The Bariatric Reality

America's epic obesity problem seems matched only by the epic statistics on the subject. The Centers for Disease Control and Prevention (CDC) calculated the cost of obesity-related medical care at $75 billion for 2003 — that equates to about $175 for every person in the country. The American Obesity Association estimates there are 60 million obese and 9 million severely obese adults living in the U.S. — and 127 million U.S. adults who are overweight.

So how is the obesity epidemic impacting DME, from product offerings to product sales?

Wheelchair Weight Capacities Rise

Bariatrics — the medical specialty that studies and treats obesity and related conditions — has become so common a part of the DME landscape that many manufacturer Web sites include bariatric navigation buttons to locate heavy-duty products more efficiently. Another sign of our times: "Standard" weight capacities for DME have risen along with weight capacities for bariatric products. For example, in the past few years, Permobil raised the officially listed weight capacities for its power chairs in the American market. Permobil's Street Corpus rear-wheel-drive power chair has a weight capacity of 300 lbs. in the United States. But look at the chair's weight capacity in, for instance, the Australian market, and you'll find it listed as 120 kg, or 264 lbs.

A quick check of other power mobility products shows how "standard" weight capacities are rising. Innovation In Motion's X4-Extreme power chair has a 400-lb. weight capacity, even though the chair is not referred to as a bariatric product. Ranger All Season's Solo scooter and Teftec's OmegaTrac power chair both list standard weight capacities of 360 lbs.— though neither vehicle is considered bariatric and both companies have specific bariatric offerings or options capable of carrying at least 100 lbs. more.

At the same time, more and more vehicles built specifically for bariatric applications are being offered. Sunrise Medical's Quickie S-646 and S-646SE power chairs can carry 400 lbs. each, as can Pride Mobility Products' Jazzy 1170 power chair and Legend XL and Victory XL scooters. Pride's Quantum Rehab division offers power chairs able to carry from 400 lbs. (the Quantum 1402) to 650 lbs. (Quantum 1650). Invacare Corp.'s Storm power chair series carries from 350 to 400 lbs., depending on model and option packages, while its Pronto M94 has a 500-lb. weight capacity.

The Centers for Medicare and Medicaid Services (CMS) seemingly agreed with the need for higher weight capacities for power mobility offerings. The 49 new power mobility codes scheduled to go into effect on Jan. 1, 2006, include sub-groups for Heavy-Duty (user weight up to 450 lbs.), Bariatric (to 600 lbs.) and Bariatric Plus (more than 600 lbs.) vehicles.

And as "mainstream" manufacturers raise their weight capacities, bariatric specialists are doing the same. "Going back 15 years, our maximum weight capacity was 500 lbs.," says Gendron's Steve Cotter. "Today we feature user-weight capacities up to 850 lbs. for a production folding wheelchair and greater weight limit for custom-design chairs." Wheelchairs of Kansas has a 750-lb. power chair called the PEV 2000. 21st Century Scientfic's Big Bounder H-Frame power chair lists a weight capacity of 1,000 lbs.

Your Clients: Bariatric Support & Help

Is bigger better?

Similar trends can be seen in market segments other than wheelchairs and POVs. In bath safety, for instance, Gendron has products rated up to 850 lbs., and Invacare has a bariatric commode listed with a 700-lb. capacity. ConvaQuip, another bariatric specialist, has shower stools and bathtub transfer benches rated to 850-lb. weight capacities, and commodes rated to 1,500 lbs.

Big Boyz Industries, ConvaQuip, Gendron and Wheelchairs of Kansas all offer bariatric beds rated to 1,000 lbs. or more. Liko manufactures a patient lift with a 1,014-lb. lifting capacity. Both Med-Lift & Mobility and Golden Technologies manufacture lift chairs with 500-lb. capacities. Rising obesity numbers even impact DME categories without weight limits, such as diabetic supplies. According to the Centers for Disease Control and Prevention (CDC), the number of adults living with diabetes in the United States rose from 5.8 million in 1980 to 13.8 million in 2003, implying a vastly greater need for diabetic supplies, such as lancets.

Higher weight capacities and the barrage of statistics about the obesity epidemic might suggest that developing bariatric products is as simple as increasing weight capacities, seat widths and seat depths. But while there is a need for increased weight capacities, meeting the DME needs of bariatric clients is not just a matter of bigger being better.

"The obesity epidemic will be with us for awhile," says Invacare's John Lescher. "Weight capacities will continue to rise, but eventually it will reach a cap. Depending on what the product is, there is a point where it just does not make logical sense anymore to raise the capacity."

Rather, the future evolution of bariatric DME is likely to rest in design and function elements specifically created for the obese client. At the heart of this challenge is the fact that bariatric clients are not created equal, so two people each weighing 500 lbs. may look very different. Clinicians describe obesity as taking two general forms. Clients with abdominal obesity — the stereotypical "apple" shape — carry their weight around the abdomen. "Pear-shaped" clients with gluteal-femoral obesity carry their excess weight mainly on the thighs and rear end.

The different types of obesity cause different DME challenges. For instance, clients with abdominal obesity may require deeper seats on wheelchairs, POVs, commodes or shower chairs. Balancing the weight safely in the chair or seat so tipping does not occur can also be an issue. Clients with gluteal-femoral obesity may require wider seats, may have a hard time reaching pushrims in order to effectively self-propel a manual wheelchair, and may need special legrests to support their weight.

It is not enough, therefore, to merely make a seat "bigger" or a wheelchair more "heavy-duty." Says Gendron's Steve Cotter, "Beginning about six years ago, we overhauled our entire wheelchair line... our users and dealer customers were very vocal about the design elements and features needed for this type (of) client. We learned very quickly (that) one size does not fit all."

So while bariatric weight capacities will hit a ceiling, and seat depths and widths will continue to increase, look also for manufacturers to increasingly incorporate design features especially helpful to bariatric clients, including seats/backs with overhangs to support soft tissue around the waist and buttocks, and the non-skid, protective material placed on top of the wheel wells of Ranger's Solo 550 scooter, so a driver can rest his feet there instead of having to tuck his legs onto the floorboard.

"We've done a lot of redesigning on it," says Ranger All Season's Randy Riecks, in explaining that bariatric development entails much more than simply expanding a seat or frame. "We triple-reinforced the front frame on the 550, and we've gone to a larger-diameter seat post. There's a plate underneath where the lower seat base bolts to the bottom?there's a plate underneath it that reinforces that (area). And there's a plate also on the front that reinforces the front where the tiller comes through, because that takes a lot of weight. A lot of people use (the tiller) to push themselves up and down."

What's the size of this market?

Ironically, for all the statistics about the obesity epidemic, at least one DME manufacturer doubts the bariatric market will ever show explosive growth.

"It's going to take a few years for everyone to come to the conclusion that the bariatric market is really not as large as they're making it sound," says Joe Battiston of TFI Healthcare. "You cannot relate obesity to bariatrics."

"It is not an enormous market for per-piece volume," agrees David Battiston, Joe's brother. As an explanation, the Battistons suggest envisioning a typical American restaurant. While as many as half the customers in the restaurant will be overweight, according to current statistics, relatively few of them will be obese to the point of needing DME to compensate. Even fewer will be morbidly obese to the tune of 750 to 1,000 lbs., which suggests that bariatric products with the highest weight capacities are not yet in great need. And may never be.

But what will continue, at least until Americans take steps toward reducing obesity, is the need for bariatric DME developed specifically for these clients' special needs. "We are seeing obesity increase not only in the United States, but globally as well," says Invacare's John Lescher. "As the market continues to evolve, so will the products."

Your Clients: Bariatric Support & Help

Jokes, taunts, stereotypes and blame: People living with obesity have likely heard and experienced a lot of it. In fact, such behaviors have been called the "last acceptable form of discrimination" in American culture. Consider the conclusions of two obesity-related studies:

  • Mildly obese Caucasian women earned 5.9 percent less than standard-weight counterparts. Morbidly obese Caucasian women earned 24.1 percent less. — Employment-discrimination study by Mark Roehling, Western Michigan University
  • 24 percent of nurses said they felt "repulsed" by obese patients. — R. Puhl and K.D. Brownell in a study entitled "Bias, discrimination, and obesity," Yale University
  • For all the talk of an obesity epidemic, it's surprisingly difficult to find Internet resources related to obesity support and advocacy (unless you count the plethora of Web sites hosted by companies specializing in surgical interventions). One worth passing on to your clients is www.obesity.org, the site of the American Obesity Association (AOA).

While the AOA does receive some funding from companies such as Jenny Craig and Weight Watchers, it is also supported by the American Association of Retired Persons, the American Dietetic Association, the American Society of Bariatric Physicians and the State of Maryland Department of Health and Mental Hygiene, among others. The site has sections devoted to advocacy, employment and health-care discrimination, consumer protection, obesity as a disability and childhood obesity.

There's also a community section, where visitors can share their own stories. Says one writer, who said she had to use truck scales at a grain co-op to determine her true weight: "If you read this, just know you are not alone in the battle of obesity."

This article originally appeared in the July 2005 issue of HME Business.

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