This informal CPD article Management of Plus Size People was provided by Mary Muir, National Clinical Consulting Manager at Arjo, who believe that empowering movement within the healthcare environment is essential to providing quality of care.
Management of Plus Size People
1.9 billion adults, aged 18 and over are overweight1, with 650 million people recorded as obese2 – approximately 13% of the world’s adult population,2 with 2.8 million dying every year3 as a result of complications associated with obesity. In the UK, there were approximately 900,000 obesity related hospital admissions in 2018 to 20194, costing the NHS an estimated £6.1 billion5 and by 2034; approximately 70% of adults will be overweight or obese6. Furthermore, Public Health England linked obesity to increased risk of coronavirus-related hospitalisation, intensive care admissions and consequently death7. Caring for overweight or obese people is a key element for today’s health and social care providers8, placing considerable pressure on available resources9 10.
Terminology
When referring to the individual person, the term plus size is the preferred terminology as the word bariatric is the branch of medicine that focuses on the causes, prevention, and treatment of obesity and does not encompass the individual’s holistic needs9.
Definitions
Descriptions that focus solely on weight fail to allow for the fact that people are affected differently by excess weight, dependent on body shape11, which impacts on equipment needs12, space required and functional activities of daily living9. Patients are considered morbidly obese when they have a body mass index (BMI) of 40 kg/m², or greater than 35 kg/m² with at least one serious obesity-related condition, or being more than 45kgs over ideal body weight13. An alternative measurement is the MUST tool (Malnutrition Universal Screening Tool) which estimates height by measuring the ulnar length and BMI category by measuring upper arm circumference14.
Health consequences
Obesity is impacting people’s lives now, across the generations, affecting an individual’s quality of life by increasing the risk of developing chronic illnesses, such as musculoskeletal conditions and type 2 diabetes; and exposing us to the physical and social difficulties that often result from the development of severe obesity15. People living with obesity can also suffer from weight-related stigma and prejudice16.
Body shape
Plus-size people can have a wide variety of body shapes in addition to differences in BMI. Two people may weigh the same, however their body shapes, functional mobility and weight distribution, may be completely different. Body shapes are based on waist to hip ratio and are commonly classified into categories. Each body shape poses its own functional challenges in relation to activities of daily living, transfers, mobility and equipment selection.
Practical solutions to support person centered care
The management of plus size people education module promotes practical solutions that can be applied within a variety of health and social care settings. The guiding principles behind the module is to promote independence and provide the participant with information that supports them in their everyday practice. A key focus is to promote a culture of harm-free care and fosters an integrated person-centred approach with mobility as the key focus. The route to delivering quality care begins by predicting the challenges and then implementing, monitoring and evaluating risk reduction activities.17
We hope this article was helpful. For more information from Arjo, please visit their CPD Member Directory page. Alternatively please visit the CPD Industry Hubs for more CPD articles, courses and events relevant to your Continuing Professional Development requirements.
References
1World Health Organisation (2017). 10 facts on obesity. https://www.who.int/features/factfiles/obesity/en/ Accessed August 2022
2World Health Organisation (2020) Obesity and Overweight – key factors https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight Accessed August 2022
3World Health Organisation (2020) https://www.who.int/data/gho/data/themes/theme-details/GHO/body-mass-index-(bmi) Accessed August 2022
4NHS Digital (2020) Statistics on Obesity, Physical Activity and Diet, England, 2020 – Part1: Obesity related hospital admissions https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/england-2020/part-1-obesity-related-hospital-admissions-copy Accessed August 2022
5Peter Scarborough P., Bhatnagar P., Wickramasinghe K., Allender S., Charlie Foster C., and Rayner M The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs Journal of Public Health | pp. 1–9 | doi:10.1093/pubmed/fdr033 https://www.ias.org.uk/uploads/pdf/Economic%20impacts%20docs/pubmed.fdr033.full.pdf Accessed August 2022
6Davies A., Bhatia T. (2015) Nuffield Trust Can the NHS help tackle the UK’s obesity epidemic? Blog post https://www.nuffieldtrust.org.uk/news-item/can-the-nhs-help-tackle-the-uk-s-obesity-epidemic Accessed August 2022
7Public Health England (2020) Protecting and improving the nation’s health. Excess Weight and COVID-19: Insights from new evidence. July 2020 Public Health England, London https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/903770/PHE_insight_Excess_weight_and_COVID-19.pdf Accessed August 2022
8Muir, M, Archer-Heese, G. (2009) Essentials of Bariatric Patient Handling Program, OJIN: The Online journal of Issues in Nursing Vol. 14, No. 1
9Muir, M A and Rush, J A (2013) Moving and Handling of Plus Size People an illustrated guide, Towcester: National Back Exchange, 9 2019
10Cawley, J. and C. Meyerhoefer, The medical care costs of obesity: an instrumental variables approach. J Health Econ, 2012. 31(1): p. 219-30.
11Corbyn C, Rush A (2010) Challenges of wound management in bariatric patients. Wounds UK 6(4): 62–71
12Swann J (2013) Understanding the difference between overweight, obese and bariatric. J Paramedic Pract5(8): 436–41
13https://obesitymedicine.org/what-is-morbid-obesity/ Accessed August 2022
14https://www.British Association for Parenteral and Enteral Nutrition Malnutrition Universal Screening Tool (MUST) bapen.org.uk/pdfs/must/must_page6.pdf Accessed August 2022
15Public Health England (2020) Adult obesity: applying All Our Health. https://www.gov.uk/government/publications/adult-obesity-applying-all-our-health Accessed August 2022
16Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, et al. (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 2010;67(3):220-9 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/210608 Accessed August 2022
17Hignett S and Griffiths P (2009) Manual handling risks in the bariatric (obese) patient pathway in acute, community and ambulance care and treatment. Work 33(2), 175
