Let_s take for example the patient with lumbar injury. He/she may have a lifting restriction of twenty pounds. Yet the patient is now 40-60 pounds overweight and continuing to gain weight.
If you look at the patient_s developmental history, you occasionally find that s/he played some sport while in high school. However, more often, s/he has led a largely sedentary life with hobbies such as fishing.
These are not individuals who went to a gym or jogged or even regularly took walks. They had a daily schedule in which they worked, came home and watched TV. And they ate.
After injury, you simply take from that schedule the necessity to work. Now they are arising late, napping during the day, and they are continually snacking (a phenomenon I equate to grazing in which there are not nutritional goals, merely the use of unhealthy foodstuffs as a new _recreational_ past time).
The patients are quick to point out that there is no work suitable for the educational and training background, now that they have this 20 pound lifting restriction. However, they fail to register that they are continually making orthopedic demands upon themselves by their morbid obesity.
Food intake has become an increasing means of pleasure seeking during the course of an oppressive injury, failing to realize/accept that the increase in weight is actively thwarting improvements in their health.
There are two options available to those treating patients:
a. Be certain that the patient fully understands and is willing to participate in their own recovery process including increase in allowable exercise and improvements/restrictions in food intake, or
b. Everyone accept that the limitations upon recovery are being imposed by the patient_s refusal to completely participate in the rehabilitative process