By Chris Corcoran RN, MS, and Karen Janicek, RN

Rising rates of obesity among our Medicare patients is quickly becoming a critical issue for those of us who provide care to older adults. By being proactive in planning equipment, facilities and care, as well as training our staffs to better serve adults with bariatric needs, we can better help our obese patients meet their health care needs.

Rates of obesity among Medicare patients doubled from 1987 to 2002, from 11.7% to 22.5%. This increase in obesity is a major health issue for older adults because, in adults between ages 51 and 69, it is associated with increased rates in chronic disease, symptoms and disability, including heart disease, diabetes, hypertension and arthritis.

Obesity is measured using Body Mass Index, a calculation based on height and weight. A person is obese when his or her BMI is 30 or greater, while being overweight means having a BMI of between 25 and 29.9. At 40 BMI, one is considered morbidly obese.

These distinctions are important in light of studies on mortality. A 2006 study in the New England Journal of Medicine reported significantly higher premature death rates in middle-aged overweight people and dramatically higher death rates in obese people.

In a 2004 census of Community Care participants in both the PACE and Partnership programs, we found that 18.5% of them had a BMI greater than 35. Nine percent had a BMI greater than 40. Assuming our population will follow national trends, we expect the percentage of our program participants who are obese or morbidly obese to continue to increase, and we want to take the lead in providing the best possible care to them, as we do to all our participants. That means being proactive in planning to meet their needs.

As we expand our programs, we are building new facilities with bariatric patients in mind. Our new Adult Day Health Center at 3220 W. Vliet in Milwaukee is built with doorways large enough for oversized wheelchairs, which have an average seat width of up to 30 inches. The facility also offers bathing facilities, bariatric floor-mounted toilets that hold up to 300 pounds, an exam table and furniture that easily accommodates bariatric patients. Having appropriate facilities, furniture and equipment for obese people is critical for their care. It is also important in providing them a place where they feel comfortable and enjoy visiting. Large people are often afraid to sit in chairs if they are not confident they will hold them.

It is particularly necessary when planning care for bariatric patients to be proactive and plan for each patient’s needs because of the additional factors their size plays. Will they be comfortable in the transportation provided? Are they able to easily leave their home, which may have doorways that do not accommodate their size? Do we have an oversized wheelchair available to them? Are we prepared to address the additional health risks they face because of obesity?

Clinic room space must allow room for them to maneuver. Exam tables must be able to hold them. Equipment must also be considered. Insulin syringes for bariatric patients should have larger needles; obese women need larger pap smear speculums. Bedpans, seating devices and chair lifts should be appropriate in size.

We have also found it beneficial to be proactive in training staff. With a growing obese population, it is critical that staff members are knowledgeable about their nutritional needs, health risks, treatment guidelines and behavioral components associated with obesity.

In addition to meeting their needs, staff members should also help support the changes bariatric patients need to make in order to live healthier lifestyles. Education of staff members is critical to prepare them to help bariatric patients deal with diet and food cost issues, safe physical activity and behavior modification.

Caring for the special needs of our bariatric patients is critical to their health and success and will be an increasingly important part of our work at Community Care.