OBESITY is a chronic, multifactorial disease associated with increased mortality and various non-communicable diseases (NCDs), including type 2 diabetes, cardiovascular disease, musculoskeletal disorders, and certain cancers. Effective treatment requires strategies that extend beyond the simplistic advice to “eat less, move more” by addressing behavioural, environmental, and healthcare system factors. Primary care, as the initial and continuous point of contact within health systems, is globally recognised as central to obesity management and NCD prevention.

Inclusive healthcare models for addressing obesity

An inclusive healthcare model integrates obesity care into primary care services, ensuring accessibility, continuity, and coordinated multidisciplinary support. Effective models demonstrate the following key features:

•Person-centred care that recognises individual contexts, barriers, and goals.

•Multidisciplinary teams comprising medical professionals, nutritionists, psychologists, exercise specialists, and physiotherapists.

•Structured lifestyle intervention programmes emphasising diet, physical activity, and behavioural change.

•System support including training, tools, and adequate provider reimbursement.

Notable examples include the Counterweight Programme (United Kingdom), where structured primary care training and implementation resulted in meaningful weight loss (≥ five per cent) at 12 months in one-third of participants, representing a significant outcome in community settings.

Systematic primary care interventions, encompassing 56 randomised trials, demonstrate that primary care-based programmes can significantly reduce body mass index and waist circumference, underscoring their effectiveness when adequately resourced.

The role of physiotherapy in primary care for obesity and NCDs

Physiotherapists possess unique qualifications to support obesity care across the continuum, from prevention to treatment and long-term maintenance, owing to their expertise in physical activity, movement sciences, behavioural change support, and functional restoration. Emerging research identifies physiotherapy as an essential component of multidisciplinary obesity management, particularly when combined with pharmacotherapies that reduce weight but risk muscle mass loss. Physiotherapists can prescribe, progress, and tailor physical activity and exercise to preserve lean mass, enhance physical function, and maintain metabolic health.

Within primary care models, physiotherapists contribute value in several key areas:

1) Assessment and risk stratification screening for functional limitations, movement barriers, pain, and cardiorespiratory risk factors.

2) Exercise prescription and supervised progression through individualised programmes that account for comorbidities and fitness levels.

3) Behavioural support and motivational interviewing to assist patients in adopting and sustaining integrated care plans involving collaboration with nutritionists, physicians, psychologists, physiotherapists, and community services to ensure coordinated goals.

4) Education and self-management support focused on teaching patients safe, enjoyable methods to remain active in daily life and to manage setbacks.

Physiotherapists bridge gaps between clinical guidance and real-world physical activity behaviour, a central component of obesity and NCD care.

To effectively operationalise physiotherapy in primary care for obesity and other NCDs, physiotherapists should adopt structured, guideline-aligned roles beginning with early engagement and routine screening. This approach facilitates timely conversations about prevention and risk reduction rather than deferring to specialist referrals. Physiotherapists also play a central role in delivering high-intensity lifestyle support, particularly by leading the exercise and physical activity components of coordinated obesity care programmes while collaborating with dietary and behavioural interventions through safe, tailored, and progressive plans that promote long-term adherence.

Physiotherapists also play a crucial role in collaborative care navigation, acting as connectors within multidisciplinary teams by facilitating referrals, contributing to shared care plans, and guiding patients through structured care pathways. Outcomes should extend beyond weight loss to include measurable improvements in mobility, strength, endurance, and balance, as well as behavioural markers such as adherence and self-efficacy, which strongly correlate with sustained reductions in NCD risk. This approach reinforces healthy behaviours at both individual and population levels.

Looking ahead

To address the obesity epidemic, health systems must expand primary care capacity, employ multidisciplinary teams, and prioritise inclusive, evidence-based models that integrate physiotherapy into obesity and NCD management. Physiotherapists contribute personalised exercise expertise, functional rehabilitation, and behavioural support, all of which enhance clinical outcomes and patient well-being.

Let’s advocate for and take action on inclusive care and promote policies that fund, train, and fully integrate multidisciplinary care into primary care for obesity and related chronic diseases in Jamaica.

Offniel Lamont is a sports medicine, exercise and health specialist, physiotherapist and public health youth advocate with the Jamaica Physiotherapy Association (JPA). E-mail contact@jpajm.org.