GUEST COLUMN: Obesity Management- Emerging Role of Physiotherapist - DR.ANNU & DR.HIMANSHU TANWAR

Physiotherapy has a wide scope of practice with emerging specialties. As the time changes, the needs of society change and we have to equip our technologies and treatment methodologies to suit the same. Rising incidence of obesity all over the world is leading to more people approaching health professionals with complaints of joint pain and other related co morbidities arising from being overweight.

Obesity is widely recognized as a disease state now and medical fraternity is coming forward to address the need to treat, manage or prevent it. Since exercise and physical activity are considered to play a major role in management of obesity, physiotherapists are often the first contact person for secondary conditions resulting from obesity. Though physical activity is seen as a major solution to curb obesity it can’t be the only one. Multi dimensional approach is more advisable to cater to the needs of all type of patients who are physically inactive or severe obesity is hindering their ability to perform activity.

Diet plays an important role in controlling obesity as usually extra calories left after consuming a heavy meal are stored up inside body in form of fat. Machines have always helped mankind with their ability to ease out our work. Here also, latest technology designed by scientists has found way to destroy the fat cells.

As per definition also, physiotherapy not only relies on manual therapies or exercise, it also takes help of electrical modalities like ultrasound, micro currents, cryotherapy, short wave diathermy etc. Following the same principle, a new specialization is looking for role of physiotherapists in its growth. Non surgical options are fast emerging in the field of weight management and body contouring. These include high intensity ultrasound waves, cryotherapy, radio frequency, low intensity lasers, muscle stimulators, heat therapy etc.  Since electrotherapy is a core subject of physiotherapy curriculum and is not as widely taught under any other specialty, it is imperative that physiotherapists take up the desired role in understanding the functioning of these latest procedures concerning weight loss and inch loss.

The principle behind ultrasonic cavitation or cryolipolysis is same as in the therapeutic ultrasound and cryotherapy. Owing to difference in frequency and wavelengths the application and usage is different in both fields. Non surgical options are very wide these days. Ultrasonic cavitation, laser, cryolipolysis and far infra red therapy are among the best technologies available in leading weight loss clinics. Celebrities have popularized them very much when they step out unbelievably thin for a particular role. They turn to these cosmetic procedures only to get quick results. Many experts of the field talk about their benefits. They should be used as an addition to exercise and healthy eating habits. The scientific basis behind these technologies is that they help convert complex fatty acids into simple molecules which are further easily utilized by the body for its energy needs. Ultrasonic cavitation technology uses sound waves to generate micro bubbles in the fat tissue of targeted area. When these micro bubbles collapse they create an abrupt pressure change that dissolves the fat cells in the local area. The dissolved fat get to the liver through lymphatic system, the liver decomposes them and the byproducts leave the body with urine.

Fat cells are more susceptible to cold injury as compared to the surrounding tissue (skin, muscles, blood vessels). The exact mechanism is yet to be understood though fat cells undergo cell necrosis and the dead tissue is eaten up by phagocytes resulting in a visible and measurable fat reduction at the treated area. Many non invasive procedures are invading market and customers who are looking up to shape up their problematic fat areas are choosing them more frequently over surgical option. The role of these procedures is to reduce the volume of fat and provide long lasting results in well maintained body.

The process of cryolipolysis involves applying probe on the target area which has vacuum suction function attached to it and controlled low temperature is achieved. The suction creates reduction of blood flow in the target area and induces crystallization of fat cells. The non freezing layer applied over skin prevents any injury to the dermis and epidermis. Studies have shown detailed analysis of the fat tissue exposed to cold injury; it undergoes cell edema, reduced Na-K-ATPase activity, and reduced adenosine phosphate, increased lactic acid levels and mitochondrial free radical release.

An inflammatory process started by the apoptosis of adipocytes as reflected by an influx of inflammatory cells can be seen 3 days after treatment and peaks around 2 weeks. At 14-30 days after treatment phagocytes and macrophages engulf and digest lipid cells. Four weeks after treatment inflammation lessens and adipocyte volume is decreased. By 2-3 months time inflammation is further subsided and visible reduction in shape is seen.

With the evolving market, weight loss industry is emerging across all tier cities and is not just limited to metros. As the mushrooming of weight loss clinics is on the spree, it is of concern that proper guidelines and supervision be ensured in this field as well which is currently lacking any standard operating guidelines. Physiotherapists have a role to fulfill here owing to their knowledge and command over electrotherapy. They should lead the role by supervising that these advanced non surgical electro technologies are used properly within safety parameters ruling out any contraindications on the treating individual.

Since there is lack of literature on the efficacy of such procedures, research needs to be done by practitioners in the concerning clinical settings. Patient safety will be enhanced if handling of these machines will be given under properly trained physiotherapists and not just any cosmetic field trained person as these machines involve human body and may impact vital organs if not handled properly. Content development should also be encouraged on this topic. Short term courses or seminars on the subject by experts are needed to imbibe confidence among latest crop of physiotherapists so that they can take up leadership roles in this field without hesitation. Regulating state councils and professional authorities should also aim toward research development on managing obesity, developing recommendations and guidelines for line of treatment in different types of obesity. Physiotherapists have a bright future in this upcoming field and it should be recognized well soon.

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