Creating an Obesity-Friendly Practice

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:

• Amplestuff, PO Box 116, Bearsville, N.Y. 12409. 866-486-1655.www.amplestuff.com.Catalog includes medical items, such as large-sized hospital gowns and bloodpressure cuffs, as well as a variety of products for home and travel.

• ConvaQuip Bariatric Equipment, PO Box 3417, Abilene, Texas 79604.800-637-8436.www.convaquip.com.Online catalog lists chairs, commodes, gurneys, beds, wheelchairs, andmore.

• Hausmann Industries, 130 Union St., Northvale, N.J. 07647. 888-HAUSMANN(888-428-7626).www.hausmann.com.Offers a wide variety of exam and treatment tables accommodating increasedweight capacities.

• Moore Medical Corp., PO Box 1500, New Britain, Conn. 06050-1500.800-234-1464.www.mooremedical.com.Offers many of its products in oversize dimensions and with additional weightcapacity, such as large dressing gowns, exam tables, ambulance transfer cots,and scales that can withstand up to 600 lbs.

• Rehab Seating Solutions, Eight Alton Pl., Suite #3, Brookline, Mass. 02446.800-525-SEAT.www.rehabseating.com.Manufactures and markets the Ascender Seating System product line—safetychairs, bariatric chairs, orthopedic chairs, and transporters used byhospitals, rehab centers, nursing homes, and individuals.

• Shamron Mills Ltd., 242 West 38th St., New York, N.Y. 10018. 800-426-1414.www.shamron.com.A patient gown and scrub-suit company. About 50% to 65% of its patient-gownsales are extra large to 10XL.

• Standard Textile Bariatric Gowns, One Knollcrest Dr., Cincinnati, Ohio45237. 800-999-0400.www.standardtextile.com.

• Superior Pad Outfitters, 6295 Foley Ln., Central Point, Ore. 97502-9606.888-855-7970.www.superiorpads.com.Provides patient gowns up to size 10XL.

• Trimline Medical Products Corporation, 34 Columbia Rd., Branchburg, N.J.08876.www.trimlinemed.com.Sells bariatric blood pressure cuffs.