I’m thrilled that Mobility Management is now publishing quarterly newsletters to focus on specific topics within Complex Rehab Technology (CRT) — and we’re kicking off the series with bariatric mobility.
Given all the different specialties within CRT, why bariatrics?
One reason is the relative scarcity — it seems to me, anyway — of bariatric mobility reporting.
Bariatric surgery is an ultra-popular internet topic. So are bariatric medicine and general weight loss. And there are plenty of bariatric wheelchairs for sale, particularly manual wheelchairs of the durable medical equipment type, with few or no specialized positioning functions.
Judging solely by these wheelchair listings, you’d think bariatric mobility is as simple as making wheelchairs wider and using steel instead of aluminum to build wheelchair frames.
But this specialty isn’t as simple as that — is it? Even if a bariatric patient lacks the neuromuscular diagnosis that’s the core of CRT, doesn’t a higher body weight often create complexity?
“That’s a good question and observation,” said Brad Peterson, Amylior’s vice president of global clinical sales and education.
Brad referenced the recent battle to win Medicare funding for power seat elevation on power wheelchairs, and the CRT industry’s contention that two sets of HCPCS codes and allowables — one for standard patient weights, and one for bariatric weights — were necessary to ensure proper access to the technology.
“Going back to the power seat elevation code and wanting one specific to heavy duty: Everybody who was in that work group felt that heavy duty should be treated differently,” Brad said. “And that is because while [clients] may not be complex in terms of a neurological condition or a need for specialty drive controls, to get the best outcomes — which is what I hope we’re all looking for — you need to have something that’s made specifically for them and something that allows us to accommodate their different shapes and sizes.”
My second reason for focusing on bariatrics is to celebrate the complex work that supports better client outcomes.
In addition to reading my Q&A with Brad Peterson in this edition, I hope you’ll read “Considerations When Working with the Bariatric Population” by Stephanie Tanguay, OT/L, ATP, clinical education specialist for Motion Concepts. It’s chapter 24 in the new Seating and Wheeled Mobility: A Clinical Resource Guide, second edition, edited by Michelle L. Lange and Jean L. Minkel.
Steph has long championed the unique needs of bariatric end users and has spent so much of her career teaching colleagues how to take accurate client measurements during seating clinic and how to accommodate a client’s panniculus, as examples — all while treating the client with respect and compassion.
Mainstream articles suggest by their simplicity that bariatric mobility is simply a matter of accommodating higher body weights. In reality, seating professionals with bariatric clients know that every presentation is unique. In some cases, weight is distributed uniformly throughout the body. But many other clients, such as those with lymphedema, will present with most of their weight in their lower extremities. Or with adipose tissue on the backs of their thighs that keeps them sitting on the front of the seat and unable to make good contact with the back support.
An April 2017 study — “From Stigma to Empathy: Reframing Our View of the Bariatric Patient,” published in Bariatric Times — said obese patients reported “devaluation of self, embarrassment in social situations, embarrassment about appearance, repeated failure of weight loss diets, frustration arising from limitations.” Researchers added that obese individuals “are often negatively perceived as weak willed, lazy, unmotivated, unsuccessful and/or unintelligent people who have poor will power, lack self discipline, and are nonadherent to weight loss treatment.”
Literature reviews suggested that weight bias is increasing; that it takes place in all settings, including in workplaces and within patients’ families; and that health-care professionals can also exhibit weight bias against patients with obesity, with some professionals spending less time with bariatric patients.
The right seating and wheeled mobility can optimally position bariatric patients, help with weight shifting and pressure relief, support safe and efficient performance of activities of daily living, slow or prevent progression of conditions, lead to greater inclusion and participation … in other words, seating and mobility can do for bariatric clients what it can do for clients of all sizes.
For bariatric clients to be treated with care and dignity, and to have access to the most appropriate seating and wheeled mobility currently on the market — that would be a wonderful goal for CRT and health care in general to work toward in 2025 and beyond.
