POSITION STATEMENT

Occupational Therapy in Obesity in Childhood

and Adolescence
Statement of position being taken
Enhancing health and wellbeing through engagement in occupations, whatever the weight of the child
or adolescent is the focus of occupational therapy interventions.
Obesity prevention: Occupational therapists work with individuals, families and/or communities to
target modifiable risk factors associated with the development of obesity. For example, occupational
therapists can facilitate the development of dietary, physical activity, and play activities enhancing
occupational habits and routines 1,2.
Obesity treatment: Occupational therapy is an essential part of a multidisciplinary approach to
evidence based treatment options for obesity. This includes family-based multi-component and
lifestyle weight management/maintenance services for children and adolescents3. Occupational
therapy is also part of the team who focus on lifestyle approaches for pre- and post- surgical
interventions for the treatment of obesity. This includes access to peer networks and enabling children,
adolescents and families to plan for the future.

Statement of the significance of position or issue to occupational therapy

Occupational therapists enable participation in occupations that promote health and well-being
including physical activity, healthy eating and sleep; focusing on occupations across the lifespan
including preconception and pregnancy care as recommended by the World Health Organization
(WHO)5. In addition, occupational therapists have the capacity to foster self-determination and self-
advocacy skills that will enable making healthy choices4.
Occupational therapists focus on promoting occupational outcomes that are meaningful for children
and adolescents and enhance motivation for sustainable health behaviour changes that may or may
not include weight loss.
Occupational therapists address issues that reflect the broad social determinants of health for groups
and communities. Occupational therapists advocate for, and make changes within, the social and built
environment to promote access to nutrient rich foods, safe spaces for play, and active recreation for
children and adolescents of all abilities. We also acknowledge the need for culturally tailored
interventions.

Occupational Therapy in Obesity in Childhood and Adolescence [2019] 1|5

Statement of the significance of the position to the community or society
Obesity is associated with restricted participation in life events important in childhood and
adolescence including those associated with physical, psychosocial and vocational development. The
perspectives of occupational therapists on the interaction between the person, environment and
occupation to promote health and wellbeing are established practice. This trained workforce could be
readily utilised to promote an occupational perspective at a societal level, alongside provision of
individualised interventions for families. Occupational therapists have an important contribution to
make to public health messaging that is focused on health and well-being associated with prevention,
treatment, and minimisation of the impact of obesity on children’s and adolescents’ lives.
Occupational therapists are also effective advocates to reduce weight bias and stigma associated with
obesity and to promote access to services and resources designed to meet the needs of people with
obesity5.

Summary and conclusion

Occupational therapy services and interventions are important considerations for the prevention,
treatment and management of obesity in children and adolescents. The comprehensive approaches
used address elements of body functions and structures, activity limitations, personal and
environmental factors associated with obesity that impact participation in life roles.

References
1. Canadian Association of Occupational Therapists (CAOT). (2015). CAOT Position Statement:
Obesity and healthy occupation. Available from:
https://www.caot.ca/document/…%Healthy%20Occupation.pdf. [Accessed 20th July 2019].
2. Clark F, Reingold F S, Salles-Jordan K. Obesity and occupational therapy (Position paper).
American Journal of Occupational Therapy. 2007; 61(6): 701-703.
3. World Health Organization. (2016). Report on the commission on ending childhood obesity.
Available from:
http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1 [Accessed
20th July 2019].
4. Stewart D, Freeman M, Law M, Healy H, Burke-Gaffney J, Forhan M, Guenther S. The transition
to adulthood for youth with disabilities: Evidence from the literature. The State University of New
York: Center for International Rehabilitation Research Information and Exchange; 2010.
5. Forhan M, Ramos Salas X. Inequities in healthcare: A review of bias and discrimination in obesity
treatment. Canadian Journal of Diabetes. 2013; 37:205-209.

Contributors (listed in alphabetical order)

Yolanda Suarez-Balcazar (United States of America)
Ma Concepcion Cabatan (Philippines)
Karina Dancza (United Kingdom)
Mary Forhan (Canada)
Trish Tucker (Canada)
Jenny Ziviani (Australia)

Please refer below to the “Supporting Document on Occupational Therapy in Obesity in Childhood
and Adolescence” for more detailed information.

Occupational Therapy in Obesity in Childhood and Adolescence [2019] 2|5

SUPPORTING DOCUMENT

Role of occupational therapy in obesity in childhood and adolescence

Introduction to the purpose of this Statement
The purpose of this Statement is to describe the World Federation of Occupational Therapists’ (WFOT)
position regarding occupational therapy’s role in the prevention, treatment and minimisation of the
impact of obesity on the daily lives of children and adolescents. Occupational therapists are concerned
with how people engage in meaningful everyday life occupations, and how this influences their health
and wellbeing. Occupations are more than just paid employment; it is everything people do, such as
eating a meal, getting ready to go out, going to school or socialising with friends. Occupational
therapists work with individuals, communities and organisations when everyday life roles and
associated occupations are impacted (or have the potential to be impacted) or at risk by disability,
illness, life circumstances or changes experienced with ageing.
According to the World Health Organization (WHO) 1, worldwide obesity has nearly tripled since 1975.
In 2016, 41 million children under the age of 5 and over 340 million children and adolescents aged 5-
19 had a weight-for-height classified as overweight or obese1. The WHO definitions of overweight and
obesity for children and adolescents are as follows:

•Overweight: Weight-for-height greater than 2 standard deviations

above WHO Child Growth Standards median
Under 5 years
•Obesity: Weight-for-height greater than 3 standard deviations
above the WHO Child Growth Standards median

•Overweight: BMI-for-age greater than 1 standard deviation above

the WHO Growth Reference median
5 - 19 years
•Obesity: Greater than 2 standard deviations above the WHO
Growth Reference median

Figure 1. Definition of overweight and obesity1

Occupational therapy focuses on facilitating meaningful, active and engaging occupations for children
and adolescents such as play, studying, and self-care. The WFOT believe that children and adolescents
at risk for developing obesity or those living with obesity should have access to occupational therapy
approaches that can prevent, treat, and minimise the impact of obesity on daily life and on adulthood.

Statement of the position being taken

Contributing to the prevention of obesity in children and adolescents, occupational therapists work
with individual families and/or communities to target modifiable risk factors associated with the
development of obesity. For example, occupational therapists can facilitate the development of
dietary, physical activity, and play activities enhancing occupational habits and routines through goal
setting; grading activity; health promotion and group work2-4. Enhancing health and wellbeing
through engagement in occupations, whatever the weight of the child or adolescent is the focus of
occupational therapy interventions.

Occupational Therapy in Obesity in Childhood and Adolescence [2019] 3|5

Occupational therapy is an essential part of a multidisciplinary approach to evidence based treatment
options for obesity. This includes family-based multi-component and lifestyle weight
management/maintenance services for children and adolescents5. Occupational therapy is also part of
the team who focus on lifestyle approaches for pre- and post- surgical interventions for the treatment
of obesity. This includes access to peer networks and enabling children, adolescents and families to
plan for the future. We also recognise that children who have obesity are not necessarily referred to
occupational therapy services, yet occupational therapists see children who have obesity for other
issues relating to their engagement in occupations.

Statement of the significance of position or issue to occupational therapy

Occupational therapists have the skills and knowledge to promote participation in occupations that
promote health and well-being including physical activity, healthy eating and sleep; focusing on
occupations across the lifespan including preconception and pregnancy care as recommended by
WHO5. In addition, occupational therapists have the capacity to foster self-determination and self-
advocacy skills that will enable making healthy choices6.
Occupational therapists understand that the focus solely on losing weight can feel disempowering with
choice narrowed and goals prescribed. Our perspective shifts this focus to promoting occupational
outcomes that are meaningful for children and adolescents and enhance motivation for sustainable
health behaviour changes.
Occupational therapists can also address issues that reflect the wider social determinants of health for
groups and communities. For example, occupational therapists can advocate for, and make changes
within, the social and built environment to promote access to nutrient rich foods, safe spaces for play,
and active recreation for children and adolescents of all abilities. Current evidence indicates that
children in urban environments and from ethnically and racially diverse backgrounds, those living in
poverty, and children and adolescents with disabilities are more likely to experience obesity related
complications and barriers to healthy lifestyles 7-9. We also acknowledge the need for culturally tailored
interventions10, 11.

Statement of the significance of the position to society when appropriate

Obesity is associated with restricted participation in life events important in childhood and
adolescence including those associated with physical, psychosocial and vocational development. The
perspectives of occupational therapists on the interaction between the person, environment and
occupation to promote health and well-being are established practice. This trained workforce could
be readily utilised to promote an occupational perspective at a societal level, alongside provision of
individualised interventions for families. Occupational therapists have an important contribution to
make to public health messaging that is focused on health and well-being associated with prevention,
treatment, and minimisation of the impact of obesity on children’s and adolescents’ lives.
Occupational therapists are also effective advocates to reduce weight bias and stigma associated with
obesity and to promote access to services and resources designed to meet the needs of people with
obesity12.

Conclusion
Occupational therapy services and interventions are important considerations for the prevention,
treatment and management of obesity in children and adolescents. The comprehensive approaches
used address elements of body functions and structures, activity limitations, personal and
environmental factors associated with obesity that impact participation in life roles.

Occupational Therapy in Obesity in Childhood and Adolescence [2019] 4|5

References
1. World Health Organization. (2017). Obesity and overweight factsheet. Available from:
http://www.who.int/mediacentre/factsheets/fs311/en/ [Accessed 20th July 2019].
2. Canadian Association of Occupational Therapists (CAOT). (2015). CAOT Position Statement:
Obesity and healthy occupation. Available from:
https://www.caot.ca/document/…%Healthy%20Occupation.pdf. [Accessed 20th July 2019].
3. Clark F, Reingold F S, Salles-Jordan K. Obesity and occupational therapy (Position paper).
American Journal of Occupational Therapy. 2007; 61(6): 701-703.
4. Pizzi MA. Obesity, health and quality of life: A conversation to further the vision in occupational
therapy. Occupational Therapy in Health Care. 2013; 27(2): 78-83.
5. World Health Organization. (2016). Report on the commission on ending childhood obesity.
Available from:
http://apps.who.int/iris/bitstream/10665/204176/1/9789241510066_eng.pdf?ua=1 [Accessed
20th July 2019].
6. Stewart D, Freeman M, Law M, Healy H, Burke-Gaffney J, Forhan M, Guenther S. The transition
to adulthood for youth with disabilities: Evidence from the literature. The State University of New
York: Center for International Rehabilitation Research Information and Exchange; 2010.
7. Cahill S. & Suarez-Balcazar Y. Promoting children’s nutrition and fitness in the urban context.
American Journal of Occupational Therapy. 2009; 63: 113-116.
8. Pizzi M, Vroman K, Lau C, Gill S, Bazyk S, Suarez-Balcazar Y, Orloff S. (2014).Occupational therapy
and the childhood obesity epidemic: Research, theory and practice, Journal of Occupational
Therapy, Schools, & Early Intervention. 2014.
9. Anderson L, Ball G, Birken CS, Buchholz A, Carsley S, et al. (2017). The Team to Address Bariatric
Care in Canadian Children (Team ABC3): Team Grant Research Proposal. BMC Research Notes.
Available from DOI 10.1186/s13104-017-2506-z
10. Suarez-Balcazar Y, Hoisington M, Orozco A, Arias D, Garcia C, Smith K, & Bonner B. Benefits of
a culturally tailored health promotion program for latino youth with disabilities and their families.
American Journal of Occupational Therapy. 2016; 70(5).
11. Suarez-Balcazar Y, Friesema J & Lukyanova, V. Culturally competent interventions to address
obesity among African American and Latino children and youth. Occupational Therapy in Health
Care. 2013. Available from DOI: 10.3109/07380577.2013.785644
12. Forhan M, Ramos Salas X. Inequities in healthcare: A review of bias and discrimination in
obesity treatment. Canadian Journal of Diabetes. 2013; 37:205-209.

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