Administrators: Space and Attitude

In my experience, administrators tend to often underestimate the amount of outpatient space needed to run an obesity clinic. Given the larger size of these patients, there is need for larger seating, larger scales, larger exam tables, and wider doorways (not to mention the critical importance of floor-mounted toilets!). This means larger waiting rooms, larger exam rooms, larger changing booths, larger rooms for group sessions, etc. Add to this, the additional time needs for patients to dress and undress and move between rooms, it should be no surprise that an obesity clinic will take up at least 50% more space than a regular clinic to see the same number of patients per unit time. 

And while we’re on the topic of space, let us consider the physical location of the clinic in terms of accessibility including distance from parking or public transportation. Having to walk a few hundred metres, navigating ramps, long hallways, or even stairs may prove physically exhausting or almost impossible for patients with severe obesity and mobility issues. 

At this point it may be appropriate to put in a plug for an exciting project on designing a bariatric-friendly hospital, championed by my colleague Mary Forhan in a partnership between Alberta Health Services and Obesity Canada at the Medicine Hat regional hospital in Alberta. 

Key findings from this project, that would make an in-hospital encounter far more safe, efficient, and pleasant for both patients and staff include mandatory education of all staff on weight-bias and respectful interactions, better understanding of the unique needs of people living with obesity, access to and knowledge in the use of bariatric equipment and supplies, and the need to respectfully communicate patients’ needs to other departments (e.g. diagnostics, wards, etc.). As a learning from this project, Obesity Canada is currently working on finalizing a simple labelling system that would readily indicate the weight capacity of all hospital or clinic furniture and equipment.

Finally, when it comes to naming the program, I recommend avoiding the use of the word “weight” (as in “Weight-Loss Clinic”, “Clinic for Healthy Weights”, “Weight Wise”, etc.), as a key tenet of obesity management is to improve the overall health of the patient and not just focus on changing numbers on the scale. This is why I much prefer the terms “Obesity”, “Metabolic”, or even “Bariatric”, as used in a clinical context.  These terms will also help differentiate your centre from commercial “weight-loss” programs that are solely focussed on helping patients lose weight rather than on practicing obesity medicine or providing bariatric care.

Thus, even the most enthusiastic administrators may require some education around the specific needs of this patient population, which will hopefully not dampen their enthusiasm too much. It is far better to anticipate these needs than to try to meet them once the program is up and running. 

Berlin, D