Professor Kim Bennell APAM and Dr Kim Allison APAM are physiotherapy researchers at the University of Melbourne’s Centre for Health, Exercise and Sports Medicine (of which Kim Bennell is also the director), where they are researching musculoskeletal conditions including osteoarthritis (OA), with a focus on lifestyle management.

They recently published research looking at the possibility of physiotherapists providing advice on weight loss to OA patients with overweight or obesity.

The project initially examined the attitudes of physiotherapists towards playing a role in weight management (Allison et al 2019), showing that participants were open to the idea.

Following this, the team developed EduWeight-OA, an online training program for physiotherapists designed to teach them about weight management and attitudes towards obesity (Allison et al 2023) as well as providing practical training in communication about weight management.

Covering biosocial elements of obesity and weight management, it was co-developed by a group of endocrinologists, obesity researchers, education specialists, practising physiotherapists and dietitians with experience in weight loss interventions for OA.

The next step was the POWER trial (Allison et al 2024), a randomised controlled trial looking at a physiotherapist-led delivery of a very-low-energy diet and exercise program online.

Kim Bennell says it’s important to note that the weight loss program was delivered by physiotherapists who had completed the EduWeight-OA training program.

Professor Kim Bennell, director of the University of Melbourne's Centre for Health, Exercise and Sports Medicine, is interested in lifestyle management of musculoskeletal conditions.

‘They weren’t just giving trial participants generic advice about weight loss.

‘They were actually prescribing and supporting a very-low-energy diet, which is quite different from just saying “Weight loss can help with your knee pain; you might want to speak to your doctor about that,”’ Kim Bennell says.

Both researchers believe that physiotherapists can assist patients who are seeking to manage their weight, although they stress that the role is mostly as a coach and supporter.

They hope to roll out their training program more widely as a tool for physiotherapists to use to help all their clients, not just those with OA, with weight management.

Kim Bennell says it is part of a wider pattern of supporting behaviour change, something with which physiotherapists are familiar.

‘That’s mostly what it is.

‘The patient can read about how you do it; we all know how to lose weight.

‘But actually having someone to be accountable to makes a difference.

‘It’s the same skills that physios use in supporting exercise adherence,’ says Kim Bennell.

A number of barriers, both for the patient and for the physiotherapist, might make a discussion about weight difficult or uncomfortable.

On the patient side, there’s the stigma about weight and the perception that they are being judged, right from the point of entering the clinic.

‘The physical environment of a physiotherapy clinic can make people feel vulnerable anyway, no matter what sort of body size they have,’ says Kim Allison.

‘There’s a preconception of physio as the fit profession, with the young kids in lycra and Pilates and that image of exclusivity.

‘When people don’t see themselves in other people, they don’t trust them as much.’

Kim Bennell says that patients might feel uncomfortable explaining to the physiotherapist that they find the prescribed exercises or physical activity hard to do.

‘According to work we’ve done, people with obesity might feel that they are going to have more trouble doing the exercise.

‘It might be harder for them to move; they might be worried about being able to exercise and be physically active.

‘So that’s a barrier in terms of their own self-efficacy in being able to exercise,’ she says.

Another barrier is the presence of more complex presentations and comorbidities, including mental health issues like depression and anxiety, which may affect a patient’s motivations and their thoughts and feelings about whether or not they are likely to improve with physiotherapy treatment.

From the physiotherapist’s perspective, a lack of confidence can prevent them from talking to their patients about weight.

Kim Allison says there are two main considerations for a physiotherapist who might be thinking about how and when to bring up weight loss with their client.

Dr Kim Allison is a physiotherapist and researcher at the University of Melbourne's Centre for Health, Exercise and Sports Medicine, where she has developed an online training program to teach physiotherapists about weight management.

‘Obviously there’s a clinical reasoning paradigm—is it relevant to this person and their outcomes or their treatment options?

‘But the establishment of therapeutic rapport and the trust between client and clinician is more fundamental,’ she says.

Another consideration is duty of care to the patient, says Kim Bennell. In the current Osteoarthritis of the Knee Clinical Care Standard, Quality statements 4 and 5 refer to weight loss and exercise, with recommendations that patients set weight and exercise goals.

‘The core capability framework for osteoarthritis says that having a discussion about weight management—in terms of the importance of achieving and maintaining a healthy weight—is the role of all health professionals,’ she says.

‘If you were treating someone’s back and you saw something that looked like a suspicious melanoma, you wouldn’t just ignore it.

‘You’d say to the person, “Look, you know, there’s something here.”

‘It’s the same sort of thing—having the conversation or planting the seed is everybody’s concern.

‘It doesn’t necessarily mean you treat it but you can ask permission to discuss it and refer them to the GP or a dietitian for further information.

‘That’s important but how you bring up the topic is also important.’

Kim Allison says that providing physiotherapists with the skills and confidence to discuss weight management with their patients in a sensitive and supportive way is crucial.

‘If weight is discussed in a not-very-sensitive way, people can feel misunderstood or as if they have a personal responsibility for their illness because they feel that you’re assuming that they’re not doing what they need to do to lose weight or look after themselves,’ she says.

QUICK LINKS

• references

COURSES OF INTEREST

The importance of understanding energy balance 

Mentoring Series #18—treating osteoarthritis & more chronic issues