A Crossroads In Obesity Care
“The purpose of the policy is to advance obesity treatment and prevention,” AMA president Ardis Dee Hoven said in her June 25 blog posting. “It issues a call for a paradigm shift in the way the medical community tackles this complicated issue.”
The call for action is understandable given the mounting evidence of rising obesity rates, associated health conditions, and increasing healthcare costs. The Robert Wood Johnson Foundation’s annual report, F as in Fat: How Obesity Threatens America’s Future, examines strategies for addressing the obesity crisis. The ninth edition, which also looked at how obesity could impact the future health and wealth of the United States, found on their current trajectory, obesity rates for adults are estimated to reach or exceed 44 percent in every state and exceed 60 percent in 13 states. However, the foundation goes on to say that reducing the average adult BMI (body mass index) by only 5 percent in each state could spare millions of Americans from serious health problems and save billions of dollars in health spending.
Many healthcare organizations began addressing the issue a decade ago when rising rates of obesity began getting attention. For the built environment, however, the road to accommodating obese and bariatric patients has not been easy. For one, there’s no minimum weight requirement or code to follow. Further complicating matters is the lack of a standard for what defines a bariatric patient. Designers often specify products that are based on weight or design to a specific carrying capacity, while the Centers for Disease Control and Prevention (CDC) uses body mass index to define obesity. Rates of occurrence also vary around the country, making it difficult to develop requirements that would be universally appropriate.
The Facility Guidelines Institute (FGI) offers some guidance with its Guidelines for Design and Construction of Health Care Facilities with recommendations for bariatric accommodations. However the guidelines serve as a series of minimum recommendations to code and are updated every four years to keep current with industry trends. (The next edition will be released in early 2014).
What surprises many designers and owners is that designing for Americans with Disabilities Act (ADA) doesn’t necessarily cover bariatric patients, as well. For example, in an ADA toilet room, the maximum distance from the side wall to the center line of the toilet is 18 inches. But guidelines for a bariatric toilet room suggest placing the fixture at 24 inches to accommodate caregivers on each side to best assist the patient. “So if I have a bariatric toilet room, it doesn’t conform to the ADA guidelines,” says Michael Zambo, principal, Bostwick Design (Cleveland).
How obesity fits into the codes and ADA rules may change with the AMA policy. “When the ADA came into law, there were instances where people who were obese tried to use the law to get accommodations in the workplace,” says Debra Harris, ceo, RAD Consultants (Austin, Texas). “Now that obesity is a disease, it may create situations where the ADA can be used by those with the disease to force changes in the physical environment.”
With this call for a paradigm shift in obesity care and treatment, how will designers, architects, and owners address the built environment? What do we already know about bariatric design and what more needs to happen? And are minimum design requirements, similar to ADA, necessary to help outline issues, such as weight limits, door widths, accessibility, clearances, and equipment needs?