associated with physical impairments. There is no evidence to suggest what the occupations of diet and exercise mean to obese people, as no research has yet considered asking these questions.

    2. A report on health policies and trends authored by the Canadian Policy Research Networks (CPRN) for the Canadian Association of Occupational Therapists (CAOT) identified obesity as an area of high priority (Pierre, Pollack, & Farfard, 2007). Gaps in knowledge and research in the area of obesity include areas of interest to occupational therapy services such as promoting the development of environments to enable participation in physical activities and developing partnerships with policy makers, industry, and non-governmental organizations to address the ¡°personal health and societal challenges posed by obesity (Pierre et al., p. 27). Occupational therapists need to be aware of the current state of knowledge about obesity and the implications for occupational performance in order to be effective in mitigating the causes and consequences of obesity.

    3. The medical, functional, and social consequences of obesity are consistent with other chronic conditions that result in disability (Alley & Chang, 2007). With the current prevalence of obesity and the role that occupational therapy plays in the management of chronic conditions it is highly probable that occupational therapists come into contact with obese persons in their clinical practice. In a recent survey of 830 occupational therapists across Canada, 83% agreed that they have worked with clients who have obesity (Forhan, Garraway, & MacDonald, 2008). Less than 50% of therapists surveyed believed that occupational therapists know the needs of clients who have obesity. As well, occupational therapists responding to the survey indicated that it was important for occupational therapists to be better informed about the causes and consequences of obesity, in addition to helping persons with obesity participate in occupations identified as meaningful by them.

    4. Obesity is a chronic disease for which treatment options include lifestyle modification, pharmacotherapy, and surgery (Canadian Medical Association, 2007). Occupational therapists are key members of the healthcare team for persons with obesity, as in other areas of chronic disease prevention and management.  It is not necessary for occupational therapists to develop new skills to meet the needs of people with obesity. Rather, occupational therapists need to be informed about obesity, obesity treatment, and participation experiences to determine, clarify, and advocate for the application of occupational therapy in the area of obesity prevention and treatment.

    5. The Canadian Population Health Initiative Action Plan 2007-2010 identifies the location and methods of how we work, learn, live, and play are key determinants of health (Canadian Institute for Health Information, 2006). The occupations of everyday life contribute to the experience of health and well-being for individuals and populations. Occupational therapists are charged with the task of enabling individuals, groups and communities to engage in occupations that will enhance or improve their health. Persons with obesity are at risk for occupational deprivation in the areas of self-care, productivity and leisure. Therefore, it appears logical that for persons at risk of developing obesity or persons with obesity would benefit from access to occupational therapy services.

    6. Occupational therapy can contribute to the reduction of obesity for individuals, as well as to enable participation in occupations meaningful to persons living with obesity.  Obesity is a multidimensional condition that for some individuals is a temporary state, however for others it is a chronic condition that will require accommodation and for which remediation will result in a weight reduction but not always eradication of an obese body.

Glossary of Terms
Enabling (verb) Enablement (noun):
  Focused on occupation, is the core competency of occupational therapy what occupational therapists actually do and draws on an interwoven spectrum of key and related enablement skills, which are value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and/or social change (Townsend & Polatajko, 2007).

Enabling occupation: Refers to enabling people to choose, organize, and perform those occupations they find useful and meaningful in their environment (CAOT 1997, 2002, p. 180).
Obesity: Defined as having a body mass index (BMI) determined by weight in kilograms divided by the square of height in metres (kg/m2) of 30kg/m2 or more. Obesity is subdivided into types of obesity as follows: 1) class 1 (BMI 30-34.9); 2) class II (BMI 35-39.9) and; 3) class III (BMI ¡Ý40). Obesity in children is defined as a BMI at or above the 95th percentile for children of the same age and sex.  (WHO, 2000).

Occupations: Groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture; everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997, 2002); a set of activities that is performed with some consistency and regularity; bring structure and are given meaning by individuals and a culture (adapted from Polatajko et al., 2004, and Zimmerman et al., 2006).

Occupational therapy: The art and science of enabling engagement in everyday living through occupation; enables people to perform the occupations that foster health and well-being; enable a just and inclusive society so that all people may participate to their potential in the daily occupations in life.

References
Alley, D. & Chang, V.  (2007). The changing relationship of obesity and disability, 1988-2004.  JAMA, 298(17), 2020-2027.

Canadian Association of Occupational Therapists (CAOT). (1997, 2002). Enabling occupation: An occupational therapy perspective. Ottawa, Ontario: CAOT Publications ACE.

Canadian Institute for Health Information (CIHI) (2006). Improving the health of Canadians: Promoting healthy weights. Ottawa, ON: CIHI. Retrieved from www.cihi.ca/cphi.

Canadian Medical Association (CMA) (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children, CMAJ, 176
(8 suppl): pp. 1-120. Retrieved from www.cmaj.ca/cgi/ content/full/176/8/S1/DC1

Forhan, M., Garroway, D., & MacDonald, J. (2008). Results from a national survey of occupational therapists regarding clients with obesity. Unpublished manuscript.

Hammell Whalley, K. (2004). Dimensions of meaning in the occupations of daily life. Canadian Journal of Occupational Therapy, 71(5): 296-305.

Hasselkus, B.R. (2002). The meaning of everyday occupation. Thorofare, NJ: Slack.

Health Canada (2003). Canadian guidelines for body weight classification in adults. Ottawa, ON

Pierre, N., Pollack, N., & Farfard, P. (2007). Health policies and trends for selected target groups in Canada: an overview report for the Canadian Association of Occupational Therapists (CAOT). Canadian Policy Research Networks (CPRN) Research Report. Retrieved from http://www.caot.ca/pdfs/health%20policy.pdf

Polatajko, H. J., Davis, J. A., Hobson, S., Landry, J. E., Mandich, A. D., Street, S.L. et al. (2004). Meeting the responsibility that comes with the privilege: Introducing a taxonomic code for understanding occupation. Canadian Journal of Occupational Therapy, 71(5), 261-264.

Townsend, E. & Polatajko, H.  (2007).  Enabling Occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation.  Ottawa, ON: CAOT Publications ACE.

World Health Organization (2000). Obesity: Preventing and managing the global epidemic: Report of a WHO consultation on obesity. Geneva: WHO.

Zimmerman, D., Purdie, L., Davis, J., & Polatajko, H. (2006). Examining the face validity of the taxonomic code of occupational performance. Presented at the Thelma Cardwell research day, Faculty of Medicine, University of Toronto, ON, Canada. Retrieved from http://www.ot.utoronto.ca/research/research_day/documents/rd_06_proceedings.pdf

Position statements are on political, ethical and social issues that impact on client welfare, the profession of occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON. K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca.