Managing Lymphoedema in Every Body

In this episode of Lymphoedema Insights, Maree is joined by Nadia Walton to explore the realities of managing lymphoedema in people living in larger bodies. This thoughtful and practical conversation moves beyond assumptions to address what truly matters in clinic: building trust, adapting assessment techniques, navigating compression challenges, and creating sustainable, realistic management plans. Together, they discuss size-inclusive language, clinician bias, manual handling considerations, compression decision-making, exercise “snacking,” and how to set patients up for long-term success without overwhelm. Whether you’re early in your career or highly experienced, this episode offers practical strategies and reflective insights to strengthen your confidence, clinical reasoning, and patient engagement when working in this often complex space. 

About our guest speaker - Nadia Walton 

Nadia Walton is a leading Melbourne physiotherapist specialising in size-inclusive care. With over a decade of experience in public and private healthcare, she empowers people living in larger bodies to move with confidence, strength, and joy. Nadia’s work blends evidence-based physiotherapy, lymphoedema management, and personalised movement programs to improve pain, mobility, and overall well-being, without judgement. 

As founder of Laneways in Fitzroy North, Melbourne Nadia champions inclusive healthcare, guiding individuals and organisations to create environments that respect and support all body sizes. She also works at a community health lymphoedema clinic, diagnosing and managing complex lymphoedema and lipoedema. Nadia is passionate about dismantling weight stigma and building sustainable movement habits that fit each person’s life. 

Sponsor

This episode of Lymphoedema Insights is proudly supported by Haddenham Healthcare, a family-owned, UK-based medical device company with a global outlook. They specialise in compression therapy for lymphoedema, designing products that integrate into patients’ daily lives. They support therapists working with clients of all body shapes and sizes, offering flexible solutions including wide-sizing options and custom garments. Made-to-order and custom flat-knit garments can include features such as grip tap openings, making therapy easier to manage for clients living with larger bodies. They innovate with purpose and partner long-term to ensure every patient is supported. 

Learn more at www.hadhealth.com.au  

Stay connected with Lymphoedema Education Solutions (LES) 

LES offers a diverse range of professional learning opportunities – including online self-paced courses, face-to-face workshops, and accredited training modules – to help you build confidence in your lymphoedema management skills. 

🌐 Visit the LES website to explore upcoming course dates and learn more: https://lymphoedemaedu.com/ 

👉 Subscribe to the LES monthly newsletter for updates, resources, and course announcements: https://lymphoedemaeducation.us10.list-manage.com/subscribe?u=21477ad0021cc388b9c1d508b&id=65df668025 

Transcript

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SPEAKER_00 0:06

Today, we're talking about managing lymphedema in everybody. This episode is all about supporting clinicians to better manage lymphedema and clients living in larger bodies with a strong focus on practical, evidence-informed care. We'll be talking through adapted assessment techniques, compression and management strategies, and ways to optimise outcomes using a holistic, client-centred approach. Welcome to Lymphedema Insights for Health Professionals. I'm Marie O'Connor, physiotherapist at Lymphedema Education Solutions, where we empower health professionals with the tools and knowledge to manage lymphedema confidently and effectively. This podcast is for educational purposes and is intended for health professionals only. It does not replace individual clinical judgment or medical advice. So please consult appropriate guidelines and qualify professionals when making decisions in practice. This episode of Lymphedema Insights is proudly supported by Haddenham Healthcare. To help us explore this very important and often challenging topic, I'm joined by Nadia Walton, one of Melbourne's leading physiotherapists specialising in size-inclusive care. She is experienced across public and private health care and currently works both in her own private practice in Carlton North and in a large community health lymphedema clinic in Melbourne, diagnosing and managing complex lymphedema and lipodema. Welcome, Nadia.

SPEAKER_01 1:37

Thank you. It's lovely to be here.

SPEAKER_00 1:40

So, Nadia, what unique challenges and risks do people in bigger bodies face when it comes to lymphedema?

SPEAKER_01 1:49

So I think primarily this is about when the person arrives in your office, they have already had a long relationship with their body and a long relationship with healthcare providers who invariably they tell you, and you know, it's incredibly common that they've had a lot of experience of internal stigma and also stigma sort of pushed on them that the reason they have the condition they have is because they're fat, and that's the way it is. And unless they lose weight, there's nothing we can do. And so you often are needing to pull that back to give them some belief and some hope that you're on their side, and belief and hope that even if we aren't able to affect weight change, we're going to be able to improve the lymphedema or sort of impact that in a positive way. And so one of the things I think if you're identifying that, you know, the person walks in the door as a big person, there's a lot already in the room. There's a lot of history already in the room.

SPEAKER_00 2:54

So sometimes do you need to sort of back off a little bit and allow them that time? Do you know what I mean? What do you think their expectations are when they're walking in the room?

SPEAKER_01 3:05

Yeah, I think a good skilled clinician is able to identify where this person uh living a larger body sits on a spectrum of um are they someone who has been trying to lose weight their entire life and they're very tired and feel very disappointed in uh their body weight? Or are they someone who is actually really body positive and very happy to uh to be to live in the body body size that they're at, but they'd like their health needs addressed. And part of it isn't is not making that assumption uh that that you have an opinion on their body weight. I see that we're a healthcare provider and we actually need to address the patient, the patient's needs. And uh it's not about shying away from discussing weight, it's about building the relationship and building trust and and then seeing where we can uh everyone needs to be healthier and we can be healthier and more active and have better um you know limb volume from a lymphedema point of view, um, and and be part of that journey without the shame and the guilt. And and as a healthcare provider, we want to be on the patient's side, not not feel that we're the police.

SPEAKER_00 4:27

And I can imagine that they would be coming in with that already, their radars out to feel is this person going to be on my side or not? And as practitioners, we come with our own beliefs anyway, don't we? And that's a that's a challenge, I think, when we have people with probably not well, one, I suppose maybe larger bodies, because we think, oh, that's gonna really impact it, but even that severe edema, you already think, well, hang on, how did we get to this point? You know what I mean? So, you know, I mean, how are we gonna be able to move forward? Because I think I'm sure, and I'm not the only one that will say this, you have that sort of, oh, you know, is this person going to be committed? Do you know what I mean? I think they're sort of the belief that we just got to be careful that we stay on that fence, don't we?

SPEAKER_01 5:10

Yes, and and making sure that what is what is utmost is that the patient walks out the door feeling like you're an ally. It means they'll come back, but it means they'll also uh you've got more chance of getting them to engage in in, you know, essentially lymphedema care is is is hard, it's expensive, it takes time, you need to commit, commit to, you know, a long-term plan. So we we actually want them to think um that you are are with them, not that you're going to keep telling, you know, telling them. They've had many other healthcare professionals already tell them how they should be or what they should be. That I I can I can, I mean, I've been doing this for a long time, and I don't think I've ever had a patient once we've built a connection and we've drilled down, that they don't have a sad story about a healthcare provider telling them that their toe infection or their, you know, migraines will be better if they lose weight. And and that is is something that if you've lived in a smaller body, you you don't start the consultation there. You've never experienced that.

SPEAKER_00 6:16

Yeah, really, that's a that's a tricky one. So if we sort of continue with this assessment, because that is a key for our first step, we really do need to get that right. What do you think are some of the challenges clinicians face when assessing lymphedema, just even from a practical point of view with techniques with people with larger bodies?

SPEAKER_01 6:37

Yeah, I think there's a dignity element that again it's about this building the relationship. But say for legs, we often want someone to strip down and then we poke and we prod and we look. And we do that all day, every day. But so we become very quick at kind of we feel like that's normal, but for the patient that can be very confronting. So often just slowing down, having the conversation, putting the towel over the top that very quickly often gets whipped off, but actually giving them that sense that this is a bit special and you know we're we're we're going to be kind of invading your space and we're going to be poking and putting things that maybe you don't feel good about. The other thing is obviously the therapist manual handling. So, particularly for our sort of more acute patients or our home-based patients who don't walk into the into our services, that should be a red flag that you are you you're you're at risk because we don't have standardized beds at home or standardized chairs, and we definitely don't have things that electronically lift up and down, and we might have those heavy arms and legs. And so, really being careful about um how you position yourself, and if it's not possible to do your standard measurements or your standard assessment because it puts you at risk, you it's actually not worth it, and so you have to sometimes do some proxy, non-ideal measurements. So, for example, I might have a patient who is in a wheelchair, who's who's coming in a power wheelchair but doesn't have any active leg uh leg movement. I might do my 10 centimetre circumferences in the wheelchair without a measuring board, doing the best I can, but it means that I don't have to lift these big legs, uh, let alone move them in onto a plinth. But I I don't think it's worth it often to lift the legs up onto something else. I think also the the other bit that so we do know that abdominal weight makes a big difference to uh lower limb swelling, and um there is a bit of a tendency I see to to just add uh sorry, as a basic, just take a weight measurement. You arrive, I put you on the scales, and then I start talking, you know, and then we do our consultation. That can be highly triggering and and I some I am pretty reluctant to weigh people, even though, you know, sometimes I do think, oh, I'd I'd really like to know what's happened to the weight because your circumferences have gone, uh have really changed. Is this an abdominal weight change as well? But I I'm very careful to think about whether that is actually beneficial for the patient. Um, and it's so it's a measure that I sometimes I'd like to take that I I don't take because I don't think it's worth it. So um there are a couple of the things that I think about when I have someone who presents who, particularly if their mobility or their emotional state I can pick up is they're already feeling it's going to be a challenge or the non-standard. I think about well, what information do I actually need and how can I do it in a way that keeps me safe, but also the patient psychologically safe.

SPEAKER_00 9:50

So do you look at sort of other type of measurements, I suppose? Um, I suppose one way would be if you have a lymph scanner, maybe you could look at it that way or something like that. But but also some of the questions you would get then. Do you know what I mean? Their quality of life. Because at the end of the day, you know, I mean, that's the that's what we want, isn't it?

SPEAKER_01 10:11

So yeah, absolutely.

SPEAKER_00 10:13

Yeah.

SPEAKER_01 10:13

So the lymph scanner is is brilliant, and and um that's a really nice thing. So is um, you know, your bees, um, although we have to put in a weight, and so we need to be able to be um have conversations around that, and obviously there's some weight limits for that um uh in a standing position, I think is around 170 um kilos, and I will definitely see people bigger than than that. So in you know, we can stand, I think, till about 230. Quality of life is really important, and so I yes, I use some sometimes I use a uh you know a formalized scale, but often it's actually just the skill of a of having the conversation about how does this impact you and making sure you have some nice notes on on what are the things you'd like to be able to do that you can't do right now and what worries you. Um, you know, it can be very technical, but it can also be those very basic.

SPEAKER_00 11:11

Do you ever use simple things like visual analog scales? Do I mean like, you know, if they say something and then you say, okay, from zero to ten or zero to five, how big a problem is this to get a sense of what's going on?

SPEAKER_01 11:23

Yeah, I think it's a really nice, a really nice um clear measure. I I think as a clinician, we always want quantitative and it makes us feel safe and makes it us feel like we're um doing improv, you know, making improvements when we can see a change.

SPEAKER_00 11:40

And I suppose our palpation's important too, documenting that. One of our tools obviously is photographs. How often would you use that though?

SPEAKER_01 11:49

Is that something so uh as soon as you said what, you know, I that's exactly right. I would be I photograph at almost every patient. We I would, yeah. Um, not always on the first appointment, because again, it's about building that trust. And one thing that can be really confronting, particularly, is if you ask someone to take their pants off and stand against a white wall, and then I'm gonna take a photo and then I'm gonna upload it into a system. And you know, yes, it's a clothed system. So, yes, um, particularly wounds and lympharea and th and you know, anything that's sort of um fairly medically unwell, yes, of course, every patient. Um, I suppose where I the measure that I would take most is circumference, and sometimes it would just be at that 10 and 20 measure. Um, I find that because I can do it in any position, I can have the person's leg um just sitting in the chair and I'm on my knees, um, and we don't have to undress if we can't, if if that's big, it's a if that's a big stepping stone. Um, but I suppose, yeah, the tape measure for me is probably the thing that I feel like um gives me as a clinician the quantitative measure that I I want. Um yeah.

SPEAKER_00 13:04

Because even in a sitting position, you could even just I know it's not completely reliable, but you could run a tape measure from the sole up and say, okay, at 30 centimetres or 50 centimetres, do it either side, maybe, and sort of get it there. It's it's better than nothing. And if you're looking at changes anyway, you're probably looking more than your 0.5, you know, of a of a centimetre. So I think that's going to give you some wins for them as well. When you think about all the the treatment side of things, so we're looking at obviously compression, skincare, exercise, etc. What are some practical and realistic strategies clinicians can use to tailor it?

SPEAKER_01 13:41

So obviously, our um anything that allows you to extend extend that arm reach for the legs is brilliant. So for our moisturizer applicators, our you know, um easier um applicators, I use those a lot. I also use a lot of bands and things that help people get to um their feet. Um in regards to exercise, often it's about allowing them to believe that a little bit of exercise is beneficial and it doesn't have to be. So there's this sense that exercise equals routine. It must be three or four times a week to be effective, that it has to be the same time, probably that you need to be, you know, up at 6 a.m. and need to love it, and that you'll get endorphins, and that, you know, and I I always think about the nutrigain ads, and that's the picture of what happy exercises are. They wear bikinis, they're up in the dark, it really hurts, you puff a lot, um, and it's got to be a lot. I see often that if we get people to do a little bit more walking in their hallway or when they're waiting for the kettle to do their little um heel raises, that we can see a lot of change. I run some online group exercise classes, small group exercise classes for just for people in larger bodies. And I have had patients that were housebound and they've come for two or three years, once a week for two, two to three years. I've got two women in mind that I'm thinking about who were now able to go back to work because they just have slowly over over two, one's two and one's three years, turned up once a week for 45 minutes of seated that's progressed to standing exercises. And so it's about it's it's it's way below what you know the world tells you good exercise transformation is. We we boot camp, it doesn't need to be a boot camp, it needs to be a steady commitment, and that can be a daily couple of minutes or it can be once a week. Um there's some good literature that came out that said weekend warriors that do the same. So if you did five hours of exercise on a Sunday versus one lot of five, one sorry, five times in the weekday, one hour, at the end of the effort or you know, the measured period, they get the same health outcomes. And so that having these conversations with with people, some of my people in larger bodies, and I just really want to highlight that some of my people in larger bodies are fit and active and strong and love exercise and love walking. Similarly, people in smaller bodies, and then I also see a group in larger bodies who exercise has never been part of their regime or their pleasure or their joy, just as well as that, you know, people in smaller bodies. Some people, it's a genetic disposition, it's got nothing actually to do with the body size. So I just really want to highlight that this is what we're talking about, is not saying that people in larger bodies don't like exercise. We're talking about that group that need the support to develop exercise routines. They may never love it, it may never be a true routine of Monday, Wednesday, Friday. It may be sporadic and we will still see improvement. And I talk about this with patients a lot. This, you don't, it doesn't have to be four times a week, one hour. It can be I did a I had a great week because the kids were away this week on camp. And so I, you know, busily did a bit for myself. But then I've had about, you know, I haven't had enough time the next few weeks. All of that is progress.

SPEAKER_00 17:27

They do talk about exercise snacking. Snacking is probably not the best word.

SPEAKER_01 17:30

Um I love the snacks. We love exercise snacks. I think it's a brilliant way to think about it. Yeah, and snacking for your body is a really good thing.

SPEAKER_00 17:39

That's true.

SPEAKER_01 17:40

Food, it's it's about how you snack.

SPEAKER_00 17:42

Well, that's right, exactly right. And I think you normalize that exercise as well, because we're all the same. Like I know lots of people that don't are not exercise freaks, so to speak, and don't want to do it. And we've set up, I think, a really negative side of things with all these guidelines. If you don't do this, you don't do that. So people say, Well, I can't do it, so I'm not gonna do anything. So I think it's a really important that, yeah, they're they're the same, really, which is really good. What about compression? What do you think about compression?

SPEAKER_01 18:10

Tricky, very tricky, and we would use those amazing uh, you know, um clinical consult consultants from all the other uh compression services. So um, yeah, sometimes you can have uh a set of big legs and you're thinking, wow, I'm you know, where do I start and how do I do that? And I think the trick is it is I'm very lucky I work in a big um public service that I get to knock on the door of the very experienced people next to me and say, what do you reckon? And we have it, we and we're all kind of um not sure, but we're giving it a go. And then we'll obviously um have a you know have a bit of a consult together who the with the people who are in my service, and then we'll also call the technicians and uh you know at the different um or the reps at the different companies. And the collaboration is the key because you're working in uncharted space, you're working in this, and and you're working in this space where you we're all giving it a go to see if it works and letting teaching the patient that um this is a work in progress. Uh, you know, that's very much your um saying, Marie, but I use that a lot, and the more we talk about that with the patients as well, that you know, we're just gonna give this a go, and you've got a tricky shaped leg. Um, and they know that they're really, they're really aware. The thing is, you're you're saying you have a tricky shaped leg, but it, you know, this is not about anything you could or should have done. There's no blame. We're healthcare professionals, we want to help you, and we're gonna work on this. This is not you're not, you're not it, you're not the challenge. This is just a tricky leg for us.

SPEAKER_00 19:56

Um yeah. Because sometimes I think you've got a good point there, that tricky leg, because regardless of the size of the person, we often have tricky legs. And I think if we bring it back to that context, that you know, I mean, this is a tricky leg, you know. I mean, that's the way it is, and we need to, like any others, we need to source out and we don't get it right always. But as you say, it's a work in progress. If we could get a win, do you know I mean? Because we don't want to make it so bad that they I think sometimes as new clinicians, we get to the end point, try to get to the end point, whereas we probably should have stopped along the journey. Do you know what I mean? And said, okay, we're gonna go this step, you know, so far this time, and then we'll look at it and then we'll, you know, sort it out. And people say, Oh yes, but won't that cost a lot of money if we don't, but it costs more money if you go the other way, don't you think? Yeah.

SPEAKER_01 20:50

Absolutely. And I think sometimes it's you know, I we always try with skincare and exercise first. And if a patient is we we start to buy in some wins that way, and we talk about um, you know, maybe the exercise isn't going to directly impact the lymphedema, the size, the circumference that I've measured around your ankle or your or your you know, up at your knee. But what I can see is wow, you moved, you came in here, you're moving so much better. How are you going getting in and out of bed? Oh, actually, it's a bit better because I've been, you know, I think because I've been doing all those um stands at the kettle. And then I say, Oh, okay, I really think your skin's looking so much better. You're starting to do some exercise and you're starting to do it without guilt and challenge, and you know, I can see you're you're feeling really good. There's this other concept around how we try to move the fluid out of your legs, or um, you know, how we try and keep it out. Here, here are the options. What do you think? And some people say, look, I want to try the pump first, or or you know, wraps are a great starting point. We're not quite ready for um getting into compression. But we know ideally I would like them in compression, but we I often find a route for success is a pump first. But I'm the whole way I'm priming them to tell them that this isn't gonna be enough. This isn't gonna be enough to keep you um, you know, not developing wounds again or you know, um, and and so it's about kind of stepping them forward one thing at a time, not overburdening their sense of how much time and money and effort this is gonna be, um, and also really priming them the whole way that this has got to be probably gonna be forever. And and that's okay because we're looking for the least amount of investment, time and money to get you forever. And and it is almost just setting up these same conversations, and every time you see them, you know, once a month as you start to sort of build and see their skin change, celebrating how well they do and being like, we are doing so well. You have, you know, you've put the hard yards in. Now there's another thing that we've got to add. And and it's the positive reinforcement. And then the patients, you see, and it's never once about their body size. It's about I want you to be the healthiest version of yourself. And that's not a proxy for weight, weight loss. That is the true proxy for getting in and out of bed, being able to feed yourself, have a shower, being able to get on public transport, God forbid, you know, all those things.

SPEAKER_00 23:36

Before we move on, I'd like to thank our episode sponsor, Haddenham Healthcare, a family-owned UK-based medical device company with a global outlook. They specialise in compression therapy for lymphedema, designing products that integrate into patients' daily lives. They support therapists working with clients of all body shapes and sizes, offering flexible solutions including wide-size options and custom garments. Made-to-order and custom flat knit garments can include features such as grip tab openings, making therapy easier to manage for clients living with larger bodies. They innovate with purpose and partner long term to ensure every patient is supported. I'm grateful for their support for this podcast. You can find more information at www.hadealth.com.au. And the link is also in today's podcast notes. I like the idea that you set it up and you keep drip feeding it, I suppose, and keeping that same message going because there's no point all of a sudden getting to a session saying, Oh, by the way, there's compression, and they go, Oh my god, what's all this about? But you've already set it up, you know. I mean, at some point, you may not say it straight away, but we're going to talk about in the future, you know, here's some whatever. I think that's a really nice strategy. We often rush ourselves too much, and that's where we need to be careful, I think, with what we're we're doing. You talk about wraps. Um, obviously, some people will be able to get down and put a wrap on. Do you know what I mean? Um, I don't know how much success you've had with thigh wraps. I find it tricky. So we'll probably go for more the the foot come, the leg wrap rather than the thigh, and look at other ways, perhaps eventually, to deal with the edema. I think you I don't know about you, but I often think the priority is often the foot and calf, because that's where we often see the wounds, maybe. Um, what's your thoughts?

SPEAKER_01 25:38

Yeah, I think that you know, we've got to call a spade a spade, and I will talk about that with the patient. If you have um excess fat in your sort of the inside of your leg, we we can't fit the wrap in. And it and for most people they'll find it really rubs and it moves a lot. And and I talk about that with them. And then I will say, oh, you know, there is an option about putting in a segment, or we might try some pantyhose, but that has challenged challenges around um you know getting to and from the toilet and chaps, and and we talk that through with the patient for some patients, for other patients, it's just better to say this is what we're going to do. But I agree with our bigger um bodies, if we are um, you know, there's a lot of skin folds and and not a lot of space between the legs, I I would often just start with a you know foot and and below knee. Um, partly is because I think it's about providing, particularly that first garment, is really about providing some success and some. I kind of like this, you know. We we don't want them to have had the chemist purchase experience that we all hear about, or the, you know, and particularly our bigger patients. I see quite a few that have done a lot of shopping online and with lovely round knit travel socks that have just done beautiful tournication all the way up. And then you're trying to say, and they say, I'm not gonna do compression, and you go, let's explain what round knit is versus flat knit and let's see how we go. Um and I must say, particularly with patients that have had that have this big history of medical kind of stigma and some experience with lymphedema management that maybe didn't feel very good. Maybe they've done this internal, you know, the private purchases themselves. Um slower is better. Some sessions I think, gosh, I've just been a full hour with a patient. We kind of haven't done anything, we've just talked and talked. And then they send you an email saying, thanks so much, that was such a valuable session. And in my head, I think wasn't valuable, but I think that's part of it in these days of seven-minute bulk build conversations with your GP or or or equivalent, they physios or or lymphedema has an opportunity to spend an hour with the patient and do education. And I think it's very valuable because you're setting them up to kind of be able to ask the questions and be able to take control.

SPEAKER_00 28:18

Yeah. I like this idea that you I was just thinking about your exercises online. You know, we we went online with COVID and everything like that, but it probably has a really positive thing for larger body people because one, they're getting a community, but they're not putting themselves out there. Do you know what I mean with their size? It's actually quite a smart idea. Um beautiful.

SPEAKER_01 28:41

So what I found is I, because I'm I'm a physio, I would see patients and I'd say, can you do your exercises? You've hurt your shoulder, do your exercises, see you in three weeks, and they'd come back in three weeks and say, I haven't done them, and my shoulders no better. And so I started to run these small group exercises. It's just for people in larger bodies. Everyone's doing their own program. And you're exactly right, Marie. We've created community. So some people come what I call the working and the walking wounded. They've got an acute injury or a subacute injury. They probably could be in a gym space or a rehab facility, but for whatever reason, they feel safer in an environment that's with plus-sized people. Public gyms don't often feel safe for people in larger bodies. There's a cohort that just feel like they're being judged. So they will come through our online programs and just stay for six or eight or ten or twelve weeks to get through that sort of acute rehab. And then I have this other group that we are their form of exercise. They might be homebound or they might be fairly mobility is a real challenge, and it is their one exercise a week, group thing of exercise a week. They can do it in their jamies, they can do it in their work clothes, they can do it at work. I have a woman that just finishes at uh six o'clock, so she jumps on at 6 15 and in her work clothes, and we've created there's always cats walking across the screen, and someone's just had a promotion, and someone's mother's gone into the nursing home. And we we've I've got, it's nearly all women, and it's we have created true middle-aged exercising community that don't we don't talk about endorphins. There's a huge population of there's a huge group of people in the in the world, small and big, who do not get any endorphins or feel goods from exercising. But we still have the maturity to know that exercise is good for everyone. So we never sort of say, oh God, don't we feel so great now we've done our exercise. We say, tick, we've done it. We're moving our bodies forward, anti-age, you know, um, anti-aging, keeping ourselves mobile, working on the balance, improving that shoulder injury, improving your lymphedema. Um, it's really nice. It's one of the highlights of my little business and what we do is our group exercise because we've we've created true community from everywhere in Australia. It's it's people come from everywhere. It's lovely.

SPEAKER_00 31:19

Have you seen any sort of success, well, everyone's a success in their own way, but have you seen any really dramatic ones where they've moved from this to the next, you know, phase? I don't know. Is there any really standout ones where you thought, wow, that was something that was quite amazing how this occurred?

SPEAKER_01 31:43

I suppose like I I can think about a whole range of personal goals that people have achieved because they've started to go to exercise and we've talked through what they what it might look like. For example, I've got a woman about to go on a 30-day cruise who a year ago thought she would not even be able to get herself to from the room to the diet to the dining hall. She had some really significant mobility issues, and we have just locked in and she's turned up every week and she goes on a cruise in March. No one else is going to think that's so amazing, but her, the five people in that group that turn up every week cannot wait for the pictures and the stories. Um that it's easy to see big change in conjunction with medical weight loss that's going on at the moment. And so we I we have a range of patients that come through who are choosing medical weight loss treatments, and and that's an easy visible thing to see. The um and the that can be really positive for people in conjunction, though, these are people that have committed to to uh to doing to keeping strong while they lose weight and to watch them build their strength. Yes, they're losing weight, which is which has been great for their swelling, you know, that's undeniable, but actually them being able to um go on a trip to Uluru, I've got another lady that just did that. Um yeah, I I think it's probably the life things that you see that happen when people come. It's it's not the oh look, now they can sit and stand from a chair five times without holding on. It's actually that they're saying, I went to uh Magnetic Island and was able to walk from the Airbnb to to so these are these are the the real goals that some of our patients, my patients have achieved in the last few months that and we that that is the joy.

SPEAKER_00 33:47

So, Nadia, if clinicians were to take away one or two messages from this podcast today, what what do you want them to gain? What are the the clear messages? If someone walked in today, perhaps a larger body, or they're seeing someone in a review session, what do you want them to know?

SPEAKER_01 34:05

Yep. So I've got two. One is that the word morbid obesity does not need to be used. It's a real clanger for the patient. It doesn't need to be communicated to to the next healthcare provider. They live with obesity or they have obesity. The word morbid obesity is that you're killing yourself by eating yourself through food. So it's not actually accurate. If you want to give commentary that the person of someone's specific size, you're much better to just use kilos or a clothing size. If you're really wanting to really provide detail that this person is very big, just kill the word morbid obesity from your language. Um, and think about that the word obesity is a medical term and the person has the condition. They're not that they are not obese, they have obesity. Um, if you if you feel like it's a word that you want to use, but living in a larger body is is generally a much more socially appropriate thing, and your patients will feel much more like you're on their side. But yes, the the word morbid obesity needs to go. That that's an easy thing and something that I hopefully you can take home. But the other bit is about is a softer thing and a reflection in how you think about the patients walking in the door to you. If you have an internal bias about and some judgment about why you think someone is in the body they're in, that is going to rub off on the patient. And really, what we want as a healthcare provider is that our patients keep coming back because we can keep them safer and healthier for longer. So that needs to be unpacked within yourself and a bit of um yeah, a reflection about how you can you can work towards being an ally for the patients. We have a third of the population living in larger bodies. So if you don't want to service these people, you're missing out on a third of the population. Um, so our our big patients are coming, and the more skilled and equipped and willing and able we are to work with them will one, make you a better clinician and and a busier clinician and um actually able to service the population that um you are trying to service, I believe, by wanting to to to you know to work in a healthcare profession.

SPEAKER_00 36:42

We need to embrace it for sure, because it is there's a huge population that we're we're seeing, and that's unfortunately probably going to see more of. So thank you, Nadia. Your insight is so impactful, especially you know, for us to engage better with these you know clients that walk through our doors and really get the best that they want, as regardless of what we want, it's what they want, their goals. And sometimes their goals may not might change over time as they get the wins, don't they? So I think that's really important. So thank you, Nadia, for your time and your insight. Stay tuned for future podcasts to empower you with the tools and knowledge to manage lymphedema and chronic edema confidently and effectively. Until next time, keep supporting your clients with evidence-informed carefully.