In 1965, researchers created the term “bariatric” to identify a field of medicine that evaluates the causes of, prevention and treatment for obesity.
Before we dive in, let’s quickly explore the history of the care of bariatric patients. The term obese is a product of the World Health Organization’s Obesity Task Force, which classifies individuals according to Body Mass Index (BMI).
- Normal BMI ranges from 18.5 to 24.9.
- Overweight BMI ranges from 25 to 29.9.
- Obesity BMI gets falls between 30 to 39.9.
- Morbid obesity is any number greater than 40.
In America, 97 million citizens are overweight and 60 million are classified as obese, according to the task force.
But, it’s on the individual level that the effects of this are sen. In fact, bariatric patients are at an increased risk of developing diabetes, osteoarthritis, hypertension, cardiac disease and complications related to skin care.
What’s more, the increased presence of adipose tissue causes atypical responses to medication, which may complicate additional necessary care. Above all, these patients will have to confront the psychological threat of anti-fat or weight bias.
What is weight bias of bariatric patients?
The increased risk and presence of humiliation, embarrassment or perception of shame related to anti-bariatric biases are the foundation for one of the last remaining domains of discrimination and prejudice in the United States.
In recent history, it was not uncommon to transport bariatric patients to loading docks or laundry rooms to weigh them using commercial scales. Many bariatric patients receive inadequate care and are denied procedures because of inadequate equipment options.
There are overwhelming accounts of discrimination in all areas of society, but the most problematic occurs in the medical community, particularly among physicians.
Many bariatric patients have reported feeling ignored or treated as if they’re nonexistent. Others have felt blamed for their obesity or have recognized the discomfort by medical professionals regarding their size.
Surveys of medical professionals confirm these biases, and it’s a problem of greater concern than initially believed. Indeed, bariatric patients experience less considerate interactions with providers and receive less patient-centered communication from physicians.
Communications that do exist tend to involve less information provided about their health crisis — and there are fewer attempts to establish patient-provider relationships.
In fact, even in death, bariatric patients suffer. They are less likely to experience good deaths in the form of hospice care, or the ability to die at home.
These are all examples of bariatric bias, and they worsen a patient’s sense of embarrassment and reluctance to seek medical attention until there is a critical emergency.
Consider the feelings of bariatric patients
We are dispatched daily to assist with a bariatric transport or emergency. We have received training on proper lifting, on the use of specialized equipment and are familiar with procedural differences.
However, these procedures rarely cover the emotional side of bariatric care.
- How do we as providers respond to this group of patients?
- What comfort measures would be unique?
- What form of therapeutic communication has proven beneficial?
Bariatric patients have their own set of specific emotional needs. They are acutely aware of stereotypes. They understand that they may be perceived as lazy, non-compliant with medical direction and generally unhygienic.
These perceptions become barriers to effective communication. Those barriers necessitate the need for the development of therapeutic communication, which dignifies care and becomes a cornerstone for quality patient management.
Thus, we must be patient advocates and maintain zero-tolerance positions regarding degrading comments, or “humor” at our bariatric patients’ expense.
How to advocate more bariatric patients
Privacy — and discretion — is paramount for this group of patients. We should ask sensitive questions in a setting as isolated as possible.
Furthermore, emergency calls involving bariatric patients will likely draw public attention. We should be mindful of the stress bystanders may cause. As such, we should be aware of the risks that will pose to our patient’s well-being and mental stability.
Our acknowledgment of the patient’s feelings, and our awareness to their internal and external concerns will set the tone for the rest of the call.
Consider opening a dialogue with the patient like this: “I would like to speak with you about how we can safely move you and I would like to assure you that we will find the safest way around for you and us.”
We must seek the patient’s input on how he or she has adapted to common mobility restraints. We need them to help us establish what works best for them to assist with transferring to a moving device.
Finally, the communication of our intentions must be clear and concise. These patients should be informed of what equipment we are using and we should be comfortable speaking to how that equipment is constructed.
Consider the feelings of bariatric patients
As pre-hospital providers, we also must develop and express additional plans in the event our original strategies fail.
Our ability to do this will provide an added sense of security and empowerment to their treatment, which may be something bariatric patients have never experienced in a medical setting.
Communication related to patient comfort should be ongoing and should absolutely occur throughout the moving process.
Our approach must be adjusted accordingly, and we must remember that transport from the home to ambulance will be the most stressful event bariatric patients will experience with us.
We must work to ensure their privacy and to reassure the safety precautions we have in place for them.
To sum up, we should review every aspect of the call.
- What could we have done better?
- If we encountered a failure, how did we address it and what is our plan for improvement?
- How did we communicate with the patient?
- Did we create an environment that protected their privacy?
- Did our body language communicate something we didn’t intend to?
- How do we feel about obese patients?
- Does that obstruct our ability to act objectively — and to provide quality care?
These critical analyses will push us to learn and to provide better care and comfort to a population that may feel devalued, misunderstood and exposed.
This analysis will begin to erode the biases that are the basis for inadequate care and discrimination. As a result, we will be more in tune with the emotional side of bariatric care — and we will become better care providers and greater patient advocates.