How Can OT Help?

Benchmark programs, such as Mayo Clinic, have included occupational therapy in their bariatric team (Mayo Clinic, 2019).

Occupational therapy (OT) has many opportunities to assist within this scope of practice as OT practitioners are skilled in creating, modifying, and adapting institutional, contextual, and attitudinal barriers to enhance opportunities for meaningful engagement (Ellison, Keesing, & Harris, 2020). Within the profession, there are increasing opportunities to develop strong evidence-based strategies to implement with individuals and communities that are seeking bariatric surgery through a perspective of prevention and health promotion (AOTA, 2015; Pizzi, 2013). OT assessment and intervention can identify strengths, areas for growth, and provide a just-right challenge to implement necessary strategies to enhance quality of life and fulfillment in occupational engagement and roles (AOTA, 2015; Mata, Mikkola, Loveland, & Hallowell, 2015).

There is a growing opportunity for the OT profession to develop strategies strongly supported by evidence to implement with individuals and communities that are seeking bariatric surgery through a perspective of prevention and health promotion rather than only providing intervention postoperatively (Pizzi, 2013).

Evaluation

There are currently no evaluations or assessments available that are made specifically to examine a client with bariatric needs from an OT perspective; however, some researchers have used the COPM to assess patients with bariatric needs and the authors were able to obtain significant results from it (Barclay & Forwell, 2018; Nossum et al., 2018).

Evaluation Tools Per Need

ADLs

Barthel Index

(Mahoney & Barthel, 1965)

FIM

(Granger, Hamilton, Zielezny, & Sherwin, 1986)

Kels

(Kohlman, 1992)

Katz Index of ADL

(Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963)

Stigmatization

The Weight Self- Stigma Questionnaire

(Lillis, Luoma, Levin, & Hayes, 2018)

Motivation

Interest Checklist

(Rogers, Weinstein, & Figone, 1978)

Volitional Questionnaire

(de las Heras, 1990)

Mental Health

Beck Anxiety & Depression Inventory

(Beck & Steer, 1993; Beck, Steer, & Brown, 1996)

Body Esteem Scale

(Franzoi & Shields, 1984)

Occupational Performance

COPM

(Law, Baptiste, McColl, Opzoomer, Polatajko & Pollock, 1990)

Occupational Questionnaire

(Smith, Kielhofner, Watts, Model of Human Occupation Clearinghouse, & University of Illinois at Chicago, 1998)

MOHOST

(Parkinson, Forsyth, Kielhofner, Model of Human Occupation Clearinghouse, & University of Illinois at Chicago, 2006)

Pain

Psychosocial Pain Inventory

(Otis-Green, 2006)

Role Identity

Revised Role Checklist

(Scott, McKinney, Perron, Ruff, & Smiley, 2019)

Worker Role Interview

(Velozo, Kielhofner, & Fisher, 1990)

IADLs

Instrumental Activities of Daily Living Scale

(Graf, 2008)

Intervention

OT can contribute effectively to interventions due to their holistic approach for therapy, individualized care for each client, knowledge on the roles and tasks necessary and desired by humans, supporting changes in health behavior with technology, and promoting the enjoyment of being active and engaged (Nielsen & Christensen, 2018). Current OT interventions that are present for individuals undergoing bariatric surgery include home modifications to promote activity participation, implementing adaptive equipment and techniques to support meal prepping, grocery shopping and eating, grading functional tasks to increase physical activity endurance and tolerance, establishing healthy daytime and sleep routines, and teaching coping strategies (AOTA, 2015; Forhan & Gill, 2013; Nielsen & Christensen, 2018).

Occupational therapists have two primary methods of intervention when working with this population: implement health promotion and disease prevention care that emphasizes creating new and healthier lifestyle choices for people at risk for weight gain or help clients that have undergone bariatric surgery restore skills that were severely impaired from their prior lifestyle (Pizzi, 2013).

References

American Occupational Therapy Association. (2015). Occupational therapy’s role in bariatric care. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/ Professionals/WhatIsOT/HW/Facts/Bariatric%20fact%20sheet.pdf

Barclay, K. S., & Forwell, S. J. (2018). Occupational performance issues of adults seeking bariatric surgery for obesity. American Journal of Occupational Therapy, 72(5), 1–10. doi:10.5014/ajot.2018.025924

Beck, A.T., & Steer, R.A. (1993). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.

Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck Depression Inventory–II [Database record]. APA PsycTests.doi:10.1037/t00742-000

de las Heras, C. G. (1990). The volitional questionnaire: A user's guide. Unpublished manual.

Ellison, N., Keesing, S., & Harris, C. (2020). Understanding occupational engagement for individuals with bariatric needs: The perspectives of Australian occupational therapists. Australian Occupational Therapy Journal. doi:10.1111/1440-1630.12657

Forhan, M., & Gill, S. (2013). Cross-border contributions to obesity research and interventions: A review of Canadian and American occupational therapy contributions. Occupational Therapy in Health Care, 27(2), 129–141. doi:10.3109/07380577.2013.785642

Franzoi, S. L. & Shields, S. A. (1984). The Body-Esteem Scale: Multidimensional structure and sex differences in a college population. Journal of Personality Assessment, 48, 173-178.

Graf C. (2008). The Lawton Instrumental Activities of Daily Living Scale. AJN American Journal of Nursing, 108(4), 52–63. doi:10.1097/01.naj.0000314810.46029.74

Granger C.V., Hamilton B.B., Zielezny M., & Sherwin F.S. (1986). Advances in functional assessment in medical rehabilitation. Topics in Geriatric Rehabilitation, 1(3), 59–74.

Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., Jaffe, M.W. (1963). Studies of illness in the aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA, 185(12), 914–919.

Kohlman, L.K. (1992). Kohlman Evaluation of Living Skills. Maryland: The American Occupational Therapy Association, Inc.

Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., & Pollock, N. (1990). The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 82–87.

Lillis J., Luoma J. B., Levin M. E., & Hayes S. C. (2018) Measuring weight self-stigma: The Weight Self-stigma Questionnaire. Obesity (Silver Spring), 18(5), 971–976. doi:10.1038/oby.2009.353

Mahoney, F. I., Barthel, D. (1965). Functional evaluation: the Barthel Index. Maryland State Med Journal, 14, 56-61.

Mata, H., Mikkola, A., Loveland, J., & Hallowell, P. T. (2015). Occupational therapy and bariatric surgery: Discovering occupation after weight-loss surgery. OT Practice, 20(1), 11–15. Retrieved from https://www.aota.org/Publications-News/otp/Archive/2015 /01-19-15/Bariatric-Surgery.aspx

Mayo Clinic. (2019). Overview - Bariatric Center in Florida - Mayo Clinic. Retrieved from https://www.mayoclinic.org/departments-centers/general-surgery/florida/bariatric-center/overview

Nielsen, S. S., & Christensen, J. R. (2018). Occupational therapy for adults with overweight and obesity: Mapping interventions involving occupational therapists. Occupational Therapy International, 2018, 1–17. doi:10.1155/2018/741268

Nossum, R., Johansen, A.-E., & Kjeken, I. (2018). Occupational problems and barriers reported by individuals with obesity. Scandinavian Journal of Occupational Therapy, 25(2), 136–144. doi:10.1080/11038128.2017.127921

Otis-Green, S. (2006). Psychosocial Pain Assessment Form. In Dow (Ed.), Nursing Care of Women with Cancer. St. Louis, MO: Elsevier Mosby, 556-561.

Parkinson, S., Forsyth, K., Kielhofner, G., Model of Human Occupation Clearinghouse., & University of Illinois at Chicago. (2006). A user's manual for Model of Human Occupation Screening Tool (MOHOST). Chicago, Ill: Model of Human Occupation Clearinghouse, Dept. of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Pizzi, M. A. (2013). Obesity, health and quality of life: A conversation to further the vision in occupational therapy. Occupational Therapy in Health Care, 27(2), 78–83. doi:10.3109/07380577.2013.778442

Rogers, J. C, Weinstein, J. M., & Figone, J. J. (1978). The Interest Checklist: An empirical assessment. American Journal of Occupational Therapy, 32, 628-630.

Scott, P. J., McKinney, K. G., Perron, J. M., Ruff, E. G., & Smiley, J. L. (2019). The Revised Role Checklist: Improved utility, feasibility, and reliability. OTJR: Occupation, Participation & Health, 39(1), 56–63. doi:10.1177/1539449218780618

Smith, N. R., Kielhofner, G., Watts, J. H., Model of Human Occupation Clearinghouse., & University of Illinois at Chicago. (1998). Occupational questionnaire. Chicago, Ill.: Distributed by Model of Human Occupation Clearinghouse, University of Illinois at Chicago.

Velozo, C., Kielhofner, G, & Fisher, G. (1990). A user's guide to the Worker Role Interview. University of Illinois at Chicago, College of Associated Health Professions, Department of Occupational Therapy.