Patients living with obesity are at significantly higher risk in hospital settings for injury and complications, due to inadequate facility design, equipment, or staff competencies in their care. Healthcare providers are also at risk for injury if there is inadequate equipment, as well as the knowledge to use the equipment. The resources and recommendation on this site are intended to promote quality care for hospitalized patients who have bariatric care needs.
It is important that patients with bariatric care needs have interactions with all staff, administrators and physicians in a manner that establishes a foundation of trust and collaboration and is free of weight bias. It is recommended that all staff receive education on the complexity of obesity and weight bias.
There are a number of online modules and webinars that provide education for healthcare practitioners for the purpose of eliminating weight bias and weight based discrimination. It is recommended that sensitivity training include information about weight bias and be included annually for existing staff and as part of staff orientation for all new staff. Ideally, a combination of face-to-face and online education is recommended. The following is a list of recommended educational resources currently available.
- Alberta Health Services Weight Bias Education
- Balanced View, Vancouver Coastal Health Authority
- University of Connecticut Rudd Center for Food Policy and Obesity
- Obesity Canada
Bariatric care needs should be determined early in the patient’s stay. To aid in their identification, a patient’s weight should be taken and recorded in their medical record as close to admission as possible. Bariatric care needs include: equipment, supplies, physical care, and routines specific to the patient’s individual care needs.
For the purpose of this recommendation, the term “bariatric” will refer to a patient who has a body weight of 113kg (250lbs) or more. The reason for this is that most equipment/furniture in the hospital environment has a weight capacity of 113kg (250lbs). Therefore, patients with a body weight greater than 113kg (250lbs) may require equipment that is classified as “bariatric” meaning that it has a weight capacity greater than 113kg (250lbs).
Body shape is another consideration in determining if a patient may have “bariatric care needs”. Where a patient carries excess weight in the form of excess tissue, including adipose and skin, can determine the need for equipment/furniture that can accommodate/support and meet the needs of a patient. Table 1 provides a description of various body shapes and associated care considerations.
Body Shape Descriptions and Associated Care Considerations
|Body Shape||Description||Care Considerations|
|Apple Shape||Patients with an apple shape carry their weight high. Legs may be relatively average-sized and the patient may have intact hip and knee flexion.||
|Pear Shape||Patients with a pear shape carry their weight in the thighs and buttocks.||
|Bulbous gluteal region||Excess buttock tissue creating a protruding shelf.||
|Proportional||Weight is evenly distributed|
Please see Algorithm for Identification of Bariatric Care Needs for step by step guide to identify the potential care needs of patients at, or prior to the point of admission to a healthcare setting.
Emergency Department Admission
Notification from the community prior to the patient arriving to the emergency department about the possibility that the patient may have bariatric care needs is recommended. This can be in the form of a call from the paramedics on scene or the physician’s office initiating the emergency admission. This call could start the collection of key information to enter into the algorithm and allow emergency department staff to prepare accordingly in anticipation of the patient’s arrival.
Referral from general practitioner or specialist to include key information about the patient that could help staff at the hospital anticipate when a patient may have bariatric care needs well in advance to their admission.
Upon Admission to the Unit
The unit, or in the case where a bariatric liaison consultant is available, will arrange for equipment and training needs and identify appropriate resources needed to meet a patient’s bariatric care needs. The algorithm to identify equipment needs to support bariatric care is intended to identify patients with bariatric care needs.
Once bariatric care needs have been identified, there are a number of considerations that should be made in regards to equipment needs for use with a patient with bariatric care needs. The following equipment should be considered in the care of the patient with bariatric care needs:
- Emergency room stretcher
- Transport stretcher
- Specialty beds/examination tables
- Specialty mattresses (for pressure reduction)
- Bariatric walkers (28-40+ inches)
- Bariatric room chairs
- Bariatric bed that lowers closer to the floor
- Mechanical lifts / slings (including limb slings)
- Gowns / pants / robe (of appropriate size)
- Bariatric bedside commodes
- Scale to weigh patient (specialty bed / standing scale / other)
- Bed trapeze appropriate for patient’s weight
- Bariatric wheelchair’s
- Bariatric resuscitation equipment
- Bariatric table in operating room
Caution: wall mounted toilets may still exist in some hospitals. Many of these wall mounted toilets have a weight capacity of 113kg (250lbs).
Selecting Appropriate Equipment
Selecting the most appropriate equipment for use with a patient with bariatric care needs is essential to the promotion of patient and staff safety. The following is a list of key considerations when selecting equipment:
- Does the equipment has the proper weight limit to support the patient?
- Does the equipment has the proper width to accommodate the patient?
- Does the equipment can fit through doorways and in spaces the patient will be using it?
It is recommended that there be consistency with regard to the brand/type of bariatric equipment that is used throughout a facility. This will allow for the development of familiarity and skill in using the same equipment across units/programs. It also allows for opportunities to share or move equipment throughout a facility and also reduce delays in patient care (e.g. sling can be kept under a patient from recovery room to unit).
There is no standard process in place in Canadian hospitals that clearly identifies the weight capacity of equipment. Health care practitioners often report that the only way to find out what the weight capacity of equipment such as beds, walkers, wheelchairs, commode chairs, etc., is to look up the information on the manufacturer’s website. This lack of immediate access to weight capacities poses a safety risk to patients and staff. Therefore, it is recommended that a universal labeling system be used to provide a quick and accurate way for patients, family members and staff to identify equipment that has a weight capacity that is safe for them to use. The following is a system that is developed and recommended for use by Obesity Canada. Labeling kits can be ordered directly from Obesity Canada.
Key Pieces of Equipment Needed
When selecting a bed, it is important to consider the weight limit of the bed, the width of the patient and the types of mattresses or surfaces available for use with the bed. Most hospital beds will support a weight of up to 227kg (500lbs), however such beds may not provide enough surface to support the full width of a patient comfortably. The use of a bariatric care bed that can support a weight of more than 227kg (500lbs) and typically has a width of >90cm (35inches) is recommended when the patient requires such weight support and/or requires a wider support surface. A bariatric bed will require more than two people to move it. Some bariatric beds have a built-in motor that will help propel, limiting the number of people required for transport.
When using a stretcher be sure that it has the proper weight limit and width to support the patient.
Bariatric Lift Chair
A bariatric reclining chair is a recommended option to have in a patient’s room for when a patient needs a comfortable, supportive place to rest during the day. Note: most bariatric lift chairs cannot accommodate the base of a portable, floor based lift. Therefore, only patients who are able to transfer with minimal assistance or have access to a ceiling lift can use a bariatric lift chair.
Options for bariatric lifts include: stand assist lifts; sit-stand lifts; mechanical passive floor lifts, and; ceiling lifts. It is recommended that all facilities have lifts readily available on units where there tends to be a higher proportion of patients who may have bariatric care needs and lifts available for sharing across programs/departments/units. It is important to also have slings available for use with all lifts available that are compatible with the lifting device and can support the weight and/or width of the patient.
Important note: Prior to moving a patient, be sure to check that when using a mobile lift to lift and transfer a patient to or from another furnishing (i.e. Recliner chair, stretcher, bed) that the base of the lift is able to be positioned properly (i.e. Compatible with the furniture).
Walker (28-40+ inches)
A bariatric walker should be available on every unit. Patients admitted to hospital and who have their own walker should have their walker with them while in hospital. If a patient is being assessed for a walker, be sure to let the vendor know that the patient has bariatric care needs.
Wheelchair (28-40+ inches)
A bariatric wheelchair should be available on every unit at in areas where patients will be transported between units/programs (e.g. emergency department, diagnostic imaging).
Transfer belts come in a variety of sizes that should be clearly labeled either with a printed label or color-coded. Some brands are designed so that they can be joined together to provide more length. However, be sure that the connections are secure and only made on brands that are designed to be connected.
All patients should be able to have their weight taken in a private setting. It is important to have a scale available for each unit that has a wide base for the patient to stand on and allows adequate foot placement for stability. A scale that can accommodate a scooter or wheelchair is ideal. Such scales are often built into the floor or installed and are not portable. Scales that are built into the bed frame, examination table, or lifting equipment are recommended. A scale with a weight capacity of up to 1800lbs is suggested where possible, particularly if the scale is to include access to mobility equipment that will add significant weight.
Consult occupational therapist to provide appropriate cushions to meet the needs of patients with bariatric care needs.
Radiology / Diagnostic Imaging
Radiology / Diagnostic Imaging department should be notified of patient’s weight and any mobility issues as close as possible to the order being received, so accommodations can be made (if necessary) for the patient’s specific diagnostic needs and equipment. Consider the length of time required for the imaging with regards to the patient’s tolerance for lying flat in a supine position, with respect to their respiratory risk.
The manufacturer technical specifications for equipment (eg. weight capacity and girth restrictions) need to be considered and noted.
A radiologist or nuclear medicine physician should be consulted if the patient’s weight or dimensions exceed the capacity of the site’s equipment. (Another site with weight / girth appropriate equipment may need to be considered.)
Each diagnostic imaging area should:
- List manufacturer’s weight restriction for specific equipment
- Have readily available a list indicating alternate locations, if they are not able to accommodate.
Consideration needs to be given to the size of the examination room, and the mobility and equipment needs of the patient. Adequate space around the exam table is also required for staff to assist the patient, and to be able to move freely and easily
Tracking and Maintaining Inventory
Inventory identified for use with patients who have bariatric care needs must be tracked in order to ensure that they are incorporated into the regular preventative maintenance program for the unit and/or site. Information must include the make, model, manufacturer, exact location and preventative maintenance requirements per the manufacturers’ instructions.
Minor Equipment on the Unit
It is recommended that a dedicated storage space of sufficient size be provided for the storage of patient handling equipment, including slings in a variety of sizes and types that are compatible with the lifts on the unit, slider sheets, and transfer belts. This space should be in close proximity to the point of use. An electronic or manual sign out system is required to keep track of the location and usage of minor equipment. Each piece of equipment should be labeled with a serial number and be clearly labeled for maximum weight capacity and/or size. A classification guide for labeling equipment is provided earlier in this guideline.
Storage for Mobility Equipment
It is recommended that a dedicated storage space of sufficient size be provided for the storage of wheel chairs, walkers, crutches, and canes designed for use with patients who have bariatric care needs. This space should be in close proximity to the point of use. Depending on the setting, this may be a place to store equipment that is shared between units/programs or for unit use only. Each piece of equipment should be labeled with a serial number and be clearly labeled for maximum weight capacity. A classification guide for labeling equipment is provided earlier in this guideline. An electronic or manual sign out system is required to keep track of the location and usage of mobility equipment.
Storage for Mobile Lifts
It is recommended that there be dedicated spaces with electrical outlets (for charging batteries) for the storing of mobile lifts. An electronic or manual sign out system is required to keep track of the location and usage of mobile lifts.
More information coming soon!
People First Language
Using people first language is now the standard in health care for addressing people respectfully. This means that a person is described as a person first and the name of the chronic condition is used after. In the case of obesity, rather than stating “obese person” or “obese patient”, the statement “person with obesity” or “patient with obesity” is recommended. This small but important change reinforces that obesity is a chronic disease and not a characteristic or adjective. Obesity Canada has a statement about people first language that can be found on www.obesitycanada.ca.
Use of Appropriate Images
Images of people with obesity used on-line or in print by members of the media, health care professionals, government, industry, etc. can be a source of stigmatization. Photos often show individuals with obesity as headless (i.e. only from the shoulders down), from unflattering angles (e.g. with only their abdomen or lower body shown), and engaging in stereotypical behaviour (e.g. eating at fast food restaurants or food courts, engaging in sedentary activity). These images degrade and dehumanize individuals with obesity while perpetuating myths and stereotypes.
It is recommended that all on-line and printed material only use images of persons with obesity in ways that are positive and non-stereotypical. Such images are available as a free resource from Obesity Canada via the Image Gallery (www.obesitycanada.ca).