Occupational Therapy for Adults with Overweight and Obesity: Mapping Interventions Involving Occupational Therapists
Table 1
Data extraction form.
Author (year), country [ref.], journal, purpose
Design, sample, age
Duration/frequency
Intervention/controls
OT role and contribution to outcomes
Outcomes
Results at discharge
Results at follow-up
Rynne & McKenna (1999), Australia [38] The British Journal of OT (BJOT), The Royal College of Occupational Therapists (UK) To evaluate an outpatient diabetes education program
Cohort One group Pre−/posttest Adults with non-insulin-dependent diabetes mellitus () Females: 27% Mean age 74 yo (range 37–87 yo)
3 mths in total 1 mnth/1 hr á wk 2 mths follow-up
IG (participants and their relatives/friends) (groups at max. 10): information on the basic physiology of diabetes; management of hypoglycemia and sick days; medications and blood glucose testing; dietary management; weight control; role of PA; foot care; motivation; Diabetes Australia services
OT as part of multidisciplinary team Planning and executing, in line with a nurse, dietitian, psychologist, podiatrist and a representative of an NGO for diabetes Client-centered approach to the intervention; planning teaching-learning process; education on the role of activity and self-management of diabetes; training in managing weight control based on exercise recommendations from the national clinical guidelines (USA); supporting clients’ self-management of lifestyle and adaptive behavior; systemic and holistic rehabilitation process; co-operation with community services
Diabetes knowledge
NS (unspec.)
NS (unspec.)
Self-management behavior in diet
NS (unspec.)
NS (unspec.)
Self-management behavior in exercise
()
()
Perceptions of wellness
NS (unspec.)
NS (unspec.)
BMI
NS (unspec.)
NS (unspec.)
Metabolic control
NR
()
Haber et al. (2000), USA [37] Family & Community Health journal, The Journal of Health Promotion and Maintenance (USA) To examine the impact of a health promotion program on the health behavior of older adults
Cohort One group Pre−/posttest Mixed-methods Older inactive, overweight and physically limited adults recruited from two sites IG included () IG completed () Mean age: 71 yo, range 64–89 yo Female 83%
9.75 mths in total 7 wks (=1.75 mths)/14 hr (1 hr twice a wk) Follow up: 8 mths post intervention
IG: 40 min PA; heart rate/PA intensity calculation; information on nutrition and stress management; 20 min group discussion on social, cognitive, and behavioral issues; social skills and environmental control training; realistic and measurable health goal setting; listing health benefits and motivational inspiration; self-affirmations; linking new health behavior with existing habits; homework assignments to increase PA time and healthy nutrition; phone calls between sessions
OT as part of OT/PT undergraduate team Executing, in co-operation with PT Active collaboration with clients; time administration; realistic and measurable health goals; supervised discussion in small groups; rethinking of existing habits, planning of new health behaviors, and environment control and modifications; adaptation of new exercise behavior; patient education and practice in progressive muscle relaxation; estimation of training intensity and heart-rate; individual diet calculation, in co-operation with dietitians; self-assessment on exercise and nutrition (additional fruit and vegetable consumption); information and experiential learning on stress management; using social support to motivation, listing health benefits and motivational inspiration, and repeating affirmations to oneself; improving memory function with social support
Brisk walk exercises
()
NS (unspec.)
Flexibility exercises
()
NS (unspec.)
Strength exercises
()
NS (unspec.)
Association for health behavior change vs the following:
(i) Participants’ educational level (ii) PT’s involvement (iii) Participants’ race
NR NR NR
NS (unspec.) NS (unspec.) NS (unspec.)
Regular PA (min. of 3 t./wk at ≥20 min)
NR
NS (unspec.)
Voruganti et al. (2006) Canada [35] The Canadian Journal of Psychiatry (Canada) To assess the feasibility of clinical implementation and evaluate the effectiveness of a novel adventure- and recreation-based group intervention
Quasiexperiment Pilot, pre−/posttest Case–control Two groups Adults with schizophrenia IG () CG () Treatment adherence = 97%, no dropouts Mean ± SD age IG: 32 ± 7.5 yo Mean ± SD age CG: 41 ± 9.4 yo
20 mths in total 8 mths intervention (2 modules at 8 wks = 8 sessions) 12 mths of maintenance phase
IG: summer and winter modules with various outdoor activities. Participants encouraged to maintain weekly contacts with the treatment team between modules. CG: recruited from wait list, received standard clinical care included some recreational activities
OTs as part of multidisciplinary team Planning, executing, and supervising, in line with a nurse and a social worker No specific OT contributions declared OTs were involved in the multidisciplinary novel adventure-based intervention including outdoor activities for psychiatric rehabilitation
[Maintenance phase]
Weight loss
NR
()a
Self-esteem
()
()
Global functioning
()
Marginally improved
Self-appraised cognitive abilities
Marginally improved
NR
Brown et al. (2006), USA [33] Psychiatric Rehabilitation Journal, the American Psychological Association (USA) To examine the efficacy of psychiatric rehabilitation weight loss program
Quasiexperiment Two groups Pre−/posttest, pilot Adults with serious mental illnesses, BMI ≥ 25 Recruited () Completed () Dropout IG (); CG () Completed IG (); CG () Female IG: 71% Female CG: 60% Mean age IG: 47 yo, range 30–61 yo Mean age CG: 41 yo (range 30–61 yo)
3 mths in total 2 hr/wk
IG: weight loss and psychiatric rehabilitation principles; diet, frequent contact with professionals, dietary education, 30–45 min moderate PA 3–5 days/wk, goal setting, social and instrumental support, skill and transfer training (dining out), granted materials (calorie counts, cooking utensils etc.) CG: no treatment
OTs as part of multidisciplinary team Planning and executing, in line with a dietician and exercise psychologist No specific OT contributions declared OTs were represented in the multidisciplinary program aimed to utilize the psychiatric rehabilitation principles and weight loss strategies
Between-group diff.:
(i) Weight (ii) BMI (iii) Waist circumference (iv) Diastolic BP (v) Systolic BP (vi) Total lifestyle profile (vii) Lifestyle profile nutrition subscale (viii) Lifestyle profile PA subscale (ix) Energy intake
() () () () () () () () ()
In-group diff. (IG):
(i) Total lifestyle profile (ii) Lifestyle profile nutrition subscale (iii) Lifestyle profile PA subscale (iv) Energy intake (v) Fat intake
() () () () ()
Pendlebury et al. (2007), UK [34] International Journal of Neuropsychopharmacology (JNP), Oxford Academic (UK) To evaluate long-term changes in weight and patient attendance based on the outcomes from the first 4 years of a behavioral treatment program
Quasiexperiment Multiple treatment reversal designs, time-series, longitudinal Repeated pre−/posttest Adults with schizophrenia and affective disorder, on psychotropic medication, wishing to lose weight () Total patient episodes (), incl. Reenrollments () Females: 61% Age mean 43.7 ± 1.2 yo (range 22–71 yo)
4 years in total One session/wk
IG (open drop-in program): measuring weight; group discussion on dietary experiences; group discussion on 8 informal rotational topics (to solve any actual issues on weight loss)
OTs as part of multidisciplinary team Planning and executing, in line with a psychiatric nurse No specific OT contributions declared OTs were represented in the multimodal program that incorporated nutrition, exercise and behavioural intervention, providing a holistic lifestyle approach to weight loss
7% body weight and BMI change at 3–6–9 mths; 1–1, 5–2–3-4 y
Normal BMI achieved
23% [at the end of each patient episode]
NR
Weight loss
Sign. NRb
Weight loss correlation with young age
()
NS (unspec.)
Weight loss correlation with adherence to the program
()
NS (unspec.)
Weight loss correlation with diagnosis
()
NS (unspec.)
Weight loss correlation with mono- or multimedication
NR
()
McClure et al. (2010) USA [32] The American Journal of OT (AJOT), The American OT Association (USA) To report a randomised controlled study of a program, designed to achieve improvements in physical and emotional breast cancer–related lymphedema (BCRL) symptoms.
RCT Two groups Individuals with BCRL, BMI ≥ 29.8 () IG () CG () Dropout () Mean ± SD age IG: 57.0 ± 2.9 yo (30.7; 78.0) Mean ± SD age CG: 59.7 ± 2.1 yo (42.2; 78.7) Female: 100%
17 wks/4.25 mths in total 5 sessions at 2 hr/5 wks/1.25 mths and a self-monitored home program (3 mths)
IG (The Breast Cancer Recovery Program): of The FLOW video (McClure & Bittman, 2003) and relaxation techniques at home daily; verbal instructions and written educational material on lymphedema coping and relaxation techniques (deep diaphragmatic breathing, progressive muscle relaxation and facial massage); a question-and-answer component and group discussion at every session CG: professional advice/usual practice
OTs as part of multidisciplinary team (team composition not declared) Supervising the assessors; guiding the assessment process Mood and quality of life monitoring
Bio-impedance z (arm swelling)
()
NR
Arm flexibility
()
()
Volume
NS (unspec.)
NS (unspec.)
Weight loss
()
Maintained sign. (unspec.)
Quality of life in norm-based physical function
()
NR
Quality of life in general health
()
NR
Quality of life in vitality
()
NR
Mood
()
()
Jacobs et al. (2011), UK [40] British Journal of OT (BJOT), the Royal College of Occupational Therapists (UK) To investigate effect of Nintendo Wii Fit as an occupation to promote weight loss in students.
Cohort Three groups Pre−/posttest A-B design, explorative 1-year university students () Dropout: 1 out of 6 Age> 18 yo Females: 100%
3 mths
IG 1: the solo Wii group (): individual Wii exercise, yoga, balance, and strength activities 4 t/wk, 30–45 min IG 2: the double Wii group (): the same training as group 2, but with a partner IG 3: the typical activity group (): moderate intensity physical activity (e.g., walking to class)
OTs as main interventionists Planning, executing Integral approach to PA, diet and activity participation; motivating for increase in PA; incorporating PA into daily routines; decreasing negative impact of obesity; promote participation in meaningful roles; using VR technology as a therapeutic tool for exercise; instructing in use of VR technology; encouraging to exercise with VR technology in leisure time
Weight:
(i) IG1 (ii) IG2 & IG3
() NS (unspec.)
BMI:
(i) IG1 (ii) IG2 & IG3
() NS (unspec.)
Motivation for PA:
(i) IG1 (ii) IG2 & IG3
NS, sugg. Improved NS (unspec.)
PA level:
(i) IG1 (ii) IG2 & IG3
NS, remained moderate NS (unspec.)
Bacon et al. (2012), Australia [39] The British Journal of OT (BJOT), the Royal College of Occupational Therapists (UK) To evaluate the Nintendo Wii Fit use in changing engagement in PA
OTs as main interventionists Planning, executing Providing access to meaningful PA PA participation on collaboration with the participants; positive role modelling; establishing positive activity behaviors and lifelong habits; instrumental support with VR technology for PA as part of the intervention and in leisure time; instruction in use of VR technology; making activity enjoyable
Total daily PA time
NS, increased
More positive attitudes towards PA
Attitudes towards PA
Increased PA, provided meaningful occupation and showed potential use of the technology
Use of Wii Fit
Christensen et al. (2011), DK [30], and Christensen et al. (2012), DK [31] BMC Public Health (USA) To evaluate the effects of the first 3 mths and 12 mths of follow-up of a 1-year long lifestyle intervention aimed to achieve weight loss among health care workers
Cluster RCT To groups Single-blinded Overweight health care workers () IG () CG () Females: 100% Divided into 7 groups Dropout phase 1 () Dropout phase 2 () Mean age 45.5 yo (range 36–55 yo)
12 mths in total 1 hr/wk during working time Two phases: weight loss-phase (3 mths), weight loss maintenance phase (9 mths)
IG: individually dietary plan with energy deficit of 1200 kcal/day (15 min/hr); strengthening exercises (15 min/hr) and CBT (30 min/hr); leisure time aerobic fitness: 2 hr/wk; additional reducing of energy intake; 15 min circuit training during the 6th–9th mth of intervention; local sport activities and jogging outdoor during the 9th–12th mth of intervention; motivation to use training log books for home exercises; composition of one’s own diet; setting realistic easy-to-implement goals based on participants’ preferences and perception of meaningfulness; coping with cravings and practicing the intervention principles in everyday life CG: monthly oral presentations at 2 hr during working time.
OTs as part of multidisciplinary team Planning/managing, executing, supervising No specific OT contributions declared OTs were represented in the multidisciplinary program that incorporated nutrition, exercise and behavioral intervention and applied to the clients’ workplace and local environments
[Maintenance phase]
Body weight
()c
()d
BMI
()
()
Body fat percentage
()
()
Waist circumference
()
()
BP
()
()
Musculoskeletal pain
NS (unspec.)
NS (unspec.)
Maximal oxygen uptake
NS (unspec.)
NS (unspec.)
Isometric maximal muscle strength of 3 body regions
NS (unspec.)
NS (unspec.)
Brown et al. (2011), USA [28], and Brown et al. (2014), USA [29] Psychiatric Services, the American Psychiatric Association (USA)/Schizophrenia Research, the Schizophrenia International Research Society (USA) To access RENEW (recovering energy through nutrition and exercise for weight loss) program in individuals with serious mental illness at four mental health centers
RCT Two groups Adults with serious mental illness IG () CG () Enrolled () Completed, at follow-up () Females 61% Mean ± SD age 44.6 ± 10.9 yo
12 mths in total Intervention: 3 mths (3 hr/wk) Maintenance: 3 mths (3 hr/mth) Support: 6 mths
IG (RENEW): energy intake reduction min. 500 kcal/day; education on nutrition; PA min. of 30 min/day; individualized goal setting; eating together; 2 meal replacements a day; weekly phone support in maintenance phase, no contact in support phase CG: usual treatment (medication, case management, voluntary participation in day programs); no restrictions from attending wellness elsewhere
OTs as part of multidisciplinary team Planning, executing, in line with a nurse, dietician and fitness instructor No specific OT contributions declared OTs were represented in the multidisciplinary program that incorporated psychiatric rehabilitation principles and evidence-based weight loss strategies; providing education and practice in modifying nutrition and PA; incorporated social and instrumental support, goal setting, skills and transfer training, and cognitive compensation.
Weight loss 5% (clinically sign.) at 3 mths
(p = .01) ∗e
NR
Weight loss 10% (weight loss maintenance) at 6 mths
(p = .22) f
NR
Weight regain at 12 months (follow up)
(p = .47) g
Differences by weight changes by site
At 3 vs 6 months: (p = .017) ∗ vs (p = .043) ∗
At 12 months: (p = .076)
Brown et al. (2015), USA [36] Psychiatric Rehabilitation Journal, The American Psychological Association (USA) To evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention.
Cohort Pilot pre−/posttest One group Adults with severe mental illness () and a BMI> 25 Dropout: 2 out of 18 Females 89% Age range 23–64 yo Mean ± SD age 47.3 ± 10.5 yo
6 mths in total Intervention: 2 mths (16 hr, 2 hr./wk) Follow-up: 4 mths
IG: Education; PA (20–30 min. Moderate intensity); healthy meals; provided printed materials (recipes and books with guidelines for eating out) and exercise bands
OTs as main interventionists Planning, executing Increasing PA participation (moderate); practicing healthy eating in groups; instrumental support to healthy eating (recipes and guidelines for eating out) and exercise (elastic bands); encouraging positive cognition; motivating for sustainable health behavior changes in long term; planning daily behaviors with impact on weight; focusing on active learning and small changes
An average weight loss
()h
()i
Increased knowledge about nutrition
()
NR
Increased PA
()
NR
Association between attendance and body weight
NS (but tended towards significance)
NR
BP = blood pressure; CBT = cognitive behavioral therapy; CG = control group; hr = hour; diff. = difference; IG = intervention group; = number analysed; mth/mths = month/months; NGO = nongovernment organisation; NR = value not registered; NS = not significant; OT = occupational therapy; OTs = occupational therapists; PA = physical activity; PTs = physical therapists; RCT = randomized controlled trial; sign. = significant; sugg. = suggested; unspec. = unspecified; VR = virtual reality; wk/wks = week/weeks; yo = years old. indicates statistically significant effect at 95% CI. a,b,c,d,e,f,g,h,i Mean weight loss in the intervention group: a −5.4 kg; b −6.2 kg; c −3.6 kg; d −5.8 kg; e −2.2 kg; f −1.9 kg; g −0.7 kg; h −1,4 kg; and i −4.3 kg.
