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It is difficult to treat the complications of obesity, let alone anyunrelated health problems, if overweight patients feel too embarrassed oranxious to visit a doctor.
A growing waistline can have numerous health effects, including the delayor avoidance ofcare.1 Some reasonscited for this are having gained weight since the last visit, not wanting tobe weighed on the provider's scale, and knowing that one will be told to loseweight.
Compounding the problem are fears of getting stuck in a too-small waitingroom chair, exposing oneself in a tiny gown, or tipping an exam table.
"Inadequate facilities and equipment not only offend obese patientsbut also may act as physical barriers to quality and appropriate healthcare," says Christina C. Wee, MD, MPH, assistant professor at HarvardMedical School and a researcher and staff physician at Beth Israel DeaconessMedical Center in Boston, where she focuses on care of patients with and atrisk for obesity.
Armed with this knowledge, there are some simple steps physicians can taketo make their practices more comfortable and welcoming for their overweightand obese patients.
Starting with the waiting room, the American Academy of Family Physicians(AAFP) recommends providing a few sturdy, armless chairs and high, firm sofasto ensure that large patients can sit and riseeasily.2 Very lowand soft sofas can be difficult for obese patients to navigate.
Other amenities that can make an office more welcoming include handicappedaccessibility, few or no stairs, wide doors, large restrooms, and adequate airconditioning.
Office scales should be capable of measuring well beyond 350 pounds. Butthe National Association to Advance Fat Acceptance (NAAFA) suggests thatpatients not be weighed without a compelling reason to do so. If it isnecessary, providers can weigh patients in a private setting and record theweight without commentary.
Often weight does need to be verified, notes Susan Keane Baker, a healthcare consultant and speaker on service quality, risk management, and patientrelations.
"But some patients might be offended if you take them at their wordon height but insist on your own measurement for weight," Baker says."If the patient declines [to be weighed], the decision can be madewithout raisedeyebrows."
Ideally, in the exam room, examination tables should be sturdy, wide, andbolted to the floor when possible to prevent tipping. The office should haveseveral sizes of blood pressure cuffs available, for the arm and thigh, aswell as longer needles and tourniquets for drawing blood.
A lavatory with a split seat facilitates urine specimen collection, and aspecimen collector with a handle can make the process even easier for largepatients.
"The major thing is just a sensitivity that the obese, andparticularly the morbidly obese, are uncomfortable going to a doctor's officein the first place," says Raul Zimmerman, MD, co-director of the HalifaxMedical Center Weight Management Program in Daytona Beach, Fla.
Size sensitivity can be instilled from the top down. "If staff seethe physician being sensitive and caring, then it will be reflected in thestaff members," Zimmerman says. 
Obesity-Friendly Marketplace
The following companies specialize in products for obese patients:
References
2. National Task Force on the Prevention and Treatment of Obesity:Medical care for obese patients: advice for health care professionals.Am Fam Physician 65:81–88, 2002.[Medline]
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