It's time to talk about mobility disability and overweight: Quality of life and need of preventive measures from the perspective of people with mobility disability and public health nurses

Abstract
Overweight and obesity are more common among adult people with mobility disability (MD). Epidemiological studies are sparse in Sweden when it comes to the prevalence of MD and weight, differences between people with MD compared to those without MD, as well as the association to HRQoL. In addition, general guidelines in obesity prevention and treatment adapted to people with MD are lacking in Sweden. This thesis comprises two quantitative (I, II) and two qualitative (III, IV) studies.

The aim of Study I and Study II was to investigate the prevalence of mobility disability, overweight or obesity and the association to HRQoL and participation in society in two different populations in Sweden. The aim of Study III was to explore the experience of healthy weight among people with mobility disability and the aim of Study IV was to develop a theory which could explain how public health nurses adapt guidelines to decrease overweight and obesity in people with mobility disability.

The results from Study I and Study II showed that people with mobility disability had higher prevalence of overweight and obesity in comparison to people without mobility disability. Despite this, Study II showed that the BMI did not increase more in people with mobility disability in comparison to those without mobility disability.The overweight or obesity has no higher association to low HRQoL or participation in society among people with mobility disability in terms of “a double burden”. In addition, Study II showed that people with mobility disability had lower HRQoL and partcipated in society to a lesser extent than people without mobility disability. The results from Study III revealed that people with mobility disability experienced problems with maintaining or regaining a healthy weight. They experienced a vicious circle where overweight/obesity excercerbated both the mobility disability and the pain. This led to difficulties in being physical active, which in turn resulted in difficulties in maintaining or regaining a healthy weight. They said also that it was difficult to receive good advice from the health care professionals because of lack of competence. The results from Study IV revealed that the public health nurses hesitate to initiate a conversation about overweight or obestiy independently of whether the people in front of them have mobility disability or not. They experienced that initiating a conversation with people with overweight or obesity was a sensitive issue but could be facilitated if they worked in teams at the health centres and had more time and resources.

Despite the fact that people with mobility disability are overweight and obese to a greater extent than people without and have lower HRQoL and participate in society to a lesser extent, they are not a prioritized group with regard to health prevention. People with mobility disability experienced that health professionals at health centres do not raise the question of health prevention; or if they do, they do not understand their patient’s situation. Public health nurses confirm that they do not raise the subject of overweight and obesity independetly of whether the patient has mobility disabiliy or not, because of its being so sensitive topic. Both people with mobility disability and public health nurses revealed that overweight and obesity prevention is not highly prioritized, and teamwork is suggested as a means to foster better lifestyle to decrease overweight and obesity.