Obesity in the United States drives growing demand for a range of HME.
by Larry Anderson

The CDC estimates about a third of the U.S. population is obese,
and the numbers are growing. It's an alarming trend that has
engendered a wide range of home care products, even though
providers can face additional costs when looking to serve bariatric
needs. It's a market that requires sensitivity and awareness in
addition to commitment and monetary investment.

"It all begins with understanding your customer, their pain
points and their needs," says Gina Spinelli, customer manager for
Philadelphia-based SCA Personal Care, which provides Tena brand
incontinence products for the bariatric market.

"Selling bariatric products requires more than just putting them
on a shelf," she says. "It is very important that the provider be
fully prepared to support the customer with education to ensure
proper selection and use of whatever products they choose to
purchase. While we believe this to be true across the board for all
our products, it is especially so for bariatric because it is a
developing market and one that needs to be handled with

Understanding how incontinence can impact a customer, for
example, enables providers to recommend the right products.
Consider that many obese individuals with incontinence experience
skin issues, which can be improved using wash creams, wipes and a
diligent incontinence management program. "If HME providers can
become more expert in the specific conditions that impact obese
individuals, they have the upper hand," says Spinelli.

"Educating employees on the unique challenges bariatric patients
face will improve your reputation in the market," adds Mike Sedlak,
group product manager for home care beds/therapeutic support
surfaces at Invacare, Elyria, Ohio. "Compassion and empathy will go
a long way in serving this customer segment."

Selling Value and Durability

Moshe Klerer, CEO of K2 Health Products, Brooklyn, N.Y., which
offers Kolb bariatric wheelchair cushions with up to a 500-lb.
weight capacity, says bariatric reimbursement is healthy, which
makes it a good opportunity. "Medicaid and Medicare understand that
costs are higher, that you are using more materials and that there
are fewer economies of scale, which increases production costs," he

Klerer sees an opportunity for HME providers to differentiate
themselves by carrying equipment for larger patients. "It is a very
profitable end of the business," he says. "Referral sources are
looking for a one-stop shop. You want to be known as the company
that can provide a wheelchair for anybody. Some HMEs do not look at
bariatrics because of stocking issues and because they think there
are too many products. They are losing out. It's not so
complicated. Companies can drop-ship products for you. There's no
reason why you can't get a bariatric product from a manufacturer
within a day or two."

But does reimbursement cover the additional expense? Not

"While reimbursements are considerably more for bariatric
products than standard products, I would agree they are not
adequate in a number of instances," says Sedlak. For example, sleep
surfaces, both therapeutic foam mattresses and powered air
surfaces, are reimbursed at the same rate as standard items yet
cost significantly more. On the other hand, the sleep surface is an
often-overlooked consideration for the bariatric patient, he points

"Also, the cost to serve these patients can be greater due to
the special needs of installing the products," says Sedlak. For
instance, in order to install a bariatric bed, a patient lift may
be required to move the patient from the current bed, which
increases the expense of the installation.

Whether the equipment is reimbursable or not, selling the value
and durability of bariatric products is critical, say the

"Most users know their own challenges, and if a product can keep
them safer, selling via cash sales should be a simpler process,"
observes Cynthia Counts, director of home care/senior product
manager for GF Health Products, Atlanta. "I believe that the
typical consumer may not be aware that there are many bariatric
products designed specifically for them." She notes it is critical
to ensure that products designed for users under 300 pounds not be
used for bariatric needs.

Regarding the cash side of the business, the bariatric market is
a niche that retail isn't fully serving, SCA's Spinelli points out.
"This provides the perfect opportunity for HME providers to supply
their bariatric customers with everything they need, whether it is
incontinence products, beds or anything in between."

Filling the Awareness Gap

Bryan, Ohio-based bariatric manufacturer Gendron approaches the
market with an emphasis on education, awareness and relationships,
says Roberta Jacobs, national sales manager. The company hosts
medical advisor Dr. Kevin Huffman, a well-known expert in
bariatrics, on its website.

"Products are always changing and improving to meet the needs of
the patient," says Jacobs. "A common misconception within
bariatrics is that all patients are candidates for surgery when
many are not, and that all bariatric patients have the same needs,"
she comments. "There needs to be a selection of products to meet
various needs." The company's beds, for example, are designed to
accommodate patients from 500 to 1,000 pounds. and can be fixed or
width-expandable for specific needs.

"[Another] common misconception is that bariatric patients are
lazy," says Sedlak. "Nothing could be further from the truth.
Through some ailment they have dramatically increased in size to
the point that simple everyday tasks become nearly impossible, and
as their activity level decreases, their size increases. Due to
this increase in size, taking a walk around the neighborhood
becomes an extremely difficult feat."

Invacare serves bariatric patients from 350 to 1,000 pounds with
products including beds, sleep surfaces, wheelchairs, walking and
bathing aids and patient transfer aids. The company's bariatric
beds are wider to allow a patient to rest comfortably and have
adequate room to reposition. "We also offer beds that expand in
length for patients who need the extra leg room," Sedlak says.

"Products need to be designed more robustly," he says. "For
example, simply taking a home care bed and making it wider will
only cause it to wear at a faster rate … In extreme cases,
some patients are spending their entire day in bed, so the design
requirement of the bed needs to take this into account."

Ed Link, vice president of marketing for Drive Medical, Port
Washington, N.Y., also sees "a void relating to consumer
awareness." Drive has a dedicated bariatric catalog as well as
videos to help fill the knowledge gap. With a full line of
bariatric products, the company's new bariatric steel folding
walker has a 700-lb. weight capacity, steel construction, contoured
hand grips and easy push-button mechanisms that can be operated by
the fingers, palm or the side of the hand.

Graham-Field concentrates in the 400- to 600-lb. market for
bariatric products, offering a line from bath safety to wheelchairs
to beds. Features include reinforced welding, dual crossbrace/frame
supports and wider seats. The products must be both structurally
sound and provide a level of comfort for the user, says Counts. For
example, the company's Imperial Collection Three-in-One Drop Arm
Commode combines seating support and weight capacity. The seat is
blow-molded to provide wider seating support and has a 600-lb.
weight capacity. Padded drop arms make it easier to slide in and

"Make sure the products you are offering come from a reliable
source that does proper testing on their products to confirm weight
claims," says Counts. "Keep durability and patient comfort
top-of-mind when purchasing bariatric products. The bariatric
market continues to increase, unfortunately, due to the growing
size of the average American, so the opportunities for bariatrics
are present even in today's economy."

Big Boyz Industries provides a range of bariatric beds to
accommodate patients up to 1,000 pounds.

"HME providers tell us they are buying our beds because they
hold up," says Terry Weisberg, Ivyland, Pa.-based Big Boyz'
director of sales. The extra durability is worth the added expense,
he says, because "with less expensive beds, after six to eight
months, the service calls eat into the profits."

Weisburg cautions providers to be aware of a distinction between
the "working weight" of a bed and the "patient weight" that it can
accommodate. The "working weight" capacity doesn't allow for the
weight of the mattress, bedding and accessories, which can
effectively lower the weight limit of the patient. One
consideration with Big Boyz' models, Weisburg notes, is that
heavier beds do require two people for delivery.

Dan Gilmore, marketing communications manager for patient
lift-maker Liko, Franklin, Mass., believes there is a critical lack
of awareness about the National Institute for Occupational Safety
and Health (NIOSH) recommendation of a 35-lb. weight-lifting limit
for nurses and caregivers. "In a home care situation involving
bariatrics, that's going to lead to an impossible lifting
scenario," he says. "Something has to be done when a bariatric
patient is unable to get out of bed."

Liko, which offers both mobile floor lifts and overhead lifting
systems, operates a Web portal (www.safeliftingportal.com)
to help educate HME providers and others about safe lifting. The
company offers certification courses to instruct providers in
installation and requirements to assess and fortify a structure to
accommodate the extra weight that bariatric products (and patients)
might require.

Boosting Bariatric Sales

When consulting with referral sources, providers should address
how their products make the lives of bariatric patients better,
says Invacare's Sedlak, who also suggests holding lunch-and-learn
sessions with wound care and bariatric nurses, doctors and
therapists to showcase company knowledge of the segment. "Ask for
input on the products and solidify relationships with those on the
front line of care for bariatric patients," he counsels.

  • Getting the word out about a provider's bariatric capabilities
    may be as simple as including two minutes on the subject during an
    in-service presentation, notes K2's Klerer. "Impress upon referral
    sources that these products exist. You're doing more harm than good
    when you try to squeeze someone into a wheelchair that is too

  • Counts of Graham-Field recommends concentrating an area of a
    retail store on showcasing products that complement the bariatric
    selection. "For providers who are set up for retail who are doing
    pharmacy, it would help to perhaps create a health-and-wellness
    area that has bariatric products but also shows health/nutrition
    books, has health food nearby, etc."

    She also recommends educating referral sources that there are
    both standard and bariatric products available so that careful
    selections are made. A GF brochure references the manufacturer's
    full line of bariatric products. "We keep this very simple yet
    detailed and provide it to our customers so they can use it when
    marketing to rehab centers, hospitals, etc.," says Counts. "On our
    website you can find detailed photos and information on our
    bariatric products so anyone can see exactly what they are

  • "Make sure you don't just have one or two bariatric products but
    rather a complete offering that will provide a one-stop shop. Also,
    take a step beyond selling products and really work on the service
    aspect," advises SCA's Spinelli. "Find conditions that are common
    among bariatric consumers and stock the products to meet those
    needs," she suggests. For instance, diabetic supplies are not
    branded as bariatric products, but a large portion of bariatric
    customers may need them, she notes.

    Spinelli adds that for providers with a retail space, it is
    important that the store be physically easy to navigate. Widening
    the aisles and reducing clutter will make the shopping experience
    for bariatric customers — and, in fact, all customers —
    more positive.

    Obesity Continues Troubling Climb

    According to a June report from the Trust for America's Health
    and the Robert Wood Johnson Foundation, adult obesity increased in
    28 states over the past year. More than two-thirds of states (38)
    have adult obesity rates above 25 percent. In 1991, no state had an
    obesity rate above 20 percent. In 1980, the national average of
    obese adults was 15 percent.

    Among key findings of the annual F as in Fat

    • Adult obesity rates rose for a second year in a row in 15
      states, and rose for a third year in a row in 11 states.
      Mississippi had the highest rate of obese adults at 33.8 percent.
      Colorado had the lowest rate at 19.1 percent and is the only state
      with a rate below 20 percent.
    • The number of states where adult obesity rates exceed 30
      percent doubled in the past year, from four to eight: Alabama,
      Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and
      West Virginia.
    • Adult obesity rates for Blacks and Latinos are higher than
      those for Whites in nearly every state. Adult obesity rates for
      Blacks are greater than or equal to 30 percent in 43 states and the
      District of Columbia. In nine states, the rates exceed 40 percent.
      Adult obesity rates for Latinos were above 35 percent in two states
      (North Dakota and Tennessee) and at 30 percent and above in 19
    • Adult diabetes rates increased in 19 states in the past year.
      In eight states, more than 10 percent of adults now have type 2
    • Ten of the 11 states with the highest rates of diabetes are in
      the South, as are the 10 states with the highest rates of
    • Currently, more than 12 million children and adolescents are
      considered obese.