Going Beyond Management and Maintenance: Occupational Therapy’s Role in Primary Prevention for Adults at Risk of Obesity—Is the Elephant in the Room Still the Biggest Challenge?

We want to start by making it clear that with our recent article (Muntefering et al., 2023), and thus our research, we have a strong motivation to help prevent people from becoming obese. Obesity increases the risk of several diseases. However, even if we disregard obesity as a risk factor for other diseases, obesity alone affects people’s everyday life and meaningful activities (Nossum et al., 2018). Through our research we have gained insight into how obesity can negatively affect people physically, psychologically, and socially. With our article, we wanted to acknowledge the impact that obesity can have on a person’s occupational engagement and identify how we believe occupational therapy can support individuals who are at risk of obesity.

As a group of authors with great knowledge and interest in obesity research, we are encouraged by the attention our article has received, because good debates are needed to move practice forward in any realm. However, the argument that Schwartz and Proffitt (2024) offered does not present an in-depth understanding of the obesity literature. Although we agree that weight-related research certainly has substantial room for growth, there is considerable evidence to support the impact of obesity on physical (Centers for Disease Control and Prevention [CDC], 2022), psychosocial (Kushner & Foster, 2000), and occupational health (Capodaglio et al., 2010; Forhan et al., 2010).

First, although Schwartz and Proffitt (2024) pointed to limitations in the obesity literature, such as body mass index (BMI), which is warranted, their statement about the need for more research to understand the link between obesity and health before further intervention work is justified is misguided. Even if we ignore research that has looked at BMI because of the limitations of this measure, occupational science gives us an understanding of how obesity can affect occupational participation and thereby influence health. Forhan and colleagues (2010) found that people with excess weight have trouble engaging in daily occupations because of pain, fatigue, stigma, and a perceived loss of control. In addition, excess weight can impose abnormal body mechanics during movement that affect (1) posture, (2) muscle strength, (3) cardiorespiratory capacity, (4) gait efficiency, and (5) motor task speed (Capodaglio et al., 2010).

Second, Schwartz and Proffitt (2024) stated that most weight loss interventions do not yield meaningful results, which is exactly why we are arguing the need for different models of care. They also stated that weight is primarily a result of genetics and social determinants of health and thus that it is a variable with a limited margin for change. Although genetics and social determinants of health are both considerable factors affecting obesity, they are by no means the only factors influencing this condition (CDC, 2021). Moreover, within occupational therapy, our response to all populations is not to limit someone with a health condition and deem their situation unchangeable. Despite many personal, environmental, and occupational factors, we work rigorously as a profession to promote greater levels of health and participation for all individuals.

In addition, with our article we were not seeking to support the notion that people with obesity are “at fault” for their condition. We particularly drew attention to interventions like Lifestyle Redesign (Jackson et al., 1998) and DO:IT (Jessen-Winge et al., 2021), which look at a multitude of factors beyond simply diet and exercise that standard care has typically supported. The selection of these interventions as models was meant to be a step away from the narrow focus that many interventions have often had on diet and exercise and that places responsibility on the client for their weight.

Finally, Schwartz and Proffitt’s (2024) reference to Golden et al. (2016) to support the potential risk of eating disorders in obesity prevention efforts is focused on adolescents, whereas our article focused on adults. Even still, Golden et al. (2016) stated that “the focus should be on a healthy lifestyle rather than on weight” (p. E1). We strongly agree with this statement and are arguing for occupational therapy’s role because we believe we have the skill set to focus on lifestyle rather than simply a number on the scale that has traditionally been emphasized in health care.

We agree that as a profession it is our duty to support the occupational participation of diverse individuals, including diverse body types. However, health management is an area of occupation in our practice framework that we should aim to support our clients in. Just as we would help support a client in medication management, symptom management, and pain management, we should also support clients in weight management. Because—we can do better!