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SEATING GUIDANCE

FOR A BARIATRIC USER

Seating a Bariatric User

Obesity is a growing challenge for many individuals as well as the healthcare system and economy in Australia. Defined as a body mass index score that exceeds 30, statistics from 2018-19 show that 67% of Australians are overweight, an increase by 4% from the previous census in 2014-15, demonstrating this number is only rising. This has an incredible impact on the healthcare system as many people with obesity are at a higher risk of developing chronic comorbidities such as diabetes, heart disease, arthritis, and stroke [3]. With the higher prevalence of the obese population, so too the need for further services in the community are required (Doctors, physiotherapists, occupational therapists, nurses, psychologists the list goes on).

Prevalence of chronic conditions in adults by weight status, 2014-15

The role of an OT involves the relationship between many factors of the person, occupation and environment in our assessment and intervention, which is made more complex when it comes to overweight clients. But in doing so we can enable participation and improve performance for this cohort of the population. The reasons why an overweight person may be referred for an OT assessment can range from implementing healthy lifestyle programmes, promoting independence through adapting a task and tackling challenges in the environment. A referral may also be due to a secondary condition for somebody suffering the effects of arthritis or having survived a cardiac or neurological event.

Prescribing assistive technology is a main aspect of our work as OTs. When it comes to a bariatric client, factors to consider are not only the persons weight but also their shape and size – which make the standard range of equipment unsuitable. Assistive technology designers and providers have had to adapt to the complex needs of an overweight individual.

When looking to prescribe a chair for example, for a bariatric client it can be very challenging. Regularly an OT will consider the features of size, posture, pressure needs of the client to guide our clinical reasoning. With a person who is obese, we must take into account the extra body mass and to consider where this is going to go when fitting someone to the correct chair for their shape and size . The Configura Bariatric range has been designed and developed with the above considerations making it one of its kind not only in Australia but also in other leading healthcare markets such as the UK and the United States. The Configura Bariatric is sensitive to the features of Weight, Shape and Size, Posture and Transfer, Pressure and can be configured as detailed below:

Weight

  • There are two options of maximum user weight for the range of chairs: 254kg & 317kg

  • Importantly, the leg rest itself has a 127kg weight capacity. This is to consider the possibility of oedematous legs but also the consideration of weight transfer from the pannus area onto the legs when sitting. Generally, the leg rest mechanism is the first part to fail as most are not designed to tolerate the excessive weight.

Shape & Size

  • The shape and accessories of the chair accommodates the extra body mass of a plus-sized person and their tendency of weight fluctuation over time.

  • The height and depth reflect the reduced dimension required for bariatric users. The depth can be further modified depending on the needs of the clients and available for fluctuations of weight and size (from 18” to 22” depth). The Configura Bariatric range starts with a Floor-to-Seat height of 16” (406mm) and this is what makes the range so suitable.

  • There are 3 size options for width by easily removing and adjusting the positioning of the armrests, ranging from 24” up to 34”.

  • The lowest back pillow cushion (or part of the stuffing) is removable to allow space for the gluteal shelf to fit at the back of the chair. This, in turn, improves posture as the backrest supports the spine more comfortably and avoids forward seating alteration.

  • A leg rest channel is an available feature which can be placed around the leg rest for reduced risk of legs falling off the leg rest.

Posture & Transfer

  • The mechanisms of the chair can be used to position somebody in upright, reclined or tilted forward.

  • By using the tilt-in-space, combined with leg raise and back recline function a person can get in a position that lifts their legs to the level of the heart, aiding circulation, which is a suitable option for treating people experiencing lymphedema or swelling in the legs.

  • When sitting upright a person who has extra body mass on their chest can recline the backrest to offload the weight. Alternatively, if a person with a different body shape cannot tolerate this, they can use the tilt-in-space function to maintain the angle at the hips and improve their comfort.

  • Postural wedges are available to place behind the backrest in prompting someone to sit more upright and correct their posture.

  • By maintaining a good posture, it will have a positive impact on vital bodily functions like respiration and circulation.

  • The rise and tilt allow someone to stand up from a chair more easily. This function is especially integral for bariatric clients as standing up is a common difficulty. The increase in height and the ability to position the feet underneath the body with knees at a 90-degree angle is an essential feature to promote independent transfers.

Pressure

  • It is often overlooked but an overweight person is at a very high risk of developing pressure wounds. This is often due to a sedentary lifestyle, inappropriate or ill-fitting equipment/furniture and poor circulation

  • Wound management is also complicated due to underlying conditions reducing the level of oxygen and nutrients reaching the tissues and affecting the healing process.

  • By providing someone with the correct sized chair there will be a reduction in risk of pressure damage.

  • The base of the configura bariatric chair can be modified to suit a person’s comfort and pressure care needs. For a person who already has developed pressure injuries, a CushionAir Alternating Seat air cushion is available for a very high level of prevention.

  • The vapour permeable material on all contact areas also allows for a better level of pressure relief as it promotes the skin to immerse and increases pressure distribution. This is a good option for people who sweat profusely and generate an excess level of moisture.

  • Not to mention that the mechanism of tilt-in-space also aids pressure redistribution for those high-risk patients.

The chair has 4 actuators with independent control of the tilt-in-space, leg-rest, backrest and rise functions. These features are all key aspects of why the Configura Bariatric is such an excellent piece of assistive technology for plus-sized individuals. Subsequently by managing the negative consequences of poor posture and pressure care the chair will have a long-term positive influence on the healthcare system and economy.


References:

Australian Government. (2019). The Department of Health. Overweight and Obesity.

World Health Organisation (2016). Obesity and overweight. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight

Professor Andrew Wilson. (2019). The Australian Prevention Partnership Centre. Obesity and Chronic Conditions. Ministerial Obesity Summit Presentation.

Australian Institute of Health and Welfare. (2017). A picture of overweight and obesity in Australia. Canberra: AIHW.

Brewster, K. Nowrouzi, & B. Davis, L. (2014). The role of Occupational Therapy in Obesity Management. University of Toronto Medical Journal.

Haracz, K. Ryan, S. Hazelton, M. & James, C. (2013). Occupational therapy and obesity: an integrative literature review. Australian Occupational Therapy Journal.

Cowley, S. & Legget, S. (2009). Manual handling risks associated with the care, treatment and transportation of bariatric (severely obese) patients and clients in Australia. Australian Government publication. Safeworkaustalia.gov.au

Birt, J. (2012). Specialized Seating and Pressure Management Principles for the Bariatric Client. Online publication.

Vaqas, B. & Ryan, T. (2003). Lymphoedema: Pathophysiology and management in resource-poor settings - relevance for lymphatic filariasis control programmes. Filiaria Journal.

Rush, A. (2009). Bariatric care: Pressure ulcer prevention. Wounds UK. 4, 68-74.

Category: Journal

Seating Guidance For A Bariatric User