1 Introduction

1.1. Overview

Obesity is one of today’s most significant health problems. Handling and mobility tasks associated with bariatric populations are complex because of excess patient weight and weight distribution, decreased mobility, and numerous co-morbid conditions Evidence demonstrates the benefit of a multifaceted, interprofessional, comprehensive Safe Patient Handling and Mobility (SPHM) Program that utilizes appropriate technology necessary to safely lift, move, and mobilize patients (American Nurses Association, 2013). The use of SPHM policies and procedures, technology, and training are especially critical when providing care to the bariatric patient.

The World Health Organization recognizes the pandemic nature of obesity and contends that obesity in adults now affects three times more people than it did 20 years ago Obesity exists regardless of gender, race, age, or regional location The proportion of Americans who are severely obese continues to increase rapidly and much faster than those with moderate obesity according to a RAND Corporation study (Hattori & Sturm, 2013). The RAND study also states that severe obesity is no longer a rare pathological condition among genetically vulnerable individuals; instead the condition affects all groups of individuals The RAND study goes on to state that from 2000 to 2010, the proportion of Americans who were severely obese rose from 3.9 percent of the population to 6.6 percent, an increase of about 70 percent. The RAND study found that more than 15 million adult Americans are morbidly obese with a body mass index (BMI) of 40 or more. It has been estimated that by 2030, 50 percent of the population will be obese (Finkelstein et al., 2012). The implication to SPHM planning teams is that programs best serve patients and caregivers when they address issues of size.

There are a number of ways to measure and define obesity. The value of a standardized measurement and/or definition is that care concerns can be anticipated simply because of an established criterion. The following are some of the recognized standard definitions within the health care setting.

 Body weight greater than 300 pounds [137 kilograms (kg)] (Muir, 2009).

 BMI of 40 or more or large physical dimensions (World Health Organization, 2000).

 Overweight by greater than 100-200 pounds (45-90 kg) (ARJO, 2005).

 Those with limitations in health due to physical size, health, mobility, and environmental access (Bushard, 2002).

Each of these definitions has value and tends to help caregivers recognize the patient who is at-risk simply because of body weight. However, for purposes of providing reasonable accommodation to patients who are challenged by excess weight or weight distribution and for the purpose of this document, the bariatric patient is defined as:

Any individual whose weight and/or size interferes with the ability to provide safe, reasonable care (Gallagher, 2012)

This may be the patient who has a normal range BMI because of excess height, yet their body weight cannot be accommodated with standard equipment because the patient’s weight exceeds the weight capacity of the bedframe. Conversely, this may be the patient with a low body weight but because of short stature, has a very high BMI and hip width, and cannot be accommodated safely in a standard bedframe because hip width exceeds width of the standard bedframe (see Enclosure 1-1 for examples of BMI Charts). The broad definition adopted by this guidebook allows caregivers the ability to create meaningful criteria to identify the patient at-risk for the common, predictable, and preventable consequences of immobility associated with size (Gallagher, 2011).

Statistics reveal that patients with a BMI greater than 35 are associated with nearly 30 percent of patient handling injuries (Drake, 2009). In addition, research shows that safer environments of care increase the quality of patient care as noted in recent publications by The Joint Commission (2012) and the Lucian Leape Institute publications (Lucian Leape Institute and National Patient Safety Foundation, 2013). To address the issues associated with patient and employee safety, the American Nurses Association (ANA) recently published Safe Patient Handling and Mobility: Interprofessional National Standards (ANA, 2013) and the corresponding Implementation Guide (Gallagher, 2013). These standards can be applied to all health care settings and used by all health care workers across the continuum of care to support improving the safety of both the health care worker and the patient, including the bariatric patient.

Increasing interest in health care safety and quality in a general sense, along with legislative movement pertaining to SPHM, and bariatrics emerging as a health care specialty, have worked synergistically to call for a safer care environment for the bariatric patient. As with all patients, the bariatric population is best served when treated with dignity and respect. This is accomplished when health care facilities have a plan in place that supports bariatric safe patient handling and mobility to optimize patient outcomes, reduce the risk of caregiver injury, and promote a size-sensitive culture.