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Morbid Obesity and Caregivers: Learning What Works

It’s not really news anymore – Americans as a rule are overweight. In fact, more than half of the population struggles with weight or is considered obese. Obesity is generally defined as someone who has a body mass index (BMI) of more than 25. Yet, despite campaigns to bring awareness to the problem and the increased number of options for individuals to work through these issues, obesity continues to increase.

Individuals who are morbidly obese (BMI greater than 40) present even greater challenges for healthcare professionals and caregivers. While on the surface it may appear simple – losing weight equates to improved health – individuals who struggle with morbid obesity find that it is difficult to manage from day-to-day. Bariatric medicine is associated with the challenges and treatment of individuals who are obese.

Caregivers face special challenges when helping their loved ones who are morbidly obese. There are emotional considerations for both themselves and their loved ones, physical challenges involving lifting, transferring, and transporting; and social stigma of obesity to name a few. There are many others as well. Caregivers who find themselves in this position are in need of supportive care in order to overcome these obstacles.

Health Concerns and Obesity:

The list of health concerns related to obesity is quite lengthy. One of the most common issues is diabetes. Diabetes can be caused by either too little insulin being produced, a resistance to insulin the body does produce or even both. The American Diabetes Association states that the likelihood of developing diabetes is higher in persons who are obese.

Coronary heart disease (CHD), high blood pressure and high cholesterol are also related to obesity. In fact, individuals who are obese is considered a major risk factor for CHD and it could lead to heart attack. The American Heart Association states, “It also harms more than just the heart and blood vessel system. It’s a major cause of gallstones and can worsen degenerative joint disease.” The risk of stroke is also increased when blood vessels or arteries that supply blood to the brain are damaged or blocked by a blood clot.

Cancer is also more prevalent in people who are obese. Men and women with higher BMI have increased incidences of cancers in the colon, esophagus, rectum, liver, gallbladder, pancreas and kidney. The Nurses’ Health Study even points increases of more than 20 pounds between age 18 to midlife can result in doubling the risk of women developing breast cancer.

Finally, mental health issues are also prevalent with obesity. A study published in the Archives of General Psychiatry indicates that individuals who are obese are 25% more likely to suffer from depression and mood disorders. Mood disorders encompass major depression, bipolar disorder and even panic disorders.

Healthcare Stigma:

With the health complications associated with obesity, it may be surprising to learn that healthcare professionals often hold negative attitudes or stereotypes of people who are obese. The Rudd Center for Food Policy and Obesity has been involved in researching subjects related to weight stigma in the healthcare industry. According to some of their studies, even those who are directly involved in the treatment of obese patients have negative biases of obese individuals. Facing negative stereotypes may lead to less effective care and increased stigma, especially if the weight condition is perceived to be caused by a controllable situation (overeating vs. a medical condition such as thyroid disease).

Caregivers who come in contact with these biases need to learn positive ways to counteract them in a way that can gain access to care for their loved ones. One of the best methods to overcome negative stereotypes is through education. The caregiver and the patient can research obesity, ways to overcome negative stereotypes, and join advocacy groups that can provide support. Mutual support groups may be found through advocacy groups like Obesity Action (www.obesityaction.org) or through bariatric clinics in the community. Support groups are available for both the patient and the caregiver.

Another way to help overcome the associated stigma of obesity is to work with a cohesive team of healthcare professionals who are treating the patient. These could include a number of specialties including bariatric physicians and nurses, psychiatric specialists, physical and occupational therapists, dieticians, pharmacists, and possibly a respiratory therapist. By developing a solid cross-functional team, the patient and caregiver can provide consistent communication to each specialty and achieve a balance of care that may not be possible when physicians and other healthcare professionals are not coordinated in care provision.

Safety Concerns in the Home:

When considering the challenges of transporting, transferring, and caring for the morbidly obese patient, the caregiver needs to be especially aware of physical safety. There is special medical equipment for bariatric patients that can help with these areas. Finding the one that works best may need some research – as well as trial and error.

Home health care options should be investigated in order to help provide patient care in the home in a safe manner. Some home health companies may be less willing to provide care, especially given the safety concerns. Others may be able to work with the family, but provide fewer services than the patient requires. For example, bathing and helping someone who is morbidly obese with activities of daily living may require the assistance of at least two persons. Insurance companies, as well as Medicaid and Medicare, however, are not likely to pay for the costs of two home health workers in the home. The patient’s family may need to provide some assistance or work with the company to find ways to pay for the cost of an additional worker in the home.

Home Equipment Options:

Bariatric walkers, wheelchairs, bedside commodes and patient lifts are available to help with patient care at home. The caregiver should research the various durable medical equipment (DME) companies that provide bariatric equipment and then investigate their options. Some equipment may be more helpful than others, and the home may need to be modified in order to use some of them.

Patient comfort is a consideration when choosing equipment to use in the home. If the device is safe, yet the patient does not feel comfortable using it, the caregiver may encounter resistance to its use. For example, the wheelchairs need to have adjustable widths and heights to provide stability and overall ease of use.
           
In addition, the caregiver needs to learn how to safely use the equipment. The DME company should provide training in how to use the product or suggest ways to obtain this training through the manufacturer. Until the caregiver has been properly trained to use the equipment, he or she should refrain from using it as it could lead to other safety or health issues. Also, the caregiver should find out what type of ongoing support or guidance is available if someone else needs to be trained to use the product. If the home provider leaves or the caregiver needs respite, how will the next person who provides care learn how to use the products?
           
Durability is also another area to consider when choosing equipment. The caregiver may want to consider:

• Is it reliable?

• Is it constructed of durable products that can support the patient’s weight?

•  Can it be delivered immediately?

•  What is the warranty available on the product?

•  If the patient’s weight increases, will the equipment still be safe to use?

•  Is assembly of the product required at home? If so, is the DME prepared to  assist with this?

Sleep apnea is another associated health risk that could require special medical equipment in the home. Sleep apnea occurs when the patient stops breathing for short periods of time during the evening. Persons who are obese are especially at risk of developing sleep apnea. A continuous positive airway pressure or CPAP machine is often used to treat sleep apnea at home. These machines work to provide a constant flow of air to hold the patient’s airway open in order to provide uninterrupted breathing while the patient sleeps. There are a variety of these machines available on the market, and while they are similar, some may pose challenges in using if the caregiver or patient is not familiar with the device. 

In-Patient or Nursing Home Care Considerations:
           
In some cases the patient is not able to rehabilitate or continue to live at home. Various challenges that exist at home such as proper diet, supervision, and continued health problems may necessitate either short-term or long-term placement in an in-patient or nursing home environment. When this happens, caregivers should consider special accommodations for the patient who is morbidly obese.
           
Some of the same alternatives at home should be taken into consideration in an in-patient environment.

These may include:

•  Is the facility willing to accept a morbidly obese patient? Some are not willing to risk caregiver safety given the special challenges in lifting, moving, and transferring a morbidly obese patient.

•  Will the physician team provide care in the facility or will there be new physicians to coordinate the care plan? Some facilities allow outside physicians while others use in-house or on-call physicians to provide care.

•  What level of rehabilitation care is provided?

•  How long will insurance(s) cover the cost of in-patient care?

There are many issues to consider when looking for a quality in-patient or nursing home facility. While the larger issues of inpatient care should be considered, caregivers need to ask specific questions that pertain to care of a morbidly obese person and the facility’s ability to respond to those issues.
           
Clearly it is a challenge to provide care both at home and in a facility setting for someone who is morbidly obese. Some individuals may thrive in this type of care and their health may improve. Other caregivers may find that they need more supportive services in the community or from the healthcare system in order to be successful. It is important to keep active communication about these types of issues since the health ramifications of obesity are often chronic and lead to serious complications.

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