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Best Practice in Obesity

Advocate for the best equipment possible.

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A major challenge I face while working in the field of occupational therapy as a COTA is the lack of bariatric hospital beds, wheelchairs, mechanical lifts, commodes, shower chairs and transfer benches in nursing homes and rehab facilities to accommodate obese clients. Even more basic items, like hospital gowns and adult diapers, are not available in all settings.

Not having the appropriate equipment can hinder clients' progress in therapy and lead to decreased independence. If a facility cannot provide an obese client with a commode that can safely accommodate his weight, that patient may be forced to use a bed pan when he actually may be able to get up and transfer to a commode. Using a bed pan can be humiliating for an individual, and it also can make him more dependent on staff for toileting. It may limit opportunities for working on transfers and functional mobility.

Without three-in-one commodes and shower chairs, obese clients are left with only the option of sponge bathing in bed. They are then more risk for skin breakdown. Sponge bathing in bed is often inadequate for the obese clients, as they may have difficulty maneuvering in bed and reaching certain areas of their body to ensure a thorough cleaning and proper hygiene.

In the article "Obesity and Occupational Therapy Practice" 1, author Letha Mosley describes an experience with a client who was admitted to a rehabilitation center to address limited mobility and pain secondary to morbid obesity. The client weighed approximately 700 pounds. The rehab facility was not set up to safely meet her needs. While she was transferring onto the toilet, it gave way; and she fell and broke her humerus. Mosley said that at that moment she realized that "her role was not to address obesity through a weight management program, but to address the functional implications of obesity and to equip the client with the tools necessary to improve her occupational performance and quality of life." She then used her clinical reasoning skills as an OT to try to do that.

It is best practice to advocate for our clients to obtain the equipment that they need to function safely and independently and use our clinical reasoning skills to help them problem solve through their challenges with activities of daily living.

And, indeed, weight loss itself through lifestyle changes can be a big part of occupational therapy practice. The Centers for Disease Control says about 34 percent of U.S. adults ─ or 72 million people ─ are obese today, compared to about 15 percent in 1980.2  It's attributable to overall increased food intact, increased intake of unhealthy foods, decreased intake of healthy foods, and decreased physical activity. And as we go though tough economical times, and are now busier than ever, it may be even more difficult to afford healthy food and make time for physical activity.

OT can provide interventions with individuals, groups and society as a whole to effect change to promote optimum health. 3 Therapists and therapy assistants can address obesity in of variety of different ways through education and community wellness programs that help people develop healthy, meaningful habits and routines. We also can make excellent activity and environmental modifications recommendations to allow for increased independence, and offer adaptive equipment training and recommendations for home modifications.

Sarah Podlasek, COTA, received her BS degree from Utica College and will graduate with her master's degree this month, and will begin practicing as an OT. She lives and works in Rochester, NY.

References
1. Mosley, J.; Jedlicka, J. S.; LeQuieu & Taylor, F. D. (2008). Obesity and Occupational Therapy Practice. OT Practice. Retrieved December 14, 2009, from http://findarticles.com/p/articles/mi_7687/is_200804/ai_n32196081/

2. Center for Disease Control and Prevention. (2009, November 28). No Increase in Obesity, but Levels Still High. Retrieved December 14, 2009, from http://www.cdc.gov/obesity/data/index.html

3. Clark, F., Reingold, F. S., & Salles-Jordan, K. (2007). Obesity and Occupational Therapy (Position Paper). The American Journal of Occupational Therapy, 61(6), 701-703.


 

I really enjoyed reading this article. As a COTA who has worked in sub-acute and long term care for 6 years I also see this as a problem. Especially with all the new changes in healthcare and medicare. It appears the only concern that the facilities have is to fill the beds for the reimbursement. Our facility lacks the necessary equipment to work with these clients. We might have one bariatric commode, but more than one bariatric client. I think as Occupational Therapists and Occupational Therapy Assistance, we can educate administration and other staff members on the implications of caring for obese clients without the proper and necessary equipment.

Laura Fay,  COTAFebruary 18, 2012
Troy, NY



This is an area of healthcare that I previously had not given much thought, but now have better understanding of some additional obstacles an obese individual could have during rehabilitation. It is concerning that there has not been a more proactive approach in healthcare facilities to provide better and more appropriate services to this population. Every person receiving therapeutic services deserves the same level of care regardless of their size or weight.

Robin Few,  studentSeptember 10, 2010
Utica, NY



Your article makes a very good point that I think is a quality of life and dignity issue. I have worked in nursing homes for ten years now and have seen the same problem. Administration wants to fill a bed so they admit someone that is obese without having the necessary equipment/supplies to meet their needs. I have even seen some places "push the limit" when it comes to wheelchairs or beds as far as the weight limit. This is a huge issue that I can only foresee growing as our population has become more obese and aging.

Amanda Anderson,  COTA,  Nursing HomeSeptember 10, 2010
Wallkill, NY



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