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Obesity and Caregivers: Learning What Works /
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Morbid Obesity and Caregivers:
Learning What Works
By Sandra Ray, Staff Writer
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.
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.
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.
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.
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.
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.
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).
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
or through bariatric clinics in the community. Support
groups are available for both the patient and the
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:
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.
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:
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.
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.
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?
also another area to consider when choosing equipment.
The caregiver may want to consider:
constructed of durable products that can support the
be delivered immediately?
is the warranty available on the product?
patient’s weight increases, will the equipment still be
safe to use?
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
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.
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.
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.
level of rehabilitation care is provided?
long will insurance(s) cover the cost of in-patient
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.