According to the National Health and Nutrition Examination Survey, nearly a quarter of US adults are currently obese—and as the nation’s obesity rate climbs, so does the demand for bariatric products. HME providers and manufacturers have responded by designing and making available many specialized devices for people weighing more than 300 pounds.

Consider the bariatric mobility niche. Ten years ago, it was challenging to even find a wheelchair with a 600-pound load capacity; now most manufacturers offer these products, and several even have wheelchairs with 1,000-pound load limits.

“Manufacturers now understand that bariatrics is a growing market, and as a result, we are seeing stronger and better-made equipment specially designed for the bariatric patient,” says Karen Atkins, owner of Mobility First, an HME provider in Independence, Mo, whose bariatric business has quadrupled since it opened 6 years ago.

But rising obesity rates and more products are only half the story. “In addition to greater numbers of obese people, there has been more awareness among health care professionals and consumers about these products,” Atkins says. Many of her bariatric customers are direct referrals from physicians.

Driving Demand
When Atkins started Mobility First, few of her clients needed wheelchairs with seat widths greater than 18 inches. Now close to 40% need seat widths that are 20 inches, and many require even larger sizes. Each month Atkins sells, on average, five manual bariatric wheelchairs and five power bariatric wheelchairs. Recognizing the strong market potential of these big-ticket items, she has advertised them on television, in direct mail flyers, in the local newspapers, and in the Yellow Pages, informing customers of the products’ weight capacities. These promotional tools have attracted clients from as far away as 100 miles to obtain or repair bariatric equipment.

In California, Carl Hoppe, operations manager of the Healthcare Equipment Center of San Gabriel Valley, has also found that the bariatric customer is a strong force in the seating and mobility market. “Bariatric patients are more willing to come forward and discuss their needs, unlike in the past when many were housebound,” he says.

When Hoppe started out in the home health care industry, he rarely saw a morbidly obese customer; now that label describes many individuals who need his services. In particular, he has seen a greater incidence of overweight individuals who exceed 200 or 250 pounds but who do not weigh enough to be considered bariatric clients. As mobility and seating customers, these people also require stronger and larger equipment.

Furthermore, add-on sales are now an important concern for Hoppe as manufacturers have made changes to other home health care products to accommodate bariatric clients. In the past, some products could not even be used because they were not durable or wide enough for obese patients, Hoppe says. But during the past several years, he has added bariatric walkers, hand grips, floor-to-ceiling poles, scales, and commodes to his inventory as the demand for these products has increased. “Many of our customers come in for a bariatric wheelchair but then end up buying additional items that they didn’t even know existed,” he says.

Product Selection
HME suppliers who want to be viewed as full-service bariatric specialists must offer customers both power and manual bariatric wheelchairs. Typically, most suppliers will work with one or two well-known manufacturers to carry several different types of bariatric wheelchairs. “Using reputable manufacturers that specialize in bariatrics and stand behind their products is essential,” Atkins says.

Bariatric seating specialists agree that one of the most important considerations in selecting the appropriate bariatric wheelchair is to respect the diversity of the obese population in terms of size and body shape. Soft tissue accumulation and weight distribution vary among bariatric patients. A person may have a pear shape, which indicates gluteal-femoral obesity, or an apple shape, which shows abdominal obesity, and there are subgroups within each of these two major groups. The person’s height also dictates the height of the chair.

According to Barbara Crane, PT, ATP, a researcher in the Rehabilitation Science and Technology Department at the University of Pittsburgh, particular attention should be paid to an individual’s medical history and plans for surgical intervention. “If an individual is going to have a gastric bypass, he or she will lose a lot of weight quickly and the equipment will need to accommodate the change,” she says. Most therapists recommend that rental equipment should be used in these situations until the person’s weight stabilizes.

If obese persons are determined to use manual wheelchairs, a realistic assessment of their mobility should be conducted. This should include a recording of the maximum distance the person can propel, the type of floor surfaces involved, and the time it takes to propel that distance. Assessing the client on ramped or pitched surfaces, as well as outdoor surfaces, is also helpful to determine the potential for manual mobility.

Crane encourages her bariatric clients to try powered mobility—even if they are certain they want manual wheelchairs—in order to experience the differences between the two. “Many bariatric clients—and sometimes their physicians and other health care providers—think a manual wheelchair is the perfect way for them to exercise,” Crane says. “It is important for them to know that wheelchairs are not exercise devices and that they are better off with a proper mobility system and an alternative plan for getting exercise.”

Hoppe notes that a person’s lifestyle plays an important role in choosing which wheelchair to purchase or rent. If a person spends most days inside, a manual chair may be appropriate; however, if the person works outside the home or is active in the community, a power chair is probably more suitable.

The home environment also is an important consideration in selecting a bariatric wheelchair. “Every effort must be made to keep the equipment as small as possible while still meeting the person’s needs to get through doorways and rooms and onto van lifts,” Crane says.

Most bariatric wheelchairs require a 34-inch or wider door. Open space should also be available in an area to accommodate the size of a walker, a mechanical lift device, and the wheelchair. Floor coverings are an important factor, particularly if the person is using a manual wheelchair. A floor with no carpet is ideal; even low-pile carpet or indoor/outdoor-type carpeting could present problems. In some cases, a client may need wider door frames or reinforced ramps or flooring.

Experts stress that if the equipment is unsuitable for the home environment, the equipment may be used in an unsafe manner or the customer may end up returning the equipment as unsatisfactory. The cost of doing a home assessment is a lot less than ending up with unnecessary inventory or having to pay restocking fees for special orders.

Since morbid obesity is a medical condition, reimbursement for HME equipment for individuals with this diagnosis is generally not a problem. However, in some instances, patients are initially denied power bariatric wheelchairs due to their cost. In these cases, dealers often work with the payor to justify the use of the equipment.

“Having a picture or video that shows how a client has difficulty propelling a manual wheelchair can make a difference in receiving adequate reimbursement for a power chair,” Crane says.

She adds that it is usually helpful to describe in the claim the benefits of a bariatric wheelchair or other piece of equipment, such as a better suspension system that can withstand heavy loads for long periods. Some payors are unaware that a bariatric chair is a cost-effective, long-term solution for obese individuals.

The Right Approach
With bariatric clients, it becomes extremely important to show sensitivity and compassion. Some bariatric patients feel uncomfortable and embarrassed about needing specialized equipment. Hoppe has found that it is best to deal with bariatric clients in much the same way as with nonbariatric clients.

“Because we were worried about hurting their feelings, we used to avoid discussing their conditions,” he says. “Now we have found that it is best to be very direct and open and let them know from the onset that we have bariatric equipment that is well suited for them.”

Hiring the appropriate individuals for these clients is also essential. “We work hard to match the right technicians with certain types of customers,” Hoppe says.

For HME dealers who can put together the right product selection and personnel, the bariatric mobility niche should continue to grow. “More medical management has been leading to exposure to rehabilitation, which leads to assessments for appropriate assistive devices, unlike in the past when most obese people would have stayed in their homes, often in bed, without any intervention,” Crane says. “Technology is available now that can help them, and this technology continues to improve.”

Carol Daus is a contributing writer for Dealer/ Provider.