By Miriam E. Nelson, Ph. D.

The National Institutes of Health reports that approximately 93 million people in the U.S. are obese. Obesity is defined as those having body mass index of greater than 30 kb/m2or weighing 100 pounds more than their ideal weight.

Obesity is a chronic disease that increases the risk for heart disease, high blood pressure, high cholesterol, stroke, diabetes, sleep apnea, osteoarthritis, respiratory conditions, and cancers of the breast, colon, endometrium, and prostate.  Higher mortality rates are also related to higher body weights from all causes. *

If your loved one is obese, caregiving on your own may be challenging. Often a team approach is best for providing care and support.  Your “team” may include you, your loved one’s physician and other specialists—such as a nutritionist, psychologist, registered dietitian, and exercise physiologist.  As the team’s leader, here are some important issues to examine that can help you better manage your loved one’s care skillfully and compassionately.

Select “Sensitive” Healthcare Professionals

Be sure each member of the healthcare team—whether a doctor, physical therapist, nutritionist or any other specialist—treats your loved one with respect.  Also, for example, if your loved one travels to the doctor’s office, check out the facility, noting if the office is accessible and if medical equipment and supplies are available to accommodate an obese person’s size.  This may include strong, wide examination tables, large adult blood pressure cuffs, a weight scale that accommodates obese patients (more than 350 pounds), and extra large dressing gowns, etc.  Interview the staff about their approach with obese patients, including asking if weigh-ins are done, and if so do they ask the person first and then do so in a private area. Also, inquire about any counseling and preventive services the provider offers.

Maintain Thorough Health Records

As the primary caregiver, it’s important to track your loved one’s health history, including his/her personal and family’s diagnosed conditions and diseases, allergies, medications and treatments (whenever possible). Keep these records up-to-date by noting all doctor appointments and phone calls (including content and outcome of these discussions), prescribed medications, copies of laboratory reports, and billing information.  Also be sure to maintain a list of “important” phone numbers for all healthcare professionals and services. Having this information on-hand can help you and the doctor anticipate and manage a majority of health-related issues for your loved one.    

Evaluate Nutritional Needs

People who are obese may have metabolic or mental health disorders or a chronic disease such as diabetes that affects their ability to control weight gain.  Ask your loved one’s doctor for a referral to a registered dietitian so that you can get good advice about a dietary plan that satisfies recommended nutritional requirements, and is appropriate if he/she has a pre-existing health condition. Know too that eating behaviors must often change to affect weight reduction. Making a change takes time and patience for your loved one andyou.

Get Moving Whenever Possible

Remember, before getting started with any physical activity, to talk to your loved one’s doctor.  If exercise is approved, then encourage your loved one to participate in some physical activity.  Talk to him/her about interests and the types of activities he/she enjoys. Adaptive aerobics, water exercises, or wheelchair workouts can be done by men and women with mobility issues; likewise a special exercise program can be designed to fit your loved one’s level of fitness and ability.  As the caregiver, make sure your loved one “listens to his/her body” so if there’s any difficulty breathing, prolonged weakness during or following exercise or a feeling of faintness, then he/she should stop exercising and advise the doctor of these symptoms.

Assess Your or Your Loved One’s Home Floor Plan

Take a walk around your house, making notes about the placement of furniture, lighting, location of stairways, width of doorways and hallways, and accessibility to and ease of mobility in the bathroom.  Then, make adjustments in your home’s layout to make mobility easier and safe, such as:

• Move furniture so there’s a clear path for walking side-by-side with your loved one (with or without crutches) or when using a walker or wheelchair
• Remove rugs to help prevent slips and falls.
• Place extra lighting in hallways and on stairways to improve visibility 
• Add handrails throughout the bathroom—on walls, near the toilet and in the tub or shower—to improve access and help prevent falls.
• Place a bench in the tub or shower so your loved one can be comfortably seated while bathing.
• Another consideration, space permitting, is to convert a first floor room into a comfortable bedroom. Ideally, a bathroom is located nearby to facilitate personal hygiene too.  Single floor living is more convenient and navigable for you and your loved one. 

Recognize your Physical Strength and Limitations

If your loved one cannot easily walk around your house or is bedridden, it’s important to understand his/her limitations as well as your own and then address them. For example, you may not be able to move your loved one on your own—whether changing positions in bed and/or providing assistance from one room to another.  If this is the case, seek the assistance of a skilled nursing service.  A trained aide can help with moving your loved one and facilitate with basic activities of daily living (ADL), including eating, dressing, bathing, toileting and transferring (moving in and out of a chair or bed; likewise, the aide can regularly help change your loved one’s position in bed to avoid bedsores and possible infection. 

Find Helpful Transportation

Your loved one may require transportation to doctor’s appointments, and possibly physical therapy and chemotherapy treatments (or other types of treatments), depending on his/her condition. If he/she is unable to drive, you may be able to accommodate him/her in your vehicle.  If not, contact community groups that offer special vehicles with ramps or movable stairs to facilitate access, as well as provide sufficient space on-board to accommodate, for example, wheelchairs.  

*Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, North American Association for the Study of Obesity (NAASO) and National Heart, Lung, and Blood Institute (NHLBI), September 1998.