The Bariatric Patient
Bariatrics is a specialty of medicine that addresses the unique challenges and care issues of obese patients. According to the American Obesity Association obesity is a disease that affects nearly one-third of the adult American population and the numbers continue to increase.
Obesity is an abnormal accumulation of body fat, usually 20 percent or more of a person's ideal body weight. St. Mary's Health System reports that 20 to 40 percent overweight is considered mildly obese, 40 to 100 percent over ideal weight is co-moderately obese and 100 percent over ideal weight is considered severe-morbidly obese.
With approximately 64.5 percent of adult Americans overweight or obese, and the number growing each year, the bariatric market is evolving with more product selection and awareness.
Reasonable prices and insurance-reimbursable products are influential factors on the selection of products for home medical equipment providers (HMEs). Yet for bariatric products, there are additional factors of equal importance. Does it meet the needs of the patient for his or her condition? Is the product comfortable for the patient? Does the product offer durable construction?
Does it meet the needs of the patient for his or her condition?
Like most patients, bariatric patients have a variety of needs. Due to limited mobility or physical dependence, many bariatric patients need products to tackle the challenges of turning, transferring or ambulating patients. Wheelchairs, walkers, commodes and patient lifts can meet the accessibility needs of the bariatric patient while also reducing the risk of injury for the caregiver. Injury can be prevented to both the patient and the caregiver with the purchase of these products. It is critical for patient and caregiver safety to have appropriately-sized equipment.
Is the product comfortable for the patient?
Having the correct width of product as well as the correct weight capacity range can assist in the overall comfort of bariatric products. Wheelchairs with adjustable seat height and widths; lifts that provide stability and adjustable rollers are all features that enhance patient comfort.
Does the product offer durable construction?
Having products that are durable and strong are the qualities that bariatric customers are looking for first. Patients need to be assured that the product can hold their weight and offer support without the fear of falling. Patients who are confident about the features of the products will be more receptive to purchasing the equipment. Offering products with weight capacity specifications can assist HMEs in the selection of products for their consumers. Many walkers are available on the market with steel frames and rubber wheels for added durability and safety.
Steve Cotter, owner of Gendron Inc., Archbold, Ohio said bariatric customers look for "reliability, durable construction to support patient weight, ability to deliver immediately and the scope of products available."
Gendron offers Maxi Rest bariatric beds, XL2000 family of bariatric wheelchairs, Millennium bariatric lift, bariatric walkers, commodes, shower commode chairs and a bariatric trapeze.
Selling Bariatric Products
Cotter said there a few things that home medical equipment providers need to know about bariatric products in order to sell them more effectively. "The equipment is heavy, bulky and not easy to transport, be prepared to handle and deliver this type equipment. Choose your supplier carefully, be sure they can provide a complete suite of bariatric patient care equipment. The patient's needs are unique and do not fit the traditional DME/HME provider's scope of service."
Gendron is a comprehensive supplier of bariatric patient care equipment enabling the provider to fully equip a bariatric suite.
Additional Products for the Bariatric Patient
Obesity can lead to the development of many related health conditions including hypertension, diabetes, cancer, degenerative arthritis, elevated cholesterol, gallstones, heart attack, stroke and sleep disorders. As a result, there are many additional products that obese patients may need for their overall health maintenance. These products may include support surfaces to prevent pressure ulcers, CPAPs if they suffer from sleep apnea, or blood glucose monitors for diabetics.
Incontinence may be another issue for many obese patients. Some obese patients struggle with the problem of making it to the bathroom on time. Having a bariatric commode placed near the bed can prevent this problem and help patients to maintain independence. Principle Business Enterprises, Dunbridge, Ohio, offers several incontinence briefs and pads for the obese patient. Principle Business Enterprises offers the Tranquility XL Bariatric Brief, Washable Pants, Flextenders (self-gripping straps for use on a disposable belted undergarment), TopLiner Booster Pad and TopLiner Booster Contour.
Duncan Thomas, regional sales manager for Principle Business Enterprises, said there are several things HMEs can due with bariatric briefs to bring value to their customers. These include:
Talk to customers about the solutions they have for certain conditions, especially people taking medications for obesity, if the HME is also a pharmacy.
Advertise both in the store and externally that they have solutions for these conditions.
Post shelf display notices targeting bariatric patients in the incontinence section and at the pharmacy counter.
Familiarize themselves with the features and benefits of the bariatric options so they can answer questions knowledgeably and understand the many alternative available to fit both a customer's condition as well as his or her desired method of handling it.
"Obesity gives rise to other afflictions such as heart disease and diabetes with a significant percentage of diabetics experiencing varying degrees of incontinence," Thomas said.
Obese patients experiencing hypertension may need blood pressure cuffs. Being aware of related conditions can help HME dealers to better serve their customers by addressing all of their needs.
Having A Rehabilitation Team
Many bariatric patients work with an interdisciplinary care team including a physician, physical therapist, nurse, occupational therapist, dietician, respiratory therapist, pharmacist or counselor. Family members and other caregivers also are considered part of this team. According to Susan Gallagher, R.N., "Physical therapists help the patient to transfer, ambulate and otherwise increase activity and subsequently endurance. Nurses collaborate with other disciplines to balance a patient's functional, emotional, physical and medical well being.
The equipment is heavy, bulky and not easy to transport, be prepared to handle and deliver this type equipment.
Nurses, certified nursing assistants and rehabilitation technicians also facilitate transfers, activities of daily living and mobility activities. Goals set by occupational therapists often entail greater independence in activities of daily living. Bathing can be difficult for the obese patient and skin folds can cause special hygiene problems that the occupational therapist can creatively address with the patient."
For patients in a rehabilitation program, Gallagher said the value of the interdisciplinary team is in the timing--the sooner the team treats the patient the better--as this provides a way for caregivers to set goals and prevent some of the complications associated with caring for the larger patients.
In a study published in the January issue of the Journal of the American Medical Association (JAMA) the CDC reported that obesity climbed from 19.8 percent of American adults to 20.9 percent of American adults between 2000 and 2001. Obesity poses a major public health challenge.
Department of Health and Human Services' Secretary, Tommy G. Thompson said that obesity and diabetes are among the top public health problems in the United States.
"I believe the patient population has always existed, we are seeing a greater occurrence of treatments available for the bariatric patient, and funding sources are understanding the long term benefits of treating the patient, therefore we are necessarily seeing market growth," Cotter said.
Researchers Shed Light on Role of Leptin In Obesity, May Lead to New Treatments
A research team led by investigators at Joslin Diabetes Center has made a discovery that puts scientists one step closer to understanding the link between obesity and the hormone leptin. The new finding may lead to new treatments for obesity in the future.
Leptin is a hormone secreted by fat cells that not only controls food intake but also many other aspects of physiology that are affected by energy balance, such as reproduction and growth. Under normal conditions, high leptin signals that it is permissible to reproduce and grow. Conversely, during times of starvation, leptin levels are low and this tells the body that there is not enough energy to support pregnancy or growth. Overweight people have high concentrations of leptin in the blood, suggesting that these people do not respond to leptin by reducing food intake. Obese patients respond poorly to pharmaceutical leptin, suggesting the presence of leptin reistance.
Martin G. Myers Jr., M.D., Ph.D. and Sarah H. Bates, Ph.D., of Joslin's Obesity Research Section and their colleagues found that by removing one single signaling pathway of the leptin receptor-the stat3 signaling pathway-in mice while leaving other signals intact, they created a mouse model similar to human obesity. "These S1138 mice are obese due to overeating, but remain fertile and grow more than normal mice. Furthermore, S1138 mice are relatively protected from the diabetes that accompanies obesity," Myers said.
Researchers who studied a mouse model that mimicked human obesity identified the stat3 pathway as a potential site of leptin resistance in human obesity," said Martin G. Myers, M.D., Ph.D. "We hope that understanding the factors that control the physiological actions of leptin and leptin resistance will enable the eventual development of therapies to prevent obesity and its complications," Myers said.
This article originally appeared in the March 2003 issue of HME Business.