Cross-cultural aspect

Approximately one-third of the global population is currently suffering from overweight or obesity (www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). In a medical sense, scientific studies confirm that excessive body weight is one of the most serious health threats worldwide, constituting a significant risk factor for non-communicable diseases such as type 2 diabetes, hypertension, cardiovascular diseases, and certain types of cancers. The obesity epidemic is a global issue affecting both children and adults.

When examining obesity from a cross-cultural perspective, the situation is not as straightforward in considering it a disease. Research indicates that in poor regions where access to food is challenging, overweight is seen as a sign of prosperity, wealth, health, and fertility. There are also areas where food is currently abundant, such as in China, where obesity is historically rooted in prosperity, and individuals with excess weight exhibit better mental well-being and are better perceived socially.

A different pattern prevails in Europe and North America, where obesity is perceived as a health problem, and preference is often given to individuals with a slender physique. Patients with obesity face stigmatization not only from society but also from healthcare workers due to their weight. Negative attitudes towards obesity have been documented among medical and physiotherapy students, active physiotherapists (Elboim-Gabyzon · 2020), and doctors (Huizinga 2009).

Patients emphasize the negative attitude of physiotherapists towards them, as therapists often emphasize body weight, especially when applying techniques to exposed body parts. As a result, individuals with obesity typically avoid healthcare systems, receive less preventive care, and obtain less health education. It is important not to use stigmatizing language such as “obese,” “fat,” “chubby,” and many other stigmatizing words used in various parts of the world when discussing with patients with excess body weight.

Current research results suggest using terminology like “weight,” “increased weight,” or “unhealthy weight” in conversations. However, it should be noted that there is no single terminology that would be the best, and physiotherapists must consider the patient’s background, gender, social status, financial status, and many other factors. It seems reasonable to inquire about the language preferences of patients, especially younger individuals – teenagers.

Therefore, clinical physiotherapists must develop their own ways of communicating with obese patients to help them understand that obesity is a health issue to be addressed, not a failure. Building trust and good relationships between physiotherapists and patients with excess body weight will allow for a discussion about weight without discouraging the patient from therapy. Based on their experience, the therapist must assess the appropriate moment to initiate a conversation about increased body weight, and it is often not during the first visit but in subsequent sessions.

It is essential to pay special attention to the above aspects and maintain sensitivity in both health communication and therapy. The application of therapeutic techniques requires direct and close physical contact with the abdomen and chest area, for which the patient’s consent is necessary. Therefore, it is crucial to explain to the patient beforehand why palpation and the use of such techniques in the torso area are necessary to avoid unnecessary stress, frustration, reluctance to therapy, and ultimately its discontinuation.

Here is a summary of some practical suggestions for the physiotherapist to overcome communication barriers and ensure respectful physical contact during the assessment:

Before the examination:

–  Clearly explain the purpose of the breathing assessment and the areas that will require physical contact.

–   Offer the option to have a chaperone present during the examination, especially if the patient feels more comfortable.

–  Provide appropriate draping to ensure the patient feels covered and respected throughout the assessment.

If you are a male physiotherapist dealing with a female patient or client, consider offering a female colleague to perform the assessment if the patient expresses discomfort.

During the Examination:

–  Use respectful language and address the patient by their preferred title (e.g., Ms., Mrs.).

–  Always obtain verbal consent before any physical touch. Explain exactly where and how you will be making contact.

–  Use a gentle, non-invasive touch when assessing the chest and abdomen. Focus on essential areas only.

–  Offer the patient options for positioning that maintains comfort and privacy. For example, they might sit upright or lie down with a strategically placed sheet.

–  If explaining breathing techniques, utilize visual aids like diagrams or demonstrations instead of solely relying on hand placement.

–  Frame the discussion around positive outcomes and the potential benefits of physiotherapy for managing obesity.

–  Avoid using weight-stigmatizing language. Focus on neutral terms like “body composition” or “weight management goals.”

–  Encourage the patient to ask questions and actively participate in their treatment plan.

Cultural Considerations (Polish Context):

–  Polish culture generally values direct communication. Explain information clearly but remain sensitive to potential anxieties about weight.

–  Maintain a comfortable distance while still being close enough for effective communication. Be mindful of individual preferences.

–  Privacy and respect are valued in Polish culture. Ensure the examination area is private and minimize distractions.

By following these suggestions, the physiotherapist can create a safe and respectful environment for the patient. Remember, clear communication, informed consent, and sensitive touch are crucial for building trust and promoting successful therapeutic interactions.

1. What similarities have you noticed in your culture?

2. What differences have you noticed in your culture?

3. What should you pay attention to when caring for a patient with different cultural values?