The obesity epidemic
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.
Recent studies have shown that even moderate weight loss can have a remarkable effect on many of the medical problems caused by obesity. Diabetes, blood pressure, cholesterol, and stroke risk can be reduced by even moderate amounts of weight loss. Providing nutritional instruction and structuring balanced diets, portion size, meal frequency, moderation, and consistency can notably impact eating habits. Compulsive overeaters can consume sizeable amounts of food and can be obsessed with food and food-related thoughts. Designing a realistic nutritional program and setting achievable weight-loss goals with the resident’s involvement can help to motivate the resident to maintain compliance and to feel good about each accomplishment.
Physical and occupational therapy
Excessive weight can stress joints, affect proper movement, and predispose a person to osteoarthritis, injuries, pain, and many other health-related problems. In addition, many morbidly obese individuals will begin to limit their mobility or take to using motorized scooters or wheelchairs as a means of getting around, further complicating their functional abilities. Physical and occupational therapists can help the bariatric resident become more active and fit by teaching them how to move in ways that are pain-free, and use equipment that is safe and sufficient to bear their weight. And by teaching bariatric residents about correct posture and movement patterns, therapists can motivate people with weight issues to increase their mobility and become more functionally independent. Therapists can also be active participants in determining room size and setup, equipment needs, positioning, and comfort techniques, and procedures for maneuvering doorways and transporting bariatric residents in and out of the facility. Converting a semiprivate room to a private room can provide increased maneuvering space and enable safe movement of lifts, commodes, transfer chairs, and other large furnishings and equipment.
Today, there are several rehabilitation companies that specialize in the management of bariatric residents and will provide consultation on how to mobilize and treat residents of significant size. Bariatric physicians can often provide recommendations regarding local rehabilitation companies that are qualified bariatric specialists.
Age-related services and activities should be a consideration when treating residents with morbid obesity. Many of the bariatric residents admitted to nursing homes can be significantly younger than other residents. Internet, DVD players, TV, stereo, and cell phones are just a few of the amenities that younger clients value. Activities should be designed in conjunction with treatment and rehabilitation plans and should reflect age-related interests. Several nursing facilities across the country now have bariatric units with dedicated programming including separate dining areas and menus, resident and family support groups, and specialized counseling groups.
Staffing and safety requirements
Back injuries are cited as the most common reason for absenteeism in the workforce after the common cold.5 There are several organizational causes of back injuries among healthcare workers including staffing shortages and obesity in employees and patients. To reduce the potential for resident and staff member injury, the administrative team must consider the number and fitness of the staff caring for bariatric residents. Turning, repositioning, or transferring residents of significant size may take up to four or five qualified staff members. Staff caring for bariatric residents must have ample strength and fitness, a good center of gravity, good judgment, and adequate information about body mechanics related to obesity. In addition, the equipment used to assist the staff in repositioning, transferring, and accommodating bariatric residents must be of sound quality and of a capacity to sustain each resident’s weight and body frame.
The obesity epidemic has touched every area of healthcare, including the nursing home industry, and more facilities now face the question of whether they are adequately prepared to care for the resident with morbid obesity. Issues that begin with access into the nursing home, to accommodations and equipment, to sufficient staffing and safety measures are just a few of the distinct challenges that must be managed. Caring for the bariatric resident in the long-term care setting is no longer a remarkable event. As the bariatric population continues to climb, admission of these residents may no longer be optional. Understanding all of the ramifications, determining weight limits for admission, and evaluating opportunities to manage treatment and cost may provide the best benefit to the organization and to the bariatric resident. n
Jan Bennet, RN, NHA, C-NE, is the Executive Vice President of the American Association of Nurse Executives (AANEX).
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- Klein M. Treating obese patients the right way. Healthcare Purchasing News ,March 2004.
- Obesity in the U.S. AOA Fact Sheet. American Obesity Association. Available at: https://obesity1.tempdomainname.com/subs/fastfacts/obesity_US.shtml.
- De Angelis T. Binge‐eating disorder: What’s the best treatment?. Monitor on Psychology, 2002 ;Vol. 33 ( 3 ).
- Thompson C.Compulsive Overeating. Available at:www.mirror‐mirror.org/compulsive.htm.
- Back injury prevention—Causes of back injuries. Premier, Inc., 2008.Available at:www.premierinc.com/safety/topics/back_injury/
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Topics: Articles , Clinical , Facility management