According to the Obesity Action Coalition in the United States, more than 93 million Americans (or about 25%) are obese, and that number is predicted to rise to 120 million in the next five years.

The pressure is increasing on hospitals to provide specially designed bariatric rooms, and several have remodelled existing arrangements or constructed new facilities.

Confronted with a big rise in the number of morbidly obese patients, Froedtert Hospital in Milwaukee, Wisconsin, opened 12 bariatric rooms with special features such as increased weight capacity and floor-mounted toilets instead of the usual wall-mounted type. Bariatrics is a branch of medicine that deals with the control and treatment of obesity and allied diseases.

Manager of clinical resources for patient care services Lynne Mueller, RN, says this has overcome the problem of wall-mounted units separating from the wall when used by obese patients.

The toilets also have an increased porcelain weight capacity of 1,000 pounds (453kg). Toilets with less capacity can break and cause injuries to patients.

“The additional cost to build the bariatric rooms was about US$3,200 per unit, but the new facilities provide substantial benefits for patients and staff,” Mueller says.

“Larger doorways and more space around beds, toilet and shower installations make it easier for patients and staff to navigate in the room.

“Shower stalls are now 4 x 5ft (1.2m x 1.5m) instead of the standard 3 x 3ft (.9m x .9m), and hand-held nozzles are mounted on the side walls of the shower rather than the back so they are easier to reach and use.

“The bariatric rooms are not in a separate area but integrated with standard rooms throughout the hospital. We don’t want these patients to feel they are being treated differently from our other patients.”

Mueller says hospital rooms must meet certain requirements to comply with the Americans with Disabilities Act (ADA).

“Toilets must be a certain distance from the wall. Patients who weigh over 500 pounds cannot sit comfortably on a standard toilet because it is too close to the wall. A few more inches away from the wall would be helpful. The ADA regulations don’t seem to recognize that the bariatric patient may also be in the disability category and require special needs.”

Hospital fixture and equipment manufacturers are gradually taking more interest in the growing need for bariatric facilities.

For example, equipment manufacturer the Hill-Rom Co of Indiana has formed a group known as the Bariatric Room Design Advisory Board (BRDAB) to look at developing industry Standards for the design of equipment and facilities for obese patients. The group consists of bariatric surgeons and nurses, medical equipment planners, nurse consultants and health-care architects.

James Harrell, of GBBN Architects in Cincinnati, is a member of BRDAB. He is concerned that most hospitals do not have dedicated units for bariatric patients. Toilet rooms are too small, and fixtures are not strong enough to support obese people.

“Bariatric patients can range from about 250 pounds (113kg) to more than 1,200 pounds (544kg), so it is important that appropriate provisions are made for their care,” Harrell says.

“Special consideration must be given to the design of the toilet room, and increased size is only one of the design factors.

“Water closets must be designed to support a patient weighing up to 1,000 pounds (453kg) and should be mounted with a minimum distance from a flanking wall of 21 inches (0.53m). Also, the inclusion of a suitable bidet in the toilet room will facilitate the hygiene of obese patients, and sinks must be strong enough to resist pulling away from the wall if grabbed by a falling patient.