The average healthcare patient’s size and weight are increasing as the global population’s average body weight continues to climb, owing mostly to lifestyle choices and high caloric/fat meals. There is currently a need to explore how healthcare staff may deliver excellent patient/resident care and safe handling of bariatric patients while avoiding injury to themselves or the patient/resident. As part of an effective risk management program, it is critical to understand what obesity and bariatrics are, the possibility for harm, and the various ways to control these injuries.
What is obesity?
The World Health Organization (WHO) defines obesity as “abnormal or excessive fat accumulation that may impair health.” Using the body mass index (BMI), defined by weight in kilograms divided by height in meters squared, patients are classified into categories of underweight, healthy weight, overweight, obese I (30.0–34.9 kg/m2), obese II (35.0–39.9 kg/m2), and obese III (≥ 40kg/m2). Of note is that while BMI can be used to define obesity, it provides limited information about muscle mass versus fat tissue, which explains the overlap between individuals who are considered “overweight” but whose excess weight comes primarily from lean body mass.
Obesity is also categorized by the American Medical Association (AMA) as Grade I (30-34.9), Grade II (35-39.9), and Grade III (> 40).
Pathologic conditions associated with obesity include: type 2 diabetes; coronary heart disease; gallstones; hypertension; stroke; and certain types of cancer including endometrial, breast, prostate, and colon cancers. It is important to note that even though obesity leads to a variety of health risks, not every individual who is obese will develop these medical conditions due to “obese survivorship,” which refers to the concept that only certain individuals become chronically ill or disabled from obesity while most people live their lives in relative health despite their excess weight.
What is bariatrics?
Bariatrics is the branch of medicine that deals with obesity and its associated pathologies. Bariatric surgery, medical management algorithms for weight loss, and nutritional support are types of care offered by bariatrics specialists within supporting healthcare organizations. While some patients have had success with dietary modifications, increased physical activity, or pharmacological interventions to achieve substantial long-term weight reduction on their own, others may require more aggressive intervention in the form of bariatric surgery or medications. Even after these aggressive methods are initiated, many individuals who undergo surgeries or begin medication regimens still have difficulty maintaining a healthy body weight due to metabolic adjustments to their change in diet and lifestyle. It is therefore essential that all staff, regardless of specialty or training level, be aware of techniques to move and handle patients/residents safely.
Injuries from patient handling activities are an ongoing issue for healthcare providers. This is largely due to the increased weight of patients/residents that require care, as well as a tendency toward less physically demanding tasks in the acute care setting. In fact, it has been estimated that between 40-75% of injuries sustained by nursing staff occur during patient transfer/mobility activities (such as standing transfers, bed mobility maneuvers, and patient repositioning). It follows then that a population whose average body weight surpasses what was previously believed “average” would result in even more frequent injury events among healthcare workers. Therefore, it is absolutely critical that all staff involved in care of bariatric patients/residents – physicians, nurses, respiratory therapists, physical/occupational therapists, dieticians, and others – have a basic understanding of what can potentially go wrong when moving and positioning these individuals.
What are the risks?
Injuries from patient handling activities can result from a variety of causes including muscle strains or tears; lacerations; compressive neuropathy resulting in local paresthesia or frank paralysis; slips/falls on wet floors with subsequent trauma such as hip fractures or lumbar spine injuries; loss of balance due to unstable surfaces beneath one’s feet leading to uncontrolled falls onto lower body regions such as the pelvis, iliac bones, femur, tibia, or feet; or shearing forces acting across joints leading to sprains or subluxations. Many of these risks are exacerbated by the fact that obese patients/residents often have one or more comorbidities (i.e., conditions in addition to their obesity) which include osteoarthritis (degenerative disease of the joints), degenerative lumbar spine disease, and other pathologies that can render them at higher risk for musculoskeletal injury when moved incorrectly.
What exactly do you mean by “incorrectly?”
When discussing patient handling activities, it is important to define two basic concepts: forward transfer and lateral transfer . A forward transfer occurs when a person moves an object (such as a patient/resident) forward and away from their body. Lateral transfer occurs when a person moves an object (such as a patient/resident) laterally (i.e., left or right) across their own body. Both of these transfers can be performed using either proper technique or incorrect technique.
Safe handling of bariatric patients and roper technique for both types of transfers includes the following key components:
1) standing close enough to the object that you can reach it easily;
2) keeping your back straight to maintain good posture and prevent low-back injuries;
3) bending at your knees, not at your waist;
4) keeping the object close to your body at all times;
5) keeping the center of gravity over the base of support ; and
6) communicating with the patient/resident about what you are going to do before you move him or her.
How do you know when you’re doing it incorrectly? It’s when the handler is bending at the waist instead of keeping the back straight and knees bent. This way, the handler is putting undue stress on the low-back muscles which can lead to injury over time. Also note that the lack of stability in this particular situation is exacerbated by the fact that she has chosen to move her patient across the bed instead of staying next to the bed and performing a proper lateral transfer across her own body.
How should it be done? When the handler is bending at the knees and keeping the back straight and close to the object, thus avoiding any injury risks associated with improper technique . Also note how much more stable this particular situation is because the handler has chosen to move the patient across the back of the handler’s own body instead of beyond it.
The most important thing for any healthcare worker to remember is that patients/residents should never be moved in a manner which can cause discomfort or make them feel unsafe; if they do not feel safe with how you are moving them, then they will resist no matter how much they may need your help (or even want it). Remember – when you feel like you’re working too hard, you probably ARE working too hard! As such, when moving obese patients/residents, it is often necessary to call for a bariatric equipment service, use proper equipment (i.e., gait belts), and/or reduce the number of healthcare workers required in order to perform safe patient handling activities.