Fear of Falling in obese adults: Developing interventions to promote activity

Obesity is a major public health problem, in the UK and globally, affecting physical, psychological and social wellbeing; currently 25% of the adult UK population are obese and the indirect costs are likely to be £27 billion nationally (1). Obese adults have lower levels of physical activity than the general population (2). Increased physical activity can promote weight loss in those who are obese, when combined with dietary lifestyle changes, and higher levels of physical activity in obese adults is associated with lower mortality and morbidity (3). However, behavioural change approaches to promote activity have had limited impact and there is a need to further understand solutions to barriers to activity in order to develop feasible, relevant and acceptable novel interventions (4). Studies have shown that obese adults have more musculoskeletal pain, falls and balance issues than those without weight problems and suffer from low mood (5,6,7). These concerns are also seen in the elderly with ‘fear of falling’ (FOF), a phenomenon which encompasses lack of confidence in undertaking activities and activity avoidance because of concerns about falling and its consequences (8). In the elderly, FOF can result in worse mobility, increased dependence and worse quality of life and is not restricted to those who have fallen and FOF is more common in those who are morbidly obese (BMI>40kg/m2) (9-12). FOF is also present in adults with conditions which can affect balance, e.g., stroke, Parkinson’s disease, and in those with chronic pain, e.g., fibromyalgia or musculoskeletal pain: there is evidence in these groups that ‘fear of falling’ is associated with activity restrictions (13-17).

Obesity is common and leads to serious health problems. Physical activity is important to help weight loss and improve health, but is low in obese adults. We need to understand why so that we can find ways to help people overcome any barriers to increasing their activity. In older people, a fear about falling can stop them being mobile and independent. We have shown that this fear is also present in obese younger adults and related to low physical activity; a novel finding, but, compared to older people, they are less about losing independence and more about being embarrassed. In this research, we want to dig deeper into what obese young and middle-aged adults think triggers these concerns in everyday life, how it affects what they feel they can do to keep active and what they think could be done to overcome these concerns. We will do this through interviews and diaries of people attending weight management services. We will also look carefully at the literature at what has been tried to help older people with this problem, and whether it helped. By matching this up with what people say in our research, we can see if such strategies might be appropriate for younger people who are obese. This will help us think through the various ways we might be able to help. We will then discuss the findings of the research with those who run or are responsible for weight management and leisure services. By doing this work, we hope to develop new ways of helping people keep active that are acceptable, sustainable and will not cost too much. These new ways will then be tested in future research projects to see if they really can help more people become more active, using robust ways of measuring activity.