Weighty Issues

There’s no question about it. America has a weight problem, and there are no signs that the population will change its ways and trim down anytime in the near future.

Over the past two decades, this country has seen a doubling of obesity in adults, a tripling of obesity in adolescents and a quadrupling of morbid obesity, says Dr. Kevin Huffman, a bariatric physician with more than 20 years of clinical experience in obesity management and bariatric advisor for Gendron.

“It’s growing exponentially, and the most rapid growth is in the segment of the morbidly obese (those who are more than 100 pounds over their body weight),” he notes.

According to Joe Chesna, national sales director of standard power for Pride Mobility Products, 32 percent of men and 28 percent of women age 60 or older are obese. “Manufacturers are continuing to look at this as a growing market segment and incorporating more bariatric models into their core products,” Chesna says.

“Unfortunately, the statistics show that our population is getting larger in size, and that makes this a growth market opportunity,” adds Sue Jotblad, marketing manager for Sunrise Medical. “A plus for providers is that there are a number of manufacturers providing products in this category now, which has made product pricing very competitive.”

Further, bariatric patients typically require more products at higher price points than the average patient, she explains. A single patient may require several pieces of equipment, such as a bariatric bed, wheelchair, shower chair or toilet and respiratory equipment.

“You’ve got good funding on these product lines,” says DuWayne Kramer, president of Leisure-Lift. “Even with competitive bidding, bariatrics is going to be a profitable line.”

Understand Special Needs

Providers that wish to be successful in this sector need to do more than just randomly sell a few bariatric items, however. They must understand the market and have a game plan, advises Jotblad.

“Serving the bariatric market is a niche business,” she says. “To be a leader in this market, it must be a conscious business decision.”

One place to start is understanding what bariatric patients need. According to Huffman, some of the special needs for this population that HME providers should be aware of include:

• Equipment that will help them ambulate

  Provide Individual Service

  As patients become heavier, it is more difficult for them to support their own weight. Wheelchairs, walkers, rollators and canes that are rated for heavy weight and have stronger frames and motors will keep the patient moving safely. “First comes safety, then comes comfort. We have to deliver that in a dignified way,” Huffman says.
• A safe bathroom environment Many bariatric patients have poor balance, so they are more likely to slip and fall, Huffman says. Also, many patients don’t bathe as frequently as they should and, as a result, their skin breaks down, he says. Grab bars, shower chairs and other bathroom aids can make it easier to bathe and help to prevent accidents.
• Reach aids Larger patients often have difficulty reaching certain areas of their body, making it difficult to maintain proper hygiene. In these cases, a reach aid may be helpful, Huffman says.
• A safe place to sleep It is important that bariatric patients have a bed that can maintain their weight and not collapse and cause injury, Huffman notes. Many bariatric beds can be lowered close to the floor to make transferring easier, and, in some cases, eliminate the need for safety rails, says Len Feldman, owner of Big Boyz Industries. Since many bariatric patients are bedridden, the heads of some beds can be raised to allow patients to sit up and eat, and the foot sections can be lifted to help reduce edema.
• A proper support surface to sleep on For bariatric patients who are confined to their beds, many have open wounds in their skin from abrasion, Huffman says. For these immobile patients, proper support surfaces, such as low air-loss mattresses, are important to prevent pressure wounds. “I tell my physicians to treat these [super-obese] patients as if they’re quadriplegic — they’re just not moving,” he says.
• Lifts and transfer equipment Some patients may weigh 500 pounds but are being cared for at home by a 100-pound spouse, Huffman notes. “If they go down with back injury, you have two people that are incapacitated.”
• Sleep equipment, such as CPAPs Sleep apnea is extremely prevalent in the U.S., especially among bariatric patients, Huffman says, adding that some bariatric centers say 90 percent of their patients have sleep apnea. Because sleep apnea remains underdiagnosed, he says, more education needs to be done to inform physicians and increase sleep testing.
• Diabetic supplies As a patient’s weight goes up, so does insulin resistance, Huffman notes, and patients must control their blood sugar to prevent further complications. “Almost all of our [bariatric] patients are diabetic,” he says. “That’s where we have real concerns, because diabetics are at risk for amputations, blindness and kidney failure.”

But not all bariatric patients are built the same. This is why it is vital for providers to be able to evaluate each patient individually for each product, particularly in the case of wheelchairs, says Kramer.

Display for Multiple Sales

“There are lots of seat depths and widths and custom backs,” he says. “Pear shapes and apple shapes have different seating requirements.” For example, if a patient protrudes out backward, they may need an extra-high gap between the seat and bottom of the back, Kramer notes. Otherwise, their tissue may push them so far forward in the seat that they can’t touch the backrest and be comfortable in the chair.

Just as each individual needs to be evaluated, each individual’s home also must be evaluated to make sure it can accommodate bariatric products, says David Jacobs, president for durable medical equipment, Medline Industries.

“While there’s adequate profitability for these products, it requires a lot more work to make sure that the home is ready for these products,” he says.

Providers should do a walk-through of the home, paying special attention to the width of the doorways and halls, Jacobs recommends.

“When you’re talking about wheelchairs that may be 24 inches wide, you need another 10 inches to go comfortably through he doorway,” he explains. “A lot of homes aren’t equipped for that. It creates a big challenge for people in the home setting because they often get confined to one area like a living room or family room where they don’t have to go through doorways.”

If a patient cannot have his or her home reconfigured, which can be costly, one solution is to use a smaller transport chair that will fit through doorways. “Even if someone can’t self-propel, they can still scooch with their feet,” Jacobs says.

And, bariatric wheelchairs can be ordered with special narrow armrests so they aren’t wider than the seat, Kramer points out.

Providers should also consider the size of other bariatric products, such as beds, to make sure they will fit in a patient’s home. Even products like a bariatric bath bench or transfer bench will take up more space because they’re bigger and bulkier, Jacobs notes.

Providers may need to make special accommodations to deliver bariatric products, Jotblad says, because they could require a larger vehicle or more than one person to do the delivery and set-up.

Because bariatric patients will typically require more than one product, providers should offer a broad portfolio of equipment, Jotblad continues. She also notes that displaying bariatric products in-store can help let customers know they are available.

“There’s a misperception that bariatric products are large, unwieldy and ugly,” Jacobs adds. “Providers can help themselves by merchandising these products and letting people know they’re not dramatically different … There’s nothing to be embarrassed about. Also, [consumers] can see the safety and security these provide for the users and caregivers.”

One product Jacobs says he doesn’t see displayed often enough in HME stores is bariatric rollators.

“It’s a fast-growing area in general because people want to be more mobile, and it’s pushed by therapists and physicians because it’s good for them,” he says. “I think that’s an opportunity for providers to make caregivers and users aware they offer bariatric products, and they look very similar to regular products.”

At Pride, bariatric scooters and power chairs have the same look as the regular line, but “underneath the hood” they have heavier-duty suspension, weight capacity, seat depth and width, says Cy Corgan, national sales director of retail mobility.

“We don’t want them to look utilitarian,” Corgan says. “Even though they’re designed for a higher weight capacity, the individual wants to have a product that is stylish, contemporary and has that curb appeal to it.”

Pride’s Chesna adds that despite the pressures of competitive bidding, providers should be careful to stick with quality products. “It will be tempting for providers to go with cheaper products,” he says. “It’s going to make it more difficut for providers to offer a quaity design that will withstand the rigors of daily use.”

Offer Help to Referral Sources

Many of the morbidly obese are homebound and often first find their way into the health care system though bariatric surgical programs, says Huffman.

That is why providers who want to expand their bariatric business would be wise to develop relationships with bariatric health and surgical centers in the community, he recommends.

“There’s a huge opportunity in this market as it evolves to educate the bariatric surgical community and bariatric health care facilities,” he says.

According to Huffman, the market for bariatric surgeries has grown from a few thousand a year a decade ago to almost 200,000 this year. By 2016, bariatric surgery is expected to be the most common abdominal surgery in the United States.

“We have a lot of good equipment in the hospital to transfer the patient around, but when they get to the home, [these patients] are often lost to the health care system,” he says. “We’re trying to educate discharge planners to ask the patient, ‘If you’re using a bariatric wheelchair or bed in the hospital, do you have that same equipment at home?’”

And having proper bariatric equipment at home — particularly equipment that keeps patients mobile — is key to recovery after surgery, Huffman says. Patients must stay active because pulmonary embolism is the No. 1 killer after surgery, he explains.

“We would have them ambulating in the hospital very well with walkers and canes, but as soon as they got home, there was nothing there to assist them with ambulation and they’d lay on the bed increasing the risk of clots developing,” he says.

He recommends finding out who is doing the bariatric surgeries in the community and meeting with their program managers and discharge planners.

“Tell them, ‘I want to help your patients at home and make sure post-operatively they’re going to do well,’” Huffman says. “I think [HME providers] will find a receptive audience there.”

Another good way to reach potential patients is to contact and educate primary care physicians in your area, Huffman suggests. The typical primary care doctor has 1,000 bariatric patients in his or her practice, he says, but many physicians simply aren’t aware there is bariatric equipment available for home use.

But make sure you have done your homework before you speak with anyone in the medical community, advises Jim Ernst, COO for Leisure-Lift.

“The [provider] needs to know what he’s talking about when he goes in,” Ernst says. “If he recommends equipment that meets [the patient’s] needs and is flexible, he will be accepted as an expert, and that makes him very valuable to them.”

Experts Interviewed

Joe Chesna, national sales director of standard power, and Cy Corgan, national sales director of retail mobility, Pride Mobility Products, Exeter, Pa.; Jim Ernst, COO, and DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Len Feldman, owner, Big Boyz Industries, Ivyland, Pa.; Dr. Kevin Huffman, D.O., bariatric advisor, Gendron Inc., Archbold, Ohio; David Jacobs, president for durable medical equipment, Medline Industries, Mundelein, Ill.; Sue Jotblad, marketing manager, Sunrise Medical, Longmont, Colo.