Weight-loss as a physiotherapy intervention

Why it’s so important

More and more orthopedic research is pointing to being overweight as one of the most important controllable risk-factors for pain and dysfunction within certain joints - particularly the knees. One study suggest that there is a 9-13% increase risk of knee osteoarthritis for every extra kg of bodyweight (1). More importantly, our risk of the major causes of early morbidity and mortality (heart disease, stroke, diabetes, some cancers) increases with bodyweight.

Are you actually overweight?

For general population (ie not high-level athletes), we can easily evaluate your weight-related health risks with the use of Body Mass Index. This is a simple value based on your height and mass that you can calculate here.

If you’re above 24.9 on this measure, reducing body weight may be one of the most important goals you could strive for. Just coming down 2 points on this scale may reduce your knee arthritis risk by 50% (2). Plus, coming into a lower category means no just living longer, but living better.

Lifestyle Changes - why it’s hard

Of course, 64% of Canadians are overweight or obese (3). We know it’s important, but it’s a challenging goal for us to work on. Many of us will already have a host of priorities we’re trying to balance, in addition to some other lifestyle changes we’re trying to incorporate (like those physio exercises). Feeling hungry and doing exercise are not necessarily things we enjoy and we are awash with marketing that offers us the ‘fast’ and ‘easy’ methods that may not be effective or sustainable.

some paradigm shifts:

Following through on your true priorities: If you list the three most important things to you, ‘health’ is probably on that list. Have you achieved it yet? How much of your time, effort, money, etc. do you actually commit to maintaining it? If you’re like most of us, health is vitally important but you continuously get pulled of course by distractions that feel more important in the moment - though obviously aren’t in the grand scheme of things. Try to look at your day to day through this broader lense and choosing the better decision may be easier.

Get set for the long-haul. We need sustainable, life-long change. Once we achieve your optimal weight, you have to maintain it. You’re not ‘going on a diet’, we’re ‘changing your diet’. Which brings us to our next point:

All-or-nothing usually results in nothing. We are tempted to try to go zero-to-hero and over-commit while we are starting out, become discouraged and then fall off the wagon. When it comes to lifestyle change, making smaller changes, adopting those habits, and then moving to the next tends to be more effective.

It's probably not easy - make your peace with it. Someone selling you something said it would be fast, easy, and you wouldn’t be hungry. Actually, we are eating less than the body needs each day in order to force it to use up some of its fat reserves. Your body will likely tell you your hungry. Is that less fun then eating cheesecake (personal favourite)? Yes. Is it an unbearable uncomfortable sensation that you can’t tolerate? Probably not.

your target:

Recommendations are to lose 1-2 pounds of fat per week (not more, not less). If you’re counting calories, this would represent a deficit (ie you burning more than you consume) of 500-1000 calories (kcal) per day. You can estimate how many calories you burn in a day (for a given activity level) here. At the same time, we don’t want people eating below 1500 kcal per day if they aren’t followed by a Registered Dietician. Not enough deficit? That’s where physical activity helps out.

Resources:

Registered Dieticians: As a physiotherapist, I’m always working with a dietician. Nutrition is a field rife with misinformation and a dieticians are the health professionals best equipped to interpret and apply the latest research and best-practices. They are also an invaluable resource for working directly with patients to tailor strategies best suited for them to make changes more manageable. You can always contact me for recommendations within the Montreal area.

Personal Trainers: Canadian guidelines recommend a physical activity, in general, but also specifically as part of your efforts to lose weight. You might not be ready to change this and your eating at the same time, and that’s OK. We also don’t need you to do traditional or structured exercise or sports. Activities such as gardening or a brisk walk also count, so you might as well find something you enjoy. If you are looking at doing a exercise program however, learning how to structure your workouts and do technique well can be valuable to getting results and reducing the risk of injury. While also a trainer, I typically focus on rehabilitation but you can always contact me for recommendations within the Montreal area.

Apps: There are a host of applications that can help with tracking your calorie needs, consumption and your progress. I like to use My Fitness Pal as it has a very large database, I can enter items by scanning the barcodes, and it gives some nutrient breakdowns of my day. Like many of these apps, you can allow it to enable your phone to track your steps.

Activity Trackers: They’re not necessary but products like Fitbit trackers can be motivating and help you track your physical activity.

Not into highly-structured programs? Here’s a couple simple things you can start incorporating:

  • Learn about Mindful Eating: this has become popular and healthy approach to addressing what and how we eat.

  • Find and cut sources of ‘empty calories’. Soft drinks, junk food, alcohol and overly refined/processed food can be a good place to start.

  • Eat smaller portions. Eating out? Leave some of the food on your plate.

  • Choose more fibre-rich foods. Fibre found in fruits, vegetables and whole grains can be more filling (and good for health more generally). People also tend to report feeling more satiated if they have sources of protein with each meal.

If you’re reading this:

You’re already making steps towards preparing in your health and wellness - that’s already an accomplishment. We’re not looking for perfection, just to gradually and consistently make choices that we’ll be glad we made later.

Steven ProcterPhysio Steve