Nearly 135 million adults in the United States are either overweight or obese; 14 million are considered morbidly obese, and an amazing 1 million are considered mega-obese.1 (Overweight is defined as having a body mass index (BMI) of 25.0 to 29.9. An individual with a BMI of 40 or more is considered morbidly obese and a BMI of 70 or greater is considered mega-obese). The American Obesity Association (AOA) reports that the age group with the highest prevalence of obesity among men is 65 to 74 years and among women, 55 to 65 years. Statistics shared by the Centers for Disease Control and Prevention (CDC) convey that there has been a dramatic increase in obesity in the United States over the past 20 years. In 2006, only four states had a prevalence of obesity that was less than 20 percent.
This significant increase in older adult obesity coupled with associated comorbidities such as hypertension, diabetes, apnea, heart disease, and other chronic illnesses is also increasing the demand for nursing facilities to admit and treat bariatric residents. Bariatrics is the field of medicine that specializes in treating morbid or extreme obesity. The consequences of morbid obesity are numerous and diverse. Obesity increases the risk of illness from about 30 serious medical conditions and is associated with increases in deaths from all causes.2 As nursing facilities consider whether to admit bariatric patients, they must be well-prepared to manage the exceptional needs of this distinct group.
Meeting the special needs of bariatric residents is no small task. Nursing facilities must consider factors such as the availability of high-capacity specialty equipment, treatment modalities, staffing needs, safety requirements, psychosocial resources, and other age-related amenities all of which can place an additional financial strain on the organization. In addition, services including physical and occupational therapy, dietary counseling, preoperative/postoperative care, and discharge planning should be taken into account when treating bariatric residents. The following areas address several of these considerations:
High-capacity specialty equipment
Providing heavy-duty frame designs with added strength capable of supporting weight that may exceed 500 pounds is an essential component of choosing the right equipment to adequately treat morbidly obese residents. Many companies now offer rental or purchase products for the bariatric population. Evaluating the worth/value of renting or purchasing each piece of equipment can help the facility determine the cost effectiveness of treating one or many bariatric residents. Bariatric equipment includes products such as:
High-weight capacity beds with larger sleep surfaces and pressure-reducing mattresses, bariatric bed linens
Lifts and slings, lateral transfer units, trapeze scales
Wheelchairs, commodes, shower chairs, gurneys, bath or transfer benches
Walkers, transfer boards, step/treatment stools
Therapy/treatment tables, parallel bars
Dining room seating, recliners, lobby chairs
Continuous positive airway pressure (CPAP) systems, blood pressure cuffs, patient gowns
The condition known as binge-eating disorder (BED) is typically seen in people who are morbidly obese. BED is marked by recurrent binge-eating without purging and often carries distorted attitudes about eating, shape, weight, and mood symptoms including depression and personality disorder.3 Eating disorder survivor Colleen Thompson shares that, “Being fat can serve as a protective function for bariatric patients, especially in people who have been victims of sexual abuse. They sometimes feel that being overweight will keep others at a distance and make themselves less attractive.”4 In addition, many morbidly obese people have isolated themselves in their homes for extended periods without social contact or have been demoralized or mistreated by family, the public, or healthcare personnel. In an effort to protect themselves, bariatric residents may often display antisocial behaviors such as being oppositional and insulting or demoralizing of others.
Meeting the emotional and psychological needs of the obese resident is a specialty. Eating disorder experts often use approaches such as helping to eliminate binging, improving body acceptance and self-esteem, reducing weight, and treating underlying psychological problems such as depression and anxiety. It is important that nursing facilities offer the services of experts who are adept at responding to the unique psychosocial needs of the resident with morbid obesity and who can also assist staff members to be sensitive to and patient with associated behaviors. Physician groups that specialize in the treatment of bariatrics or provide bariatric surgery often include psychological experts as a member of the team.