Bariatrics: A New Generation

Are adolescents the next wave of consumers for HMEs?

Try this test at home: Watch one news program or read one newspaper and you are likely to come across a story related to the nation's obesity epidemic. I tried this non-scientific test myself. First I watched the local Dallas news and saw a story about how more than a quarter of National Football League (NFL) players qualify as obese -- equivalent to a 6-foot man weighing between 260 and 300 pounds. Then I picked up a newspaper, and read a story about how California Governor Arnold Schwarzenegger wants to get rid of junk food in all of California schools. As the second-leading cause of preventable death in the United States, obesity is not only an epidemic, but also a disease that is having a significant impact on the durable medical equipment (DME) industry.

Obesity is a disease that affects nearly one-third of the adult American population, approximately 60 million adults, according to the American Obesity Association. The number of overweight and obese Americans has continued to increase since 1960, a trend that is showing no signs of slowing down.

"Demand for treatments and DME for bariatric patients has increased and will continue, in our opinion," says Steven Cotter, president of Gendron, Archbold, Ohio.

Most manufacturers say that this media onslaught and increased awareness of obesity over the last five years has translated into an increased demand for DME products. Consumers who are obese and have related mobility limitations are now more likely to be aware of bariatric products that exist. As a result, the market has grown, end-users now have more products to choose from, and manufacturers say that price points are dropping. End-users now can find a greater selection of bariatric patient lifts, wheelchairs, standers, beds and bath safety products to choose from in this market. No longer is bariatrics a niche market where only a few manufacturers are specializing in a bariatric product line; most manufacturers are recognizing the need to have larger weight capacities or bariatric versions of their current product line in order to meet consumer demand.

"This is a rapidly growing market; there used to be only specialized dealers offering these products, and now it seems like all dealers want/need bariatric products in their showroom and product lineup," says Tim Berry, director of mobility product marketing at Sunrise Medical Inc., Longmont, Colo.

To respond to this need, Berry says, Sunrise "must offer products that range from pediatric to standard to bariatric. It now seems like all standard products need a bariatric offering such as wheelchairs, canes, quads, walkers and wheels, etc."

Gendron has responded to meet consumer demand as well. "We've been able to help address a number of issues through the design of unique products that benefit both the patient and caregiver. We have developed bariatric beds for in-home care, long-term care and acute care that each have unique features depending on the care environment -- bariatric seating (furniture) for public spaces and health-care facilities, and of course, wheelchairs for users weighing up to 850 pounds," Cotter says.

Today, 127 million people are categorized as being overweight or obese. Each year, obesity causes at least 300,000 excess deaths in the United States, and health care costs of American adults with obesity amount to approximately $100 billion. But not only are more Americans obese, many are also more severely obese. The fastest-growing group of obese Americans consists of people who are at least 100 pounds overweight.

"It seems like the minimum acceptable weight capacity is rising and is now around 300 pounds for standard products. It used to be in the region of 200-250. Now the starting point for bariatric seems to be 500 pounds, but is creeping upwards to offer 1,000-pound ranges too," Berry says.

If historical obesity trends are to continue through 2020 without other changes in behavior or medical technology, the proportion of individuals reporting fair or poor health would increase by about 12 percent for men and 14 percent for women, compared to 2000. Up to one-fifth of health-care expenditures would be devoted to treating the consequences of obesity, according to Rand Health, a nonprofit research organization.

When assessing dealers' and therapists' core product needs, "80 percent of bariatric products seem to be in the 500 pound range; we want to make sure we cover the standard bariatric product offerings, as we do in all other DME product needs," Berry explains.

Although some price points might be dropping due to consumer demand, product costs are potentially rising, Berry says, "due to increased materials to safely support patient weight."

In addition to a consumer base with more obese and greater weight capacities, another trend in this market is emerging: Obesity is occurring at a much younger age. Mental health problems are the fastest-growing cause of disability in the non-elderly category, studies at Rand Health suggest that the fastest-growing causes of disability for younger people are diabetes and musculoskeletal problems -- conditions associated with obesity. One in five children is overweight, and more are becoming obese. The term "childhood obesity" may refer to both children and adolescents, according to the American Obesity Association. Children are defined as being from to six to 11 years of age, and adolescents from 12 to 19 years of age. About 15.5 percent of adolescents ages 12 to 19 and 15.3 percent of children ages 6 to 11 are obese.

The dramatic increase in childhood obesity is illustrated in the two tables from the American Obesity Association below:

Table 1.
Prevalence of Obese Children
Ages 6 to 11 at the 95th percentile of Body Mass Index
1999 to 2000 15.3 percent
1988 to 1994

11 percent

1976 to 1980 7 percent
Table 2.
Prevalence of Obese Adolescents
Ages 12to 19 at the 95th percentile of Body Mass Index
1999 to 2000 15.5 percent
1988 to 1994

11 percent

1976 to 1980 5 percent

A rise in obesity rates among the young has led to an increase in medical conditions once thought to be adult conditions. No longer is type 2 diabetes referred to as "adult onset," since so many adolescents are now diagnosed with type 2. Other obesity-related conditions now found among children include asthma and hypertension.

Manufacturers of bariatric products may have a difficult time gauging if their products are going to younger customers since they don't typically track the demographics of consumers at HME stores.

"This is a hard area for me to tell you specifics. Since our products come in sizes from small pediatric to extra large adult, we don't always know if the dealer/supplier is upsizing the product due to childhood/adolescent obesity," says Nancy Perlich COTA, ATS and the product and reimbursement specialist for Altimate Medical, Morton, Minn. "The only way we've heard that changes to product are necessary is when we do custom mods, such as wider brackets for lateral thoracic and hip supports, wider arm supports, longer seat/hip belts...etc., "I do believe in general that the market for larger DME products and more medical care will continue to grow if we as a country don't get control of the weight issue starting with very young children," Perlich says.

While the rapid growth of the bariatric market might be viewed as a gold mine in potential sales, many manufacturers and HMEs indicate that they don't view it as such since the gold mine typically translates into consumers in poor health.

With prevention being the key to pediatric care, research shows that the best opportunity to address obesity is in childhood, as change becomes more difficult when children reach adolescence. Obesity most commonly begins in childhood between the ages of five and six. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult. And a likelihood of becoming the next HME bariatric client.

Younger clients who are obese will be using the same bariatric product solutions as their adult counterparts. "Bariatrics is more of a function of weight than age, so as adolescents get larger, they probably will require similar solutions to same-sized adults," Berry says.

Looking into the future, Berry says, "We would expect standard products to keep increasing to 350-400 pounds and see bariatric creep from 500 upwards to the 1,000-pound range."

Ed Link, president of Drive Medical Design & Manufacturing, Port Washington, N.Y., thinks the market will continue to grow "until a level of awareness and education changes lifestyles."

"I believe awareness and education assists greatly at every level of the channel from end user to manufacturer. The more people and organizations know about a particular issue, the better prepared they are to change it," Link says.

American physicians are thought to be underestimating the problem of teenage obesity with as many as 2.1 million teens who already have evidence of dangerous complications of obesity and are slipping through a dangerous gap in diagnostic measurements if pediatricians use the same formula to measure teens as they do children. Young children are measured with growth charts and are rated in a percentile of children in the same age bracket, and this works for kids who are still growing, but not for teenagers. Many physicians suggest that teenagers be measured by adult standards to define overweight and obesity — a BMI of more than 25.

Peggy Walker, billing and reimbursement advisor for VGM/U.S. Rehab, says that Medicare and Medicaid are now looking at all bariatric DME and that adolescents will be billed under adult codes. "We just started getting codes for bariatric hospital beds, walkers and bed-side commodes in the last three to four years, but now all of bariatric is being looked at."

"We foresee continued growth because of the demographics of the bariatric population and funding sources recognizing that treating the core health issue of obesity is more cost-effective than treating all systemic diseases that are a result of obesity," Cotter says.

Is your bariatric equipment being used for adolescents or adults? E-mail your answers to Sandra Bienkowski, managing editor of Mobility Management at

Juvenile Diabetes
When people used to hear of children with diabetes, it was assumed that it was type 1 or juvenile-onset diabetes. However, according to the Centers for Disease Control (CDC) in the last two decades, type 2 diabetes (formerly known as adult-onset diabetes) has been reported among U.S. children and adolescents with increasing frequency. Children and adolescents, diagnosed with type 2 diabetes and generally between 10 and 19 years old, are typically obese, have a strong family history for type 2 diabetes and have insulin resistance.

  • Diabetes in children, especially in the "under five" category, has been rising at an alarming rate, according to the Juvenile Diabetes Research Foundation.
  • Health-care providers are finding more and more children with type 2 diabetes, a disease usually diagnosed in adults aged 40 years or older.
  • A statistically significant increase in the prevalence of type 2 diabetes among children and adolescents was found only for American Indians.
  • The epidemics of obesity and the low level of physical activity among young people, as well as exposure to diabetes in utero, may be major contributors to the increase in type 2 diabetes during childhood and adolescence.
  • Type 2 diabetes in children and adolescents already appears to be a sizeable and growing problem among U.S. children and adolescents. Better physician awareness and monitoring of the disease's magnitude will be necessary.

Obesity's Impact on Health-Care Costs

  • When body mass index (BMI) exceeds 30, the relative risk of obesity-related death increases by 50 percent.
  • Overweight employees experience 45 percent more hospital stays.
  • High cholesterol equates to 16 percent higher annual claims.
  • Smokers equate to 27 percent higher annual claims.
  • High blood pressure equates to 12 percent higher annual claims.
  • Poor nutrition equates to 15 percent higher annual claims.
  • High stress equates to 40 percent higher annual claims.
  • Sedentary lifestyle equates to 13 percent higher claims.

- American Specialty Health

Morbidly Obese Pay Twice as Much for Health Care

  • Five million adults are considered morbidly obese -- defined as being 100 pounds or more over ideal body weight or having a BMI of 40 or higher.
  • Between 1990 and 2000, the prevalence of morbid obesity increased from .78 percent to 2.2 percent.
  • Medical expenditures for morbidly obese adults are twice those of people considered to be of normal weight.
  • In the year 2000, medical expenditures for morbidly obese adults were 81 percent more than for normal-weight adults, 65 percent more than overweight adults and 47 percent more than obese adults.
  • Morbid obesity is associated with a substantially increased risk of sickness and death from chronic health conditions such as diabetes, hypertension, cardiovascular disease and cancer.

This article originally appeared in the April 2005 issue of Mobility Management.

In Support of Upper-Extremity Positioning