Key considerations when prescribing bariatric care equipment

Obesity is a health condition that is on the rise, with 1 in 3 New Zealand adults classified as obese in the 2017/2018 health survey (Ministry of Health NZ, 2018). Worldwide, obesity is recognised as a leading global health issue with 1.9 billion adults (18 years and older) considered overweight, of these over 650 million were obese (WHO, 2016).

Health solution providers have had to adapt to meet the complex needs of obese individuals, resulting in greater investment in the development of specialised bariatric care techniques and equipment, designed to support rehabilitation, hygiene and provide greater independence.

Although a broader range of specialist bariatric solutions are available today, those prescribing equipment to support obese individuals, have more to consider.

In this article, we’ll take a look at some of the key factors to consider when prescribing bariatric solutions for your clients.

What does ‘bariatric’ mean?

A commonly accepted definition of a bariatric client is someone who weighs 150kg or more, has a BMI of 40 or more, or has large physical dimensions, a lack of mobility or other conditions that make moving and handling difficult (ACC, 2012).

Prescribing equipment for bariatric clients

Cubro Occupational Therapist Sharon Woodward recommends clinicians to consider the following factors when prescribing equipment for bariatric clients:

• Safe working load of equipment
• The environment
• The body proportions
• Physical dimensions
• Range of movement
• Mobility and transfers
• Pressure care factors
• The needs of the caregiver 

Correct positioning

In the early days of bariatric equipment, a double-width wheelchair was commonly used, resulting in poor positioning that often caused pressure ulcers and discomfort. Incorrect seating can cause long-term postural complications, so thankfully these days solutions can be provided that will best meet an individual’s unique requirements to achieve the best health outcomes. Occupational Therapist Martina Tierney from Seating Matters advises clinicians to focus on choosing bariatric seating solutions that provide postural support, pressure management and increased independence.

Unique to bariatrics is the gluteal shelf, or bulbous gluteal region, which can make it difficult to achieve the correct postural support. Poor posture occurs when there is not enough space for the gluteal shelf, which pushes an individual forward. This increases the risk of falls and can cause the spine to curve, affecting skeletal support. It’s imperative to choose bariatric equipment that supports the gluteal shelf and provides overall postural alignment.

Key seating and positioning factors to consider:

• Seat depth: Adequate seat depth to provide support for the upper legs and abdomen
• Lower leg support: Leg rests that support the calves will take some of the weight off the ankles and heels
• Transfers: Can the client be transferred easily from the chair?
• Arm support and mobility: Swing away armrests or armrests that are further forward can assist with balance when standing

Rehabilitation

Due to the high risk of injury to the carer and individual when moving and handling bariatrics, an individual may become dependent on their carer and equipment. This may lead to minimal participation from the individual and inadvertently result in a reduction of their mobility. A balance should be maintained between rehabilitation, mobility, and use of moving and handling equipment to ensure the safety of the user (ACC, 2012). There is some great bariatric equipment available that help engage users and increase mobility (if they are capable). 

Skin and pressure care

Both very thin individuals and those overweight-obese are at a higher risk of pressure injuries and it’s often challenging to maintain skin integrity. Pressure injury prevention, management and treatment is similar to that for non-bariatric individuals, however, there are a few additional challenges like:

• Increased skin folds
• Difficulty moving independently or with assistance
• Difficulty managing their own self-care such as hygiene and toileting
• Increased body weight makes it difficult to view bony prominences and to redistribute pressure
• Due to impaired sensation, the client may not feel pain, lodged objects or hot/cold temperatures

Pressure ulcers may develop underneath skin folds and in locations where tubes or other devices could compress in between folds. The combination of moisture trapped under skin folds, the pressure of the skin folds on the underlying skin and friction and shear between the skin’s surfaces increase the risk of pressure ulcers forming under skin folds. It’s vital for carers to take extra care of these areas.

Key pressure care factors to consider:

• Access adequate assistance to thoroughly inspect all skin surfaces and folds, including but not limited to:
  • Behind the neck
  • Mid-back region
  • Under the arms and breasts
  • Under the abdomen and pannus
  • Upper and lower thighs
  • Perineal, buttock and sacral area
  • Calves, heels and ankles
• Consider risk from moisture, pressure, friction and shear
• Consider and continually monitor the impact of friction and shear
• Provide pressure redistribution support surfaces and equipment appropriate to the size and weight of the individual

(National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. 2014)