As Americans grow heavier, problems will arise in rehabilitation facilities

Some rehab facilities have started special obesity programs

Americans’ love of fast food and high-calorie snacks has led to a startling increase in obesity in the past decade, and that means rehab facilities and hospitals increasingly are coping with very heavy patients.

Recent research estimates that the number of people who are obese in the United States increased by more than 50% in the 1990s.1 Also, health care costs related to obesity now are close to $40 billion per year. Some research suggests as many as 27% of Americans are clinically obese, based on their body mass index.2

"Our patients in general are getting larger," says Judy Clementson, PhD, psychologist with Madonna Rehabilitation Hospital in Lincoln, NE. Madonna Rehab officials noticed that the staff increasingly had difficulty treating patients who were clinically severely obese, defined as weighing more than 400 lbs and 100% overweight, Clementson says. The hospital began a formal inpatient obesity program, which included making equipment and facility changes, as well as providing the staff with inservices on sensitivity issues concerning obese patients.

Cape Fear Valley Medical Center in Fayetteville, NC, also began a program to improve the rehabilitation experience for obese patients. "We began by surveying the staff to see what kind of logistic difficulties they had in providing care to obese patients," says Debra Pedersen, MS, CCC, director of speech and audiology at Cape Fear. "We took a look at how many patients in the program were over 300 lbs, and we discovered it was a prevalent problem," she says.

In one month, the 78-bed rehab department had five patients admitted who were obese. The 800-bed hospital had a total of 65 obese patients admitted that month.

"So we asked the staff if they had suggestions about what could be done to make their jobs easier in caring for these patients," Pedersen says. "We received suggestions for changing equipment, and several staff members felt we needed to do empathy training because they felt there was a bias against obese individuals."

Obese patients are stereotyped as lazy’

For example, rehab staff — like the rest of the American public — believed some of the negative stereotypes about obese people. "One stereotype is that overweight people are very lazy. That’s not true at all. The overweight people I’ve met are extraordinarily productive," explains Nicole A. Engle, PhD, clinical psychologist in Chapel Hill, NC, who held an inservice on obesity at Cape Fear. (See story on creating a more sensitive environment for obese patients in rehab, p. 119.)

Madonna Rehab and Cape Fear made the following changes to enable the staff to treat obese patients more effectively and easily and to make the facilities more comfortable for those patients:

  • Patient room changes: Madonna Rehab purchased some extra-wide beds and a lift to assist staff in transferring obese patients who are very weak. "These lifts can handle 750 lbs, and by using them, the staff do not have to physically assist in the lifting, and that makes a difference in reducing staff injuries," Clementson says.

    Cape Fear Valley has put together some special rental packages for obese patients. Vendors can quickly provide large beds, walkers, lifts, and other necessary items. Staff also can provide patients with catalogs selling personal products made for larger people, such as larger clothing hangers, Pedersen says.

  • Bathroom changes: Cape Fear purchased two shower/commode chairs that can hold patients weighing up to 750 lbs. One chair is kept in the pool area, and one is in the rehab unit, where it can be pulled out of storage anytime it’s needed.

    Madonna Rehab also purchased an extra-large commode, and the hospital remodeled the doorways to the bathrooms by taking off the doors so that extra-wide wheelchairs can fit more easily. "Even though the rooms were standard-sized hospital rooms, with the larger equipment it was very difficult for these patients to use the bathroom," Clementson says. "So in several rooms we took off the doors and purchased curtains that can be slid back and forth across the bathroom doorway."

  • Pool and exercise equipment changes:
    "One area of difficulty was that we were not able to provide our aquatics program to obese patients because it might be too difficult to get the person out of the pool in case an emergency arose," says Pedersen. "So we purchased equipment to help us."

    Cape Fear bought a head immobilizer and a backboard that can support up to 1,000 lbs. "If a person needs to be lifted out of the pool, the board is heavy enough to lift the person on it," Pedersen adds.

    Madonna Rehab’s aquatic therapy pool has steps, as well as a lift that can carry up to 750 lbs. "So an obese patient can be dropped down into the pool for walking and other exercises," Clementson says.

    "The aquatic therapy pool is one of the most effective and successful rehabilitation therapies for obese patients, in part because almost all of these patients have joint problems and have developed either arthritis or knee and hip pain as a result of the heavier load on their joints over time," she adds.

    Madonna Rehab also has exercise equipment that can hold 500 lbs, which is 150 lbs more than the typical exercise equipment.

Executive Summary


Obesity is a growing problem nationally that may require rehab facilities to make changes in equipment and staff attitudes.

Essential points:

  • Obese patients may require larger rehab room doorways to accommodate their larger wheelchairs.
  • Rehabs providing aquatic therapy to obese patients may need lifts or other equipment to assist in pulling the heavier patient from the water in the case of an emergency.
  • Exercise equipment, beds, and commodes need to be larger and able to handle excessive weight.


Need More Information?

  • Judy Clementson, PhD, Psychologist, Madonna Rehabilitation Hospital, 5401 South St., Lincoln, NE 68506. Telephone: (402) 483-9443.
  • Nicole A. Engel, PhD, Clinical Psychologist, 111 Cloister Court, Suite 100, Chapel Hill, NC 27514. Telephone: (919) 732-6732.
  • Debra Pedersen, MS, CCC, Director, Speech and Audiology, Cape Fear Valley Medical Center, P.O. Box 2000, Fayetteville, NC 28302-2000. Telephone: (910) 609-6092.



  1. Mokdad AH, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1999; 282:1,519-1,522.
  2. Oster G, Thompson D, Edelsberg J, et al. Lifetime health and economic benefits of weight loss among obese persons. Am J Public Health 1999; 89:1,536-1,542.