It's not easy to grow sales in the home medical equipment environment. But due to increased obesity awareness, and better-designed products to help the
by Patricia-Anne Tom

It's not easy to grow sales in the home medical equipment
environment. But due to increased obesity awareness, and
better-designed products to help the overweight segment of the
population, the adage “big is beautiful” has never been
more true.

“Bariatrics is definitely growing — no pun intended
— and becoming a larger part of the HME marketplace,”
says Bill Baker, director of training for Drive Medical. In fact,
both the increase in awareness and an increase in the morbidly
obese population are key reasons why sales are growing, he

When Baker entered the HME industry 27 years ago, he says
Medicare and most manufacturers did not recognize bariatrics as its
own category. However, he notes, “the nationwide emphasis on
obesity, diabetes research and the emergence of specialty
physicians and bariatric centers have created more awareness in
obesity and management of the bariatric market.”

Drive and numerous other manufacturers now offer extensive
product lineups including mobility, beds and bath safety products,
all designed to help patients live more productive lives. And after
submitting a claim and processing Medicare paperwork, the margins
are still reasonable, experts contend.

Big and Getting Bigger

There's no doubt bariatrics is starting to boom, according to
Joe Zervios, director of communications for the Obesity Action
Coalition. In the United States alone, an estimated 93 million
people are obese, according to the Coalition's figures.

Obese individuals — as determined by a body mass index of
30 or higher, or a weight 100 pounds heavier than their ideal body
weight — are at higher risk for impaired mobility. They also
are more at risk of developing diseases such as diabetes,
hypertension, heart disease, stroke, osteoarthritis and sleep
apnea, among other conditions.

In 2002, the most recent year statistics are available, 25
percent of the morbidly obese were being treated for six or more
co-morbid conditions.

As awareness of obesity grows, so do the products designed to
assist that population.

“In the past six months, more and more people are starting
to delve into this market,” Zervios says, adding that he
frequently gets calls from people with bariatric product ideas.
“It's not so much that these products didn't exist before;
before we never saw a need for these products. Obesity is coming to
the forefront and is finally being recognized by the health care
community as a disease.”

DuWayne Kramer, president of Leisure-Lift, says sales of many
HME products are growing in the 6 percent to 8 percent range. With
bariatric awareness up in the past five years, however, he has seen
sales of his company's bariatric beds growing at double that

Additionally, weight requirements for equipment designed for the
morbidly obese are going up. “We continue to increase the
capacity and increase the capability of individual units,”
Kramer says. “We now make chairs clear up to 675

“We have to assume people are getting bigger and
heavier,” says Harmar Mobility President Chad Williams, who
predicts the trend will continue. Williams says Harmar has had to
increase the weight capacities on its lifts and ramps. “We
had a 300-pound capacity lift five years ago, and last year we
upped that to a 400-pound capacity,” he says.

Bundles Can Mean Better Sales

“The bariatric market is expanding at a very fast
rate,” agrees Len Feldman, owner of bariatric bed-maker Big
Boyz Industries. “The market is growing as needs are growing.
People who use our products are using so many other products, such
as respiratory products [and] diabetic products. Once they pass 500
or 600 pounds, [patients] develop so many health problems that
anyone servicing them has a customer that is using a great deal of

That situation offers providers good opportunities for multiple
sales, manufacturers say, using one well-priced product to secure
that first sale. Then, once they have the customer's attention,
providers can often add to that sale simply by showing other
bariatric products the customer might need, says Drive's Baker.

“Bundling items — i.e., a walker, commode, bed, etc.
— seems to work well,” agrees Fran Spidare, patient
transport product manager for Invacare. She projects annual growth
rates for the bariatrics products market in the 7 to 10 percent

While there is good market potential and higher reimbursement
for bariatric products, Spidare points out, the challenge is
learning to “target marketing to the

Product Integrity Is Key

As products proliferate to take advantage of available dollars
in the marketplace, manufacturers caution providers to educate
themselves about what is available. Even if a product is labeled
appropriate for the bariatric market, it might not be. Providers
need to pay close attention to product specifications and
engineering, even for the simplest items they sell.

For example, the Obesity Action Coalition's Zervios recalls one
vendor trying to sell hangers that would better hold an obese
person's clothes. While that sounded good in theory, Zervios says,
the hangers were virtually useless since they were too big to fit
the depth of most normal -sized closets.

More practical features are those that add safety and durability
to products. For instance, when selling wheelchairs, Jim Ernst,
product manager for Leisure-Lift, advises providers to look at the
incline rating, controller, motor, turning radius, stability and
quality of components. The chair obviously should not tip over with
someone sitting in it, but it also needs to be maneuverable around
a house and have a strong enough motor to move uphill if necessary,
he explains.

“Bariatric users are always much harder on their
equipment. If you sell a marginal chair that isn't truly a
bariatric product, you're more likely to have a problem,”
Ernst says. “Many products in this category don't have the
performance and quality to last in bariatrics. You can sell cheap,
but it's going to be a problem when you can't get service
reimbursements. … If you sell a product and it's junk and it
falls apart, everyone else has to pick up the pieces.”

Granted, equipment materials being used today are much better
than they used to be, manufacturers point out. Metals, wheels and
welds have improved in the past decade. Electronics have also
improved, and products continually evolve, Big Boyz' Feldman

Yet he cautions providers against choosing an
“economy” product for their patients without also
examining its quality. Products can be economical, but they should
be durable. “You can save money going with a lighter steel,
but in the long run, it's not worth it. Plus, I want to sleep very
well at night,” he says.

Are Customers Apples or Pears?

Ultimately, serving the bariatrics patient requires education on
what product features are available in the market, as well as on
how to be sensitive to overweight patients, who already likely are
facing the negative stigma that is associated with their

“There is an educational process and approach that is
needed in the marketplace,” says Roberta Jacobs, national
sales manager for Gendron. “This includes educating the
referral sources so they know what products are available to
improve the quality of life for their patients.” She adds
that both manufacturers and providers should be aware of
sensitivity and dignity issues facing bariatric patients.

A sale involves much more than taking basic measurements,
Leisure-Lift's Kramer adds. He suggests first just looking at the
patient's body shape.

“Bariatric people come in two basic shapes: apples or
pears,” he says. “They have different criteria needs
and requirements, depending on that shape. Some have posterior
problems. Some have their weight out in front.”

One way providers can educate themselves — and
simultaneously increase sales — is to call on physicians and
hospitals that specialize in bariatrics.

In speaking with hospitals or surgery centers, caregivers or
even support groups in the area, a provider might learn that obese
people are sensitive to skin issues and need a foot rest on
wheelchairs, for example. Others might want a walker that folds
because they are trying to get out and stay mobile. The goal is to
make the patient more comfortable, and to make the caregiver's job

Once providers understand bariatric patients' issues and
“let physicians and hospitals know they know what their
patients need, and that they have the right products
available,” that opens up opportunities, Kramer points

“Dealers need to be aware of what equipment is available
to them,” Harmar's Williams says, noting that this category
requires special attention. “If they know what's available,
they will be more able to help customers.”

Drive's Baker also urges providers to get involved and become
active legislatively to try to increase reimbursements for the
category. “That would take the stress off manufacturers so
they can give outstanding and dedicated service to this important
patient clientele,” he says.

Online Opportunities

Finally, providers should consider having an online presence for
bariatric products.

“Let's face it, people who are morbidly obese are
discriminated against,” says the Obesity Action Coalition's
Zervios. “The last thing they want to do is go up to a dealer
and say, ‘Do you carry such and such item for the morbidly
obese?’ There's a ton of hesitation to go into stores to ask
for product, so a lot is being sold online.”

“An online presence definitely helps,” Williams
says. “These patients either don't want to get out and travel
or it's more difficult. Being able to reach them via the Web makes
a lot of sense.”

But with online sales, providers will need to consider what
their return policies will be, Zervios notes.

Despite the sales challenges, “this is a good
market,” Kramer sums up. “If a dealer takes a little
time to familiarize himself with it, then lets customers and
doctors know he understands this patient has special requirements,
it can be very lucrative.”

Obesity Is Bad for Waistline, Employers' Bottom Line, Study

According to researchers at the Duke University Medical Center,
among a study group, obese workers had seven times higher medical
costs from workers' compensation claims and lost 13 times more work
days from injury or illness than non-obese workers.

Researchers looked at the relationship between body mass index
and the rate of workers' compensation claims for a diverse group of
more than 11,700 Duke employees — ranging from groundskeepers
to professors — who had health risk appraisals between 1997
and 2004.

Because BMI takes into account a person's height and weight, it
is considered an accurate measure of obesity. For the U.S., a BMI
of 30 and above is considered obese, while 25 to 29.9 is considered
overweight and 18.5 to 24.9 is considered normal.

The analysis showed that per 100 employees in the study group,
those considered obese lost an average of 183.63 work days in the
study period compared with 14.19 for those within the normal BMI
range. The average medical claims costs were $51,019 for the obese
compared to $7,503 for the non-obese.

Study results also showed that the most common causes of injury
for the obese were slips, falls and lifting, with injuries most
likely to occur in the lower extremities, wrist, hand and back.

Supported by a grant from the National Institute for
Occupational Safety and Health, the study was published in the
Archives of Internal Medicine and reported by Insurance

Experts Interviewed:

Bill Baker, director of training, Drive Medical Design &
Manufacturing, Port Washington, N.Y.; Jim Ernst, product manager,
and DuWayne Kramer, president, Leisure-Lift, Kansas City, Kan.; Len
Feldman, owner, Big Boyz Industries, Ivyland, Pa.; Roberta Jacobs,
national sales manager, Gendron, Archbold, Ohio; Fran Spidare,
patient transport product manager, Invacare Corp., Elyria, Ohio;
Chad Williams, president, Harmar Mobility, Sarasota, Fla.; and
James Zervios, director of communications, Obesity Action
Coalition, Tampa, Fla.