It is no secret that Americans are getting bigger. According to government statistics, during the past 20 years obesity rates have increased dramatically. Today, the Centers for Disease Control and Prevention report that 20 states have obesity prevalence rates of 15% to 19%, 29 states have rates of 20% to 24%, and one state, Texas, reports a rate over 25%.

This growth in the population of obese people has presented strong challenges for the HME industry, and medical equipment manufacturers have responded accordingly. A review of the current medical equipment products designed specifically for overweight and/or obese patients reveals full product line availability—from bath safety equipment and wheelchairs to low-air loss mattresses, bariatric beds, and patient lifts. Product weight capacities run the gamut from 250 to 1,000 pounds.

This is not to say that there is a sufficient patient base to easily provide financial support to a company specializing exclusively in bariatric products. However, it can be a profitable sideline for HME dealers, say leading experts and manufacturers in the field.

Start with Statistics
The key to meeting the needs of the bariatric patient successfully begins with dealer education. Study your community demographics. Are you in one of the statistically high obesity-rate states? Keep in mind that most studies you may consult define obesity on the basis of body mass index (BMI). BMI is a mathematical formula that represents a person’s body weight in kilograms divided by the square of his or her height in meters. Individuals with a BMI of 25 to 29.9 are considered overweight. Individuals with a BMI of 30 or more are considered obese.

Recent results of the National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 61% of US adults are either overweight or obese, defined as having a BMI of 25 or more. Furthermore, among US adults aged 20 to 74 years, the prevalence of overweight (defined as BMI 25 to 29.9) has increased from 33% of the population in 1980 to 35% of the population in 1999. In the same population, obesity (defined as BMI greater than or equal to 30) has nearly doubled from approximately 15% in 1980 to an estimated 27% in 1999.

It is important to understand the specific terminology used to differentiate the overweight patient vs the obese patient. Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. This includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. Overweight refers to increased body weight in relation to height, when compared to some standards of acceptable or desirable weight. A classification of overweight is not necessarily an indicator of increased body fat. In actuality, the patient may be overweight due to an increase in lean muscle. An excellent example can be found in the professional athlete. The athlete may weigh more than others of the same height and may actually qualify as “overweight” due to his or her large muscle mass, yet may have an acceptable or lower percentage of body fat.

“People in general seem to be getting larger, but not necessarily obese,” says one HME product manufacturer consulted for this article.

“The problem is our industry tends to define all patients who exceed 250 pounds as bariatric, and that is just not the case,” added another manufacturer whose latest catalog will feature an ex-football player who is 6 feet and 3 inches tall and weighs 325 pounds yet is still very athletic and healthy. Consequently, product selection must take into account the patient’s height and body shape, as well as the weight. The individual equipment needs to properly fit a 5-foot-2-inch patient who weighs 195 pounds will differ greatly for a patient of the same weight who is 6 feet tall.

Referral Sources As A Resource
In addition to determining your geographic statistics, check with your referral sources to see if they confirm a need for bariatric products in your market area. Hospital discharge planners, in particular, are a great source of information for determining both the frequency and types of bariatric equipment ordered in your community. Are they readily able to access products needed for this population? What product(s) do they have a difficult time obtaining? Are they experiencing lengthy delays because products are not locally stocked and available?

Add Products Slowly
Currently, the variety of products found in the bariatric market allows the supplier to meet the very individualized needs of the end user, yet maintaining an inventory of all of these products is not cost-effective. Suppliers should have a solid understanding of product usage, availability, cost, and access before venturing into the bariatric market. A start-up inventory should include only the most basic product requirements with prompt access to additional products that are requested.

To simplify matters, let your bariatric product selection mimic your standard product base, albeit in a smaller volume. For example, for the products you sell a lot of in your basic inventory, you would initially stock only one or two in a corresponding bariatric product. Begin with a similar basic standard product inventory in bariatric products.

Routinely carried bath safety equipment, such as bath seats, shower benches, and commodes, ordered for the bariatric patient will facilitate a safe entry into the bariatric market. Bariatric walkers are always a good basic stock item to start with. Certainly, the supplier should consider adding a manual wheelchair with a seat width of 24 inches to 26 inches.

Keep brochures available for other bariatric products. Your referral sources and patients will see what you have and ask for other, high-end products, which you can then order. This helps reduce excessive inventory costs.

Familiarize yourself with product availability and shipping options. Does your manufacturer or product supplier maintain sufficient product inventory on hand for quick access? How expensive are shipping charges for oversize equipment needed the next day?

Avoid Liability
As the bariatric population grows, product availability has grown. It is critical that the supplier is aware that not all products on the market are bariatric products. Overseas companies, in particular, appear to be marketing products labeled “extra-wide” or “heavy-duty.” Therefore, it is important you know your product manufacturer. Does the company have a strong history of commitment to the bariatric product line, its dealers, and the industry, or is it a newcomer to the market?

Most reputable bariatric product manufacturers may provide and/or require product training and service for new providers entering the field. Take advantage of these resources as their guidance and expertise will help reduce liability and ensure a successful market venture.

Advertise, display, and market your bariatric products with the weight capacity clearly labeled. Informing the end user of weight limitations provides a valuable service and reduces the risk of miscommunication or misunderstanding.

The Medical Device Act approved by President Bush in October of last year provides another avenue suppliers may use to determine product safety. The act allows medical product manufacturers to submit products for Food and Drug Administration (FDA) approval. The FDA then assigns approved products an identification number. The FDA Web site (www.fda.gov) maintains a list of approved products that you can readily access if you have concerns.

“[To limit your liability] make sure when selecting a product for the end user that it is appropriate to meet the physical needs of the patient, the patient is able to operate the equipment safely, and the equipment is suitable for the patient’s environment,” advises health care attorney Denise M. Fletcher, JD, of Brown & Fortunato, Amarillo, Tex.

Performing an environmental assessment is an additional step suppliers should take to ensure the equipment is suitable for use in the patient’s home, caution manufacturers. Fitting a patient with a bariatric product in a showroom or store environment does not mean the equipment is acceptable for the home. Depending on the specific product, there may be a need for wider door frames or reinforced wheelchair ramps or flooring, not readily available in the standard home environment. If the home environment is not suitable for the equipment, the equipment may be used in an unsafe manner, or the end user may return the equipment as unsatisfactory. The cost associated with a home inspection is still substantially less than paying restocking fees for special orders, being saddled with unnecessary inventory, or protecting yourself from a lawsuit.

Providing products for the bariatric patient differentiates you from the mass merchandiser and can be a profitable sideline. But remember to do your research, enter the field slowly, and use your manufacturers’ resources to help ensure your success.

Helen M. Farrell is a reimbursement consultant and CEO of Medical Accounting and Reimbursement Services (MARS), Chesapeake, Va. Contact MARS at (757) 410-1732.