Supporting bariatric patients presents significant moving and handling challenges for carers and professionals, influenced by the environment and the patient's weight. This article is not an exhaustive resource for bariatric solutions but serves as a guide for key considerations and potential solutions, discussing biomechanical forces, dignity, fallen persons, and hoisting.

What does "bariatric" mean? Originally from the surgical field, it identifies individuals over a certain weight, typically anyone with a BMI of 40 or above or weighing 136kg (Cambridge Dictionary, 2020). However, moving and handling challenges are not just about weight but also body shape and size. Terms like "person of size" or "plus-sized" are also used. Next, we will discuss biomechanics in this context.

Biomechanics in moving and handling

Understanding biomechanics basics is crucial for justifying the cost of equipment to non-specialist managers. The key principle here is force: moving 45kg requires more than 45kg of force (Newton’s Second Law, Khan Academy, 2020). For example, lifting a 145kg person from the floor requires more than 145kg of force. Moving this weight across a room with a hoist adds friction. A person’s body shape can also complicate safe access and increase resistance. 

Dignity

Supporting bariatric patients often requires multiple carers to counter biomechanical forces, particularly during personal care. This can make patients feel exposed and vulnerable. It’s vital to understand and address these concerns, maintaining as much dignity as possible. 

Discuss your plans with the patient in advance, understanding their thoughts, concerns, and wishes. Collaborate to achieve handling goals while respecting the patient's perspective. 

The fallen person

Falls can happen for various reasons. If a person cannot help themselves up, we must have resources to do so safely, considering the patient’s weight, dignity, and the safety of carers. Paramedics and care home staff often encounter this situation. For bariatric patients, the force needed to lift them is substantial, often requiring external help. One solution is the Mangar Elk, a series of inflatable cushions placed under the fallen person and inflated cell by cell. This reduces the weight carers must manage, lowering the risk for everyone involved. Mangar Elk cushions, with a maximum load of 444kg, are easily stored and widely used by UK paramedics for this reason. 

Hoisting

Hoisting bariatric patients involves greater biomechanical force. Hospitals and care homes often require risk assessments to ensure sufficient personnel for tasks like turning patients for personal care. Mobile hoists with adequate safe working loads can lift patients from beds to chairs. However, the friction between the hoist and the floor adds to the challenge. Therefore, many facilities opt for ceiling track hoists in specially designated rooms. If not installed during construction, structural engineers must ensure the building’s support is sufficient and a retro-fit solution is installed. 

A ceiling hoist reduces the forces needed to lift and move patients from surface to surface, such as bed to chair, by eliminating friction against the floor. Motorised carriages make movement easier, potentially reducing the number of carers needed, as the strain and effort required are lessened.