This document discusses caring for bariatric patients in a safe and sensitive manner. It notes the increasing rates of obesity and associated health issues. Bariatric patients face weight loss difficulties, medical problems, and psychological stigma. Hospitals must consider the financial impact of caring for these patients and safety issues. Caregivers should focus on rapport, environment, safety, privacy, encouragement, caring, and tact. The needs of bariatric patients include comfort, safety, and self-esteem. Educating staff and ensuring appropriate equipment can help hospitals prepare.

1. Uniquely Yours
Safety & Sensitivity in Caring
for the Bariatric Population
By Tracy M. Morris, BSN, RN-BC, Clin. IV
Rucker 4 Clinical Educator

2. Overview
• Introduction
• View the objectives
• Discuss specific issues bariatric patient’s
encounter
• Discuss issues hospitals face providing
care to the bariatric population
• Conclusion

3. Objectives
Increase awareness of what weight bias
is, it sources and consequences
Verbalize the safety and sensitivity
needs of caring for the bariatric patient
Understand your role and how important
it is in caring for the bariatric population

4. Ultimate Goals
• Be inspired to make
changes in your
practice
• Make adjustments in
your perceptions
toward caring for the
bariatric population
• Better outcomes for
our patients

5. Introduction
• Quick Stats:
– Between 1962-2000, the # of obese people
in the U.S. increased from 13% to an
alarming 31% (American National Center
of Health).
– Today, ~63% of Americans are overweight
(BMI of 25 or >) (American National Center
of Health).
– 93 million Americans are obese, with the #
predicted to climb to 120 million in the next 5
years (Obesity Action Coalition).
– The U.S. spends $147 billion per year on
obesity related illnesses (CDC’s Weight of
the Nation).
– In Virginia (2006), 20-24% are obese (BMI
=or>30).

6. Introduction
• Based upon:
The escalation of obesity rates + The
# of co-morbid conditions related with
obesity = healthcare providers in
most all practice settings can expect
to care for bariatric pts.
• Providing safe, quality care to this
population can present many
challenges to healthcare providers
and their organizations.

7. Obesity & Bariatrics Defined
• Obesity – A disease characterized by
excessive body fat.
– People who are medically obese usually are
affected by behavior, genetic and environmental
factors that are difficult to control with dieting
(OAC).
• Bariatrics - branch of medicine that deals
with the causes, prevention and treatment of
obesity. Encompasses dieting, exercise and
behavioral therapy approaches to weight
loss, as well as pharmacotherapy and
surgery (en.wikipedia.org/wiki/Bariatrics).

8. Obesity & Bariatrics Defined
• Body Mass Index (BMI) r/t ―ideal body
weight‖
– 25-29.9 = overweight
– 30-34.9 = obese
– 35-39.9 = severely obese
– 40 & over = morbidly obese

9. Reasons for Obesity Epidemic?

10. Issues the Obese Patient Faces
• Weight loss difficulties
• Mounting medical problems
• Psychological stigmas—research has
found that obese pts. will often avoid
seeking medical care for fear of
insensitive handling or that the
healthcare facility will NOT be able to
accommodate their needs.

11. Issues/Concerns Hospitals Face in
Providing Care to the Obese Patient
• Financial Impact—the CDC estimates care
for the overweight/obese pts. costs an
average of 37% more than for people of
normal weight  adding an average of
$732 to the annual bill of each American.
• Daunting safety implications for both the
pt. and caregivers.
• Typically, obese pts. need more care than
the average-sized person.

12. What Do You Find to be Different in
Caring for the Bariatric Population?

13. Areas of Impact with Increase in
the Physical Size of Our Patients
• Skin care
• Respiratory challenges
• Assessment
• Resuscitation measure
• Altered drug absorption
• IV access
• Mobility issues
• ?Injury to patient or you (equipment, workload,
etc.)

14. What is Weight Stigma/Bias?
• Weight stigma is bias and discrimination
aimed at overweight people based on a
series of social attitudes that people
develop overtime, that assumes that there
is something wrong with overweight
people and they deserve to be punished
for their condition. – Rudd Institute

15. Video

16. Sources of Weight Bias/Stigma
• Frustration in helping obese pts. to lose weight
to no avail
• Fear of injuries
• Aggravation in completing a difficult task
• Challenges associated with providing care to the
bariatric pt. can be overwhelming and may elicit
feelings of inadequacy, powerlessness, and fear
– feelings may be projected on the pt. in subtle
and implicit ways and may be experienced by
the pt. as bias.

17. Snuffing Out Bias and
Stigma Associated with Obesity
• Education is the key!
– Project Implicit (Implicit Association Test)
• https://implicit.harvard.edu/implicit/demo
• ―It is well known that people don’t always ―speak their minds,‖
and it is suspected that people don’t always ―know their minds.‖
– Advance Fat Acceptance www.naafa.org
– Obesity Action Coalition www.obesityaction.org
– Rudd Center for Food Policy & Obesity – Yale
University www.yaleruddcenter.org
– American Society for Metabolic & Bariatric Surgery
www.asbs.org

18. Safe Patient Handling
• The best way to
ensure safe pt.
handling is through
the use of special – Beds
equipment – Wheelchairs
manufactured to meet – Gowns
the size/weight – Blood pressure cuffs
requirements of the – Lift systems
obese pt.
– Scales
• Essential bariatric – Bedside commodes
items ----------------- – Stretchers

19. Other Essentials
• Sturdy armless chairs specially designed
bariatric chairs.
• Scales with a wide base, located in a
private area.
• Sturdy stool when assisting patient on/off
stretcher.
• Trapeze bars above beds

20. A Model for the Sensitive
Treatment of the Bariatric Patient
• R-E-S-P-E-C-T Model is the key to providing
quality, patient-centered, sensitive care to the
bariatric patient.
– R-rapport
– E-Environment/Equipment
– S-Safety
– P-Privacy
– E-Encouragement
– C-Caring/Compassion
– T-Tact
Bejciy-Spring, S. (2008) Respect: A Model for the Sensitive Treatment of the
Bariatric Patient. Bariatric Nursing and Surgical Patient Care.

21. A Model for the Sensitive
Treatment of the Bariatric Patient
The sensitive treatment of bariatric patients
involves recognizing and attending to their:
Comfort Safety Self-esteem
Needs Needs Needs
In combination with addressing their health problems.

22. A Model for the Sensitive
Treatment of the Bariatric Patient
This appreciation for and responsiveness
to the unique
Physical
Characteristics Psychological Social
Characteristics Characteristics
of the bariatric patient is integral to optimal patient
care and positive clinical outcomes.

23. Your Very Important Role
• Rapport:
– Acknowledge each of your patients as an individual
– Include the patient’s family/friends in their care
– See the person, not the pounds
• Environment:
– Get the room ready before the patient/family arrives
– Appropriate sized gown, BP cuff, toiletry needs (floor
mounted toilets), and equipment (trapeze bar, properly
mounted grab bars, sturdy step stool)
– Appropriate furniture in room (sturdy & armless chairs)

24. Your Very Important Role
• Safety:
– Ensure safe pt.
handling by the
utilization of special
equipment
manufactured to meet
the size/weight
requirements of the
obese pt.

25. Your Very Important Role
• Provide privacy
– Procedures for weighing patients
• Ensure weighing takes place in a private setting,
the weight is recorded silently, and free of judgment
• Ensure scale is sufficient to accommodate
• Encouragement:
– Acknowledge to your pts. how difficult it is to
lose weight, focus on the pts. health
modification behaviors, not the number on the
scale

26. Your Very Important Role
• Reveal you care – Show compassion:
– Touch your patient!
– Treat obese pts. with gentleness, tact and
concern
• Tact:
– Avoid any display of frustration or distaste
when doing difficult examination
– People who are obese crave what anybody
else craves, which is just respect and dignity

27. Reality
• Only 1/11 physicians have a scale that goes over 300
pounds.
• Research studies have found that healthcare
professionals, including those specializing in the care of
the bariatric patient, have strong negative associations
and attitudes toward obese persons (Bejciy-Spring,
2008).
These pts. feel unwelcome & mistreated in healthcare
settings, where they encounter negative attitudes and
remarks, discriminatory behaviors, and challenging
physical environments.

28. Health
OBESE
Problems/
CONDITION Co-morbidities
Unhealthy Behaviors/ Need for Health Care/
Self-care/Esteem Interventions
Avoidance of Exposure to Bias in
Healthcare Health Care
Negative Feelings/
Emotional Responses
Bejciy-Spring, S. Bariatric Nursing, vol. 3, no. 1, 2008

29. Preparing Hospitals
• Educating staff
• Having a policy to
address attainment of
bariatric equipment
• Utilize bariatric
equipment (purchase or
rent)
• Facility renovations
• Promote a culture of
sensitivity!

30. Take Home Message
• The bariatric pt. has the
right to be treated as a
unique individual and
receive competent
healthcare and medical
treatment with the same
attention to quality,
comfort, safety, privacy,
and dignity as all other
patients (Bejciy-Spring, S.
2008).

31. Remember in your practice:
"Too often we underestimate the power of touch, a smile,
a kind word, a listening ear, an honest compliment, or the
smallest act of caring, all of which have the potential to turn a
life around." --Dr. Leo Buscaglia