Part 5: Office Environment Strategies to Reduce Weight Bias Overview Only one in 11 physicians have a scale in their medical office that goes over 350 pounds.1 With more than two-thirds of American adults and one-third of youth with overweight and obesity, it is important to consider the physical environment in health care settings for patients of higher weight. Providing proper seating in waiting rooms and appropriate medical equipment and accommodations in exam rooms for patients with obesity is an ethical responsibility. The purpose of this section is to guide health care providers and staff in providing safe and suitable environments for delivering healthcare to patients with obesity and overweight.Several studies of health care providers and hospital staff indicate that medical equipment is not readily accessible to accommodate patients with obesity.2-5 Research Highlight 23% of health care providers indicated that their emergency rooms are not equipped to handle patients with a BMI > 40 kg/m2 . Health care providers report that medical equipment is not readily accessible to accommodate patients with obesity: 4 o 91% did not have scales for patients over 350 pounds o 79% did not have gowns for patients of higher weight o 54% did not have armless waiting room chairs o 20% did not have longer speculum for pelvis exams o 17% did not have extralarge blood pressure cuffs In a 2013 survey,5 125 health care providers across the US were asked about the availability of appropriate medical facilities and equipment in caring for patients with obesity. Limited access to appropriately-sized equipment can contribute to negative patient health outcomes by,2,3,6,7 · Making patients feel embarrassed · Causing inadequate or incomplete clinical exams and tests such as diagnostic imaging tests. 3 Part 5: Steps to Improve the Office Environment for Patients with Obesity 1. Assess the environment Assess the office environment, and determine whether existing equipment is suitable for patients of higher weight. Try walking through your office from the perspective of a patient with obesity. 2. Plan ahead Obtain necessary equipment for patients with obesity including large size blood pressure cuffs, exam specula, and gowns. Request that your staff use specific scripts to promote sensitive practices when weighing patients. 3. Promote sensitivity Encourage all staff and clinicians to be sensitive to the needs of patients with obesity. Provide sensitivity training for providers and office staff where needed. 4. Obtain feedback from patients Ask for assistance from a patient advocate or from a patient advocacy organization regarding the suitability of the office environment for patients with obesity. When performing patient satisfaction surveys, ask about the comfort of the office environment. To assess your office environment, download this Rudd Center Checklist You and your staff can use this resource to closely examine the office environment and medical equipment for patients with overweight and obesity. 4 Part 5: Promoting a Positive Office Environment for Patients with Obesity Using the guidelines on the following pages can improve patient care in your office.8 “Once when I was going to have surgery, I had to be taken to the basement of the hospital to be weighed on the freight scales. I've never forgotten the humiliation.” -Patient reporting weight bias Create an accessible and comfortable office environment ü Provide sturdy, armless chairs and high, firm sofas in waiting rooms ü Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping ü Provide extra-large examination gowns for patients. ü Install a split lavatory seat and provide a specimen collector with a handle or that fits on the seat. Properly mounted grab bars are needed to enable a person to get up more easily. It is important to install floor mounted toilets and well-supported toilet bowls. Use medical equipment that can accurately assess patients with obesity ü Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm. ü Have extra-long phlebotomy needles, tourniquets, and large vaginal specula on hand. ü Have a weight scale with adequate capacity (greater than 350 pounds) for patients with obesity. 5 Part 5: Steps to Improve the Office Environment for Patients with Obesity Monitor obesity-related medical conditions and risk factors ü Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension, sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis. ü Consider concerns of patients with obesity that may be overlooked such as lower extremity edema, thromboembolic disease, respiratory insufficiency (Pickwickian syndrome), skin compression (ulcers), and fungal infections. Offer preventive care services ü Allow adequate time during office visits for preventive care services. ü Recommend or provide preventive care services that are not compromised by the size of the patient (e.g., pap smears, stool testing). Encourage healthy behaviors ü Discuss the benefits of a modest 5 to 10% weight loss ü Emphasize healthy behaviors to prevent further weight gain, regardless of current weight loss efforts. ü Encourage realistic physical activity goals to improve cardiovascular health. ü Seek out professional resources to assist your patients and provide referrals to registered dietitians, certified diabetes educators, exercise