Physical Therapist's Guide to
Obesity is a condition caused by the accumulation of excessive body fat. Nearly 100 million Americans are obese or overweight. Obesity is a worldwide epidemic.
A full 68% of the adult population in the United States currently is estimated to be overweight, and about 36% are obese. It is also estimated that 10% of children in the United States aged 2 to 5 years, 15% of children aged 6 to 11 years, and 16% of adolescents aged 12 to 19 years are overweight. Obesity increases the chance of early death; around 325,000 deaths in the United States each year are attributed to obesity.
Adults and children can be classified as normal, overweight, or obese by calculating their body mass index (BMI) based on their height and weight. For example, adults are considered overweight if their BMI is 25 to 29, and obese if their BMI is 30 or higher.
Obesity may be triggered by genetic, environmental, behavioral, social, physiological, and cultural factors. Sedentary lifestyles and surplus caloric intake are considered to be primarily responsible for the dramatic worldwide increase in obesity during the past 2 decades.
Obesity affects people of all ages, races, and socioeconomic levels. It contributes to many chronic diseases and can even cause early death. It can contribute to joint pain, due to increased stress that excess body weight puts on joints, muscles, and spinal discs. It can also cause a loss of "function"—the ability to perform simple daily activities like walking, climbing stairs, or doing household chores.
Numerous options for treating obesity are available today, including reduced-calorie diets, physical exercise, behavior modification, medication, and surgery. Physical therapists are experts in physical exercise, and can develop individualized physical activity plans for individuals who are overweight or obese to manage weight, prevent the development of obesity, or combat its effects.
What is Obesity?
Obesity is a condition involving the storage of excess body fat brought about by an imbalance between caloric intake (number of calories eaten) and energy expenditure (number of calories burned) occurring over an extended period of time. As little as 100 extra calories per day will lead to a 4.5 kg [10 lb] weight gain each year, which can lead to weight problems over time.
Obesity affects the body in many negative ways and can lead to other health problems, such as:
- cardiovascular disease
- high blood pressure
- cancer (breast, liver, endometrial, prostate, and colon)
- lymphedema (swelling of arms and legs)
- breathing problems, including asthma and sleep apnea
Obese people have difficulty engaging in daily activities due to the increased body weight they carry, their loss of physical conditioning, and their movement limitations.
Modern society, especially in the past 20 years, enables and encourages overeating and acceptance of overeating because there is an abundance of inexpensive, high-calorie foods with poor nutritional value available (i.e., “fast food” and “junk food”). We are also encouraged to consume unreasonably large portions of food with “supersized” fast food options, and advertising of food and eating as a way to bond and celebrate special occasions (“holiday feasting”) may also contribute. The growth of sedentary lifestyles or inactivity also contributes greatly to obesity. We spend more time playing video games instead of playing sports outside, working at desk jobs instead of performing manual labor, and riding in cars instead of walking.
How Does it Feel?
A person who is obese may experience:
- Fatigue when performing simple daily activities.
- Joint pain, especially in the legs and back from increased stress that excess fat and weight put on the joints and muscles of the body.
- Difficulty performing daily activities, such as walking, climbing stairs, or playing physically active games.
- Frustration or depression about the condition and the inability to lose weight.
How Is It Diagnosed?
If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:
- Do you have any joint pain?
- Do you have difficulty with any daily activities?
- How much daily exercise do you get?
- Do you have any other medical conditions or problems?
- Do you take any medication for your obesity or any other condition?
- Have you had any surgery related to your obesity?
- Are you under the care of a physician?
- What are your goals?
Your physical therapist will perform tests, such as motion, strength, coordination, and balance checks to help assess your overall physical ability. Your physical therapist may also perform specific obesity tests, such as calculating your BMI, or measuring your waist circumference, "skinfold" thickness, or percentage of body fat.
Your physical therapist may consult with your physician or other health care providers about your condition, who may order further tests to rule out other medical conditions that may affect the type of physical therapy you receive.
How Can a Physical Therapist Help?
Physical therapists can help people who are obese to be more physically active and fit by teaching them to exercise in pain free and fun ways. The right exercise is very important because it helps burn calories, get rid of fat, preserve muscle tissue, and protect your joints. When you start a fun exercise routine, it also helps you make better choices about your diet.
Your physical therapist will work with you to design a specific treatment program to address your needs, including exercises you can do at home. Aerobic exercise and strength training will likely be included in your program, as they both help in weight loss and weight control. Physical therapists are trained to create safe, effective physical activity programs for people of all ages and abilities, taking into account the Centers for Disease Control and Prevention physical activity recommendations for children and adults.
Physical therapists can also help individuals address any underlying reasons for their unhealthy behaviors; they are trained to identify any barriers to developing healthy habits, setting individual goals, and sticking to the program. Your physical therapist can help you:
Reduce pain. Your physical therapist will design a personalized exercise program to help you safely perform activities with the least amount of pain. Just getting up and getting moving can help relieve pain!
Improve cardiovascular fitness. Your physical therapist will design a "heart-healthy" aerobic exercise program for you, to elevate your body's metabolism and burn more calories. Physical therapists help people, including adults and children with disabilities find fun aerobic activities they can perform at their own comfortable level.
Improve strength. Your physical therapist will teach you exercises to address any muscle weakness you may have, or to improve your overall muscle strength. Building strength in muscles can help burn calories, make daily activities easier, and relieve joint pain. Gentle and low-impact forms of weight training performed with exercise bands can help avoid joint stress.
Improve movement. Your physical therapist will choose specific activities and treatments to help restore normal movement of stiff joints. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises that you do yourself.
Improve flexibility and posture. Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. Your physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can make difficult activities easier and less painful, and even improve your breathing.
Increase activity levels. Your physical therapist will discuss your activity goals with you, and design your exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.
If Surgery Is Necessary
Gastric bypass or bariatric surgery is sometimes chosen by patients and their doctors to treat severe obesity. Your physical therapist can help you prepare for and recover from surgery by designing and teaching you a preoperative and postoperative physical therapy program. Your physical therapist can guide you through each session, help you avoid injury to joints and muscles, and increase and adjust your program as needed. Preoperative programs often involve strength training and aerobic conditioning, while postoperative programs often start with deep breathing and lower-extremity (legs, ankles, feet) exercises, gently increasing to strength and aerobic training. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the speediest manner possible after surgery.
Can this Injury or Condition be Prevented?
To help prevent obesity or prevent weight gain after weight loss, your physical therapist will likely advise you to:
- Get moving! Include physical activities you enjoy into your daily routine so you can avoid returning to a sedentary lifestyle.
- Avoid watching TV more than 2 hours per day.
- Don’t use a computer longer than 1 hour without an exercise break.
- Use your body as much as you can to walk, climb stairs, garden, wash dishes by hand, and other daily activities that keep you moving.
- Educate yourself about nutrition, and especially about portion sizes, to help you understand and control your calorie intake.
- Exercise daily for at least 30 minutes (adults) or 1 hour (children). (This advice also applies to disabled individuals as well as those suffering from most medical conditions.) Always check with your physical therapist or a health care professional before beginning any exercise program.
Be sure to follow the special instructions your physical therapist gives you regarding your specific health conditions.
Your physical therapist will also prescribe a home-exercise program specific to your needs to prevent future problems or injuries. This program can include strength and flexibility exercises, posture retraining, and aerobic conditioning.
Real Life Experiences
Ryan is a 45-year-old computer programmer who has been obese for years. He has lived a sedentary life since he discovered his talent for programming computers at age 16. At that time, he gave up sports and most physical activities to spend long hours at his computer, mastering code and creating software that millions of people use around the world.
Recently, Ryan went to see his doctor about chronic knee and back pain. His doctor performed standard tests and found that Ryan was prediabetic. His doctor told him his joint pain and prediabetes diagnosis were a result of his obesity, and his obesity was a result of his sedentary lifestyle. His doctor recommended that Ryan immediately address his condition by learning about nutrition and to start exercising. Ryan expressed fear that he might worsen his knee and back pain if he tried to exercise by himself. His doctor referred him to a physical therapist.
Ryan’s physical therapist performed a full evaluation of his knee and back motion, strength, stability, and pain. She calculated his BMI, measured his waist circumference, and recorded his "skinfold" thickness over his triceps muscle. She checked his overall flexibility, strength, and posture.
She talked to Ryan about his physical activity levels over the last 30 years, and asked about his personal goals. Ryan revealed that he would like to join his friends in a weekly bowling night and play Frisbee golf with his family on Saturdays, but he was too weak and overweight to do those activities right now. His primary goal, however, was to not suffer back pain when sitting, and knee pain when trying to stand and walk, which he had dealt with for a long time. He also reported shortness of breath walking up half a flight of stairs.
Ryan's physical therapist designed a comprehensive treatment program that started off at a low level, so he wouldn’t suffer discomfort and muscular pain from the new exercises he was learning. She incorporated gentle strength training into his routine, using weight machines and Ryan's own body weight to strengthen his legs, back, core, and arms. She also included some aerobic conditioning on a stationary bike. Ryan's sessions always ended with a few gentle stretches.
Ryan and his physical therapist also discussed what factors made him want to eat more calories than he was supposed to each day. He noted that staying up late at night, or working at the computer longer than 3 hours without a break, seemed to trigger his desire for sugary and unhealthy foods. They discussed strategies to help break the cycle of unhealthy eating, such as setting an earlier bedtime, and using an alarm during his work hours to cue him to take a quick walk for 5 minutes every hour
Ryan attended physical therapy 3 times per week for 6 weeks. He participated eagerly in his program of strengthening, stretching, aerobics, and posture training. He was soon able to do a full 30 minutes of aerobic training in each session, and he felt invigorated, rather than exhausted, as his body adapted to his new activity level. He noted that he quickly felt stronger overall, and his knee pain reduced significantly. After 2 weeks, he could walk quickly up a flight of stairs with almost no shortness of breath. He proudly reported he was enjoying his new diet full of fresh, healthy foods. After 4 weeks, he lost 10 lbs. After 6 weeks, he lost 18 lbs, his BMI measurement was improved, and his back pain was less frequent.
Ryan was encouraged by his progress, and decided to continue going to physical therapy for another month. At the end of that month, he could walk quickly up 2 flights of stairs without shortness of breath or knee pain, sit for 2 hours without back pain, and—most exciting for him—he was able to join his friends for bowling night! He reported he had a terrific time, with no knee or back pain.
Ryan was discharged as a patient, but visited the physical therapy clinic during open gym hours to continue his program of weight loss, physical activity improvement, and prevention, under the knowledgeable eye of his physical therapist. Three months after starting his physical therapy program, Ryan joined his family for their Saturday Frisbee golf game—and won!
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat obesity and its muscular and joint consequences. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic or sports medicine focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of obesity. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Dutheil F, Lac G, Lesourd B, et al. Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome: the RESOLVE randomized trial. Int J Cardiol. 2013;168(4):3634–3642. Article Summary on PubMed.
Jakicic JM, Davis KK. Obesity and physical activity. Psychiatr Clin North Am. 2011;34(4):829–840. Article Summary on Pubmed.
Wills M. Orthopedic complications of childhood obesity. Pediatr Phys Ther. 2004;16(4):230–235. Article Summary on PubMed.
Racette SB, Deusinger SS, Deusinger RH. Obesity: overview of prevalence, etiology, and treatment. Phys Ther. 2003;(83):3:276–288. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.