When news about rising obesity rates in the U.S. first started making headlines, many in the design field agree healthcare facilities weren’t quite prepared to deal with this emerging population group. For instance, existing hand rails and toilets weren’t designed to support obese patients or visitors, procedures weren’t in place to help caregivers safely deliver treatment, and accommodations fell short of making all patients feel comfortable within the hospital setting.

Over the last five years, the conversation about bariatric design has evolved along with the design considerations that owners and designers can take. Recently, I’ve been diving into bariatric design for a trend report in Healthcare Design magazine’s July issue. Many designers have talked about how facilities are addressing this issue, the marketplace for bariatric-designed products and medical equipment, and where this conversation needs to go next.

I’ve also been asking them to share some of their top considerations when designing for bariatric care. While there are multiple issues and ideas to address—that can also vary according to facility type or population need—some common themes have emerged. Here are three that keep coming into the discussion. (Of course, for more information check out the full article in HCD’s July issue.)

1. The route: It’s not enough anymore to just think of the patient room or the toilet room. Facilities should be looking at bariatric care from a holistic viewpoint. “It’s getting through the front door, the entire hospital, and providing equal access to all patients,” says Craig Pickerel, architect, SSOE Group (Toledo, Ohio). That means rethinking everything from doorway sizes and waiting room accommodations to hallway widths.

2. Constructability: As facilities add in ceiling lifts, install grab bars, and widen hallways to accommodate bariatric wheelchairs or stretchers, contractors and construction crews need to be on board to understand these changes. “They can’t say ‘This is how we’ve always done it,’” says Mike Zambo, principal, Bostwick Design Partnership (Cleveland). For instance, steel plates may need to be added to walls to reinforce grab bars designed to hold up to 1000 pounds, HVAC and lighting systems may need to be rerouted to accommodate ceiling lifts, and toilets should be installed 24 inches from the wall to the center line of the toilet to allow caregivers to assist patients in the bathroom.

3. Making it feel seamless: The last thing any patient wants is to feel singled out or labeled. The challenge for designers and facilities is to incorporate bariatric equipment and design elements without making them stand out. “You don’t want them to feel penalized because of size,” says Peter Grandine, Senior Medical Planner, at HOK (San Francisco). Room designs and amenities should be as similar as possible for bariatric and non-bariatric patients, waiting areas should offer a variety of seating choices, including loveseats, and manufacturers need to supply bariatric furniture that doesn’t look big or clunky.

Design considerations such as these will help ensure better care is being delivered to all patients.