Fysioterapeuten 9-2017

38 FYSIOTERAPEUTEN 9/17 Abstract n In this article, we draw on Barbara Gibson’s critical physiotherapy ethics to argue for changes in how physiotherapists approach children and adolescents with obesity. In line with Gibson’s approach, we seek to reframe practice by applying an ethics com- mitted to openness and doubt, arguing that such an ethics can help physiotherapists discover and analyse ethical moments in the context of lifestyle programs targeting children and adolescents with obesity. Drawing on the experiences of an adolescent participant and a physiotherapist involved in two different Norwegian group-based programs emphasizing weight control, we show how Gibson’s post-critical ethics can help physiotherapists become more reflective, challenge established norms, and open up new possibilities for practice. In our conclusion, we emphasize the ability of critical physiotherapy ethics to raise questions about the status quo, stimulate de- bate, and encourage fresh thinking with regards to children and adolescents seeking to tackle their obesity. n Key-words : critical physiotherapy ethics, obesity, children, adolescents. Karen Synne Groven , Postdoc, Institute of Health and Society, Uni- versity of Oslo; Associate professor, Institute of Physiotherapi, Oslo and Akershus University Col- lege of Applied Sciences. k.s.groven@medisin. uio.no. Tone Dahl-Michelsen , Associate professor, Institute of Physiotherapy, Oslo and Akers- hus University College of Applied Sciences. This scientific article is peer reviewed by Fysioterapeuten’s guidelines, and was ac- cepted September 11th, 2017. No conflicts of interest stated. Groven is co-editor of the open-access anthology: Gib- son, Nicholls, Setchell & Groven (in press). Manipulating practices: a Critical physiothe- rapy reader, Cappelen Damm Akademisk. fag Introduction Obesity has become a topic of concern in medical literature and the media, with dis- cussion of it tending to focus on morbidity risks, psychosocial consequences, and the impact of obesity on quality of life (1–4). Considerable effort has been invested in de- veloping effective treatment programs (5– 7), many of them infused by a biomedical perspective in which obesity is seen first and foremost as an imbalance between calorie intake and output. Such programs typically emphasize lifestyle changes (8), with dietary and activity interventions identified as the best means to achieve the desired result (9): reducing patients’ BMI. There is there- fore both a preventive and a curative aspect to such interventions: they seek to prevent future health problems and diseases (inclu- ding morbid obesity) while at the same time curing participants’ obesity. In the case of children and adolescents, however, reducti- on of BMI represents only one dimension of what one might call their ‘obesity struggle’. This comprises various health-related pro- blems, including low self-esteem, psycholo- gical and emotional problems, anxiety, de- pression, and eating disorders (10–11). Physiotherapists and other health profes- sionals working with children and young people must ensure adherence to basic et- hical principles, including respect for au- tonomy, beneficence, non-malience and Critical Physiotherapy Ethics: Openness and doubt in physiotherapy encounters in lifestyle programs for children and adolescents with obesity SCIENTIFIC ARTICLE