Body mass index, or BMI, has been the traditional benchmark for classifying obesity, which affects more than 60 million adults in the U.S. But Christopher Upton, a project manager at the University of Texas Office of Facilities, Planning, and Construction (Austin, Texas), says that the system falls short in adequately defining the bariatric patient population.

Talking about size alone, which BMI measures, doesn’t help providers address the type of equipment, staffing needs, and care environments that need to be in place to treat bariatric patients, he says.

To clarify this, Upton, who served as chair of the bariatrics committee for the 2014 Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities, wants to introduce a new classification for bariatric patients that looks not only at BMI but at other characteristics that can better measure a person’s health condition, including girth, skin sensitivity, and ambulatory capacity. Upton will share his ideas on bariatric care at the Healthcare Design Conference & Expo (Nov. 14-17, Washington, D.C.) during the session “The Bariatric Patient: Making the Case for Reclassification.”

Upton’s revised definition of bariatrics breaks down patients into four levels, with a Level 1 bariatric patient having a BMI of 30 or more, no visible skin sores or blisters, a waist of more than 45 inches, and moderate independence when it comes to maintaining hygiene and dressing themselves. A Level 4 patient would exceed 450 pounds and be fully dependent on caregivers.

“Adding that type of analysis to a system can let [operators] know what are the staffing and equipment requirements,” he says.

Then facilities can better design their facilities and equip their intake points with the necessary equipment to process and start treating bariatric patients—something that Upton says has been piecemeal so far. “If you’re in the business of doing bypass or other types of weight-loss surgeries, you’re more sensitive to dealing with these patients and patient size, so your focus is there,” he says. “Ideally, we’d like to try to get all facilities to be able to handle it.”

He points to the parameters outlined in the 2014 guidelines as a starting point for design ideas, such as installing patient lifts, bariatric toilets, adding larger bed sizes, and making sure doorway widths are designed to accommodate bariatric equipment.

“I try to encourage clients to make sure that at least some part of the environment can be dealt with for bariatrics,” he says.

Christopher Upton

Anne DiNardo is senior editor of Healthcare Design. She can be reached at

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