A Handbook for Bariatric Caregiving
Caregiving comes with its own unique circumstances and understandings between the caregiver and patient. This is especially true if the person who needs care is obese.
Regardless of whether your patient is a family member or employer, bed-bound or able; if they are obese, there are certain precautions you must take while caring for them. First and foremost, you must protect your patient and yourself from injury. You must also be cautious not to pass judgement about the weight your patient carries, or their lifestyle. As a caregiver, you are there to give aid and assistance and work to improve the patient’s life. You don’t have to be your patient’s friend, but everyone deserves respect.
The purpose of this handbook is to outline the aspects of caregiving that are unique to obese/bariatric patients. We hope it will serve as a useful guide, benefitting both the caregiver and the patient.
So, first things first: What classifies a person as “obese”?
Defining Obesity in America
The obesity epidemic in America involves nearly every aspect of healthcare and healthy, happy living.
“The BMI is defined as the body mass divided by the square of the body height, according to Wikipedia. “It is an attempt to quantify the amount of tissue mass (muscle, fat, and bone) in an individual, and then categorize that person as underweight, normal weight, overweight, or obese based on that value.”
BMI is a measurement of body fat determined by a person’s height and weight.
While the BMI scale isn’t perfect, it is universally recognized in medicine as a predictor for diseases like Type II Diabetes, Stroke, and Heart Disease. The diagnosis of obesity is not a judgement, it is merely the medical classification of someone with a BMI of 30 or higher.
Typically, a BMI of 25 or lower is considered healthy. A person with a BMI of 30 or higher is classified as “obese” or “clinically obese” and meets the requirements for bariatric care. Bariatric care is the area of medicine that researches the causes, prevention, and treatment of obesity. If a person meets the classification of a bariatric patient, they will have special care needs.
If you are the caregiver of someone who is obese, you need to know about their full range of specialty care as well as care for yourself to protect you from injury.
Why do obese people have special care needs?
When a person weighs more than 400 pounds or has a BMI higher than 30, issues occur dealing with personal hygiene and healthcare. Take the skin, for instance: if special care is neglected, then irritations, sores, and infections can occur. Typically, the heavier a person is, the more medical issues they have to deal with. Because of this, diet and exercise planning must be made and followed to reduce the person’s weight.
At a certain weight, usually around 400 pounds, people start encountering problems with incontinence. This is a result of the abdomen pressing on the bowels, intestines, and bladder. Additionally, when the body becomes a certain size, toileting and personal care become difficult tasks. For these reasons, a bariatric patient may need incontinence pads or adult diapers to help.
Safety-wise: Patients with a BMI higher than 40 must only use medical products and supplies designed for bariatric patients. Bariatric supplies have higher weight limits, so they can support a weight of more than 350 pounds safely. They are also designed to be larger, so they fit the patient more comfortably and safely. Bariatric sizes and models are available for bath safety equipment, stair rails, furniture, beds and mattresses.
Obesity doesn’t only present medical problems and difficulties. It also presents many personal and emotional issues, as well. Ensuring your patient keeps their dignity is one of the main goals of a bariatric caregiver.
Furniture and equipment considerations for bariatric patients
As a caregiver, one of your main tasks is to help your patient get the supplies they need to live as functional a life as possible. There are many supplies on the market which cater to the bariatric patient. There is equipment available for every room of the house, including, but not limited to:
- Bariatric beds and mattresses
- Bariatric commodes (which can be used in any room of the house)
- Bariatric bath benches and bath safety chairs
- Reachers and grabbers
- Bariatric walkers and rollators
Before buying any furniture, be sure and check the weight limit to make sure it will work for your patient. This is especially important when buying a bed and mattress, as we all spend approximately 8 hours a day in one! The frame will need to safely support the weight. Be sure to verify the warranty on any furniture purchased, as well. Reputable manufacturers of bariatric equipment will provide weight limits and warranties on all their products for the customer’s safety.
There are also many styles of bariatric beds that have motors for lifting and lowering. You can also find this feature in armchairs. The lifting and lowering function is especially helpful for the caregiver, as they don’t risk personal injury as often when the patient can rise to them.Even if the furniture will lift and lower, a patient lift is an essential piece of equipment for caregivers, who are more likely to injure themselves boosting and repositioning patients than doing anything else. In fact, a caregiver can injure themselves lifting as little as 50 pounds, especially if that weight is lifted at an awkward angle (such as bending over a patient to pick them up or adjust them). Patient lifts can be either mobile or installed to the frame of the house, either mechanical or motorized. These lifts are designed to raise and adjust people who are unable to do so themselves.
Motorized lifts and risers are also available for toilets, but again, be sure the weight limits correspond with your patient. These come with handles or without. Wall-mounted grab bars work well in the bathroom but should be installed throughout the house, if possible, for fall prevention.
For patients who are confined to the bed, incontinence products are widely available in bariatric sizes and absorbencies. Also, you can boost the absorbency of bariatric diapers or bladder pads with bed pads (also called chux), which are placed under the patient to protect the bedding against leaks. Even those bariatric patients who are mobile might require adult diapers or disposable underwear, as their added weight often presses on the bladder and causes issues. Booster pads can be inserted into these products to add absorbency if needed. Since diaper rash can be a problem for anyone who wears a diaper, skin barrier ointments and antifungal creams are recommended. Applying these creams before a rash starts is an effective preventative measure against skin breakdown.
If the patient is mobile, getting them up and out for daily exercise is crucial. Bariatric walkers, rollators (rolling walkers), and canes are useful tools to get the patient moving safely. Speed is not the concern. Any amount of exercise is beneficial when combined with the correct level of caloric intake (as determined by a doctor or nutritionist).
Motorized scooters are also available for people with little or no walking ability. These scooters are helpful tools for keeping your patient’s social life active, for getting outside and into the fresh air, and for getting errands done where there will be long waits (like doctor visits).
Skin care for bariatric patients
Because the skin is the largest organ — and because it’s so susceptible to breakdown and injury — skin care is one of the most important aspects of bariatric caregiving. If a person already has compromised health, skin irritations easily become wounds, which easily become chronic infections.
There are a number of different reasons skin breakdown occurs in bariatric patients; we’ve outlined several of them below:
- As a person gains weight, their skin enlarges. What used to be normal and healthy ridges and bumps in the skin become folds. These typically occur at the waist, neck, groin, and arms. Skin folds are dark, warm, and often stay closed up. This makes them perfect breeding grounds for bacteria, yeast, and microbes — otherwise known as infection.
- When a person is obese, the folds of the skin rub together. This rubbing is a constant irritant that breaks the layers of the skin down. It becomes inflamed and red. It is painful; it is persistent. When the skin remains irritated for long periods of time, the infectious agents that are on everyone’s skin settle into the microscopic cracks on the surface. This is when trouble starts.
- Skin-cell breakdown can also occur because of moisture. If the skin stays constantly wet, from water or sweat, the cells and the barriers between them break down. This also allows microbes and infection into the skin. Again: dark, moist skin is a perfect breeding ground for infection. Skin infections become chronic quickly if not treated immediately.
- Skin can also break down when a person’s body stays in the exact same location for several hours. If constant weight is applied to an area of the skin, the pressure causes the cells to break. These “pressure sores” occur in obese people as well as wheelchair- and bed-bound patients. Usually pressure sores or ulcers are found on the backs of the thighs or the buttocks, but they can occur anywhere. Technology — in the form of gel pads and mattress covers — has proven to be effective against pressure sores and skin breakdown.
- Finally, the last way skin can break down is through contact dermatitis. This occurs when the patient’s skin has an allergic reaction to something it contacts. The usual culprits are latex gloves, the aloe found in some adult diapers, or bandage adhesive. Contact dermatitis will leave the skin red, itchy, and painful. It appears quickly. Doing a daily check of the skin will prevent problems with skin allergies.
Now that we’ve identified the most common forms of skin breakdown in bariatric patients, let’s take a look at prevention and treatment measures:
- The best way to treat skin ailments is to prevent problems in the first place. As a caregiver, you must monitor your patient’s skin folds daily. Wearing non-latex gloves, you must separate and open all the folds. Start at the patient’s neck and work your way down the body to the feet. If you notice wetness, odor, redness, or breakdown, make a note in the patient’s chart detailing the location and degree of the symptom. You will need to alert the doctor to these issues after the check is complete.
- Apply a moisture-drying powder, like talc, to the folds to prevent wetness. If sweat is an issue, keep your patient cooled with a dry-air fan. Regular bathing is also important. Sweat contains bacteria and is a way for our bodies to detoxify, so it should be washed off daily. This kind of cleanliness and personal hygiene will also prevent body odor.
- If an obese patient requires bariatric diapers, then they must be absorbent enough. These products must also be changed regularly and frequently. Urine and stool are acidic and can quickly cause terrible skin breakdown — diaper rash — if not cleaned up as soon as possible. Skin irritation and breakdown can also occur if the incontinence product is not the correct size. Buying bariatric incontinence products is one way to ensure the size and absorbency will be appropriate for your patient.
- Proper diet and hydration must be encouraged in order to keep the body’s systems regular. An obese person will need to consume more food and water than a non-obese person in order to keep their body functioning. Eating and drinking nutrition should be monitored and noted by the caregiver for the doctor or nutritionist. As a caregiver, you are not to tell your patient to eat or drink less to make changing their incontinence products easier.
Will I make a good caregiver?
In the triangle of patient care, all have important roles to play — the patient, the at-home caregiver, and the doctor. The patient must be willing to heed the doctor’s advice or come up with their own strategy for care. The caregiver must not make decisions or judgements, but must help the patient get the treatment they want. The doctor must trust the caregiver to follow directions and report back the care given to the patient, while respecting the patient’s body and mind.
It can be a complicated arrangement, but you will be a fine caregiver if you understand your role: You are there to take notes for the patient, ask questions about their care, report what works and doesn’t work for the patient, and do it all without judgement or bias.
You will also be your patient’s connection to various parts of the outside world. Caregiving for anyone isn’t easy. If you consider your own health and wellness, caring for an obese person is not any more difficult or easy than caring for anyone else. Your ability to listen to your patient is your strongest skill.
SuLauren Wilson is the founder of Finnegan Medical Supply, an online medical supply store based in Little Rock, Ark. She blogs regularly on issues affecting the company’s patients. Although, she has many years of experience in the healthcare industry, she is not a licensed medical professional, and the content of her posts should not be considered medical advice.