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.
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.
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.
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.
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.
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 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.
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.
