Circa 1965, a new medical word was created. It used the Greek root “bar” (meaning weight), the
suffix “iatr” (meaning treatment), and the suffix “ic” (meaning pertaining to). When combined, bariatrics
was defined as the field relating to the study and treatment of obesity.|
In today's modern culture,
bariatrics isn't simply about the study and treatment of obesity, but also branching into quality of
life for those of all sizes. And, providing stylish, performanced-based “bariatric” power wheelchairs
for those in need has become an increasing focus in the mobility industry, where just because one is
of a larger stature doesn't mean that they can't have very capable power mobility products.
Does Bariatric Begin?
Bariatric power wheelchairs start with upwards of 301 lb. user weight capacities,
and reach 1,000 lb. capacities, varying by model. Seating sizes start at 18” or 20” wide, and go up to
48” wide (standard bariatric seating is commonly available in 20” to 32” widths, where larger sizes are
often custom). Bariatric power base widths start at 23.5” wide (400 lb. capacity model), up to 45” wide,
with the average bariatric power base width in the 25.5” to 30” range. (In many cases, the seating will
be wider than the power base on bariatric models.) Bariatric models are often designated as “XL,” “HD,”
“Bariatric,” or simply noted, again, as having a weight capacity of 301 lbs. or more.
a Bariatric Power Wheelchair Different?
Of course, simply adding a larger seat to a power wheelchair
doesn't make it bariatric. Rather, a bariatric power wheelchair must be more robust in every way, from
a reinforced frame to larger motors, to higher-amperage electronics to reinforced legrests, and so on.
Speeds are often in the 4 mph range, not only to control dynamic forces like stability, but also due
to lower gearing for increased torque. Additionally, because those needing bariatric power wheelchairs
often have areas of “residual tissue” – namely behind the legs and in their lower back – custom positioning
and seating is also often needed. Endomorph and mesomorph seating is likewise common, allowing the backrest
to be narrower or wider than the seat pan to better fit body types where the hips are wider than the
shoulders or visa-versa. In whole, a true bariatric power wheelchair isn't just designed to carry more
weight, but also features specialized components to best position and support the user.
Medicare and Insurer Funding Realities|
Interestingly, bariatric power wheelchairs are recognized
by Medicare and insurers not based on “bariatric” need, but based on weight capacity. Per Medicare and
most other insurers, the term “bariatric” isn't recognized, but weight classifications are. A 300 lb.
capacity power wheelchair is classified as “standard”; a 301-450 lb. capacity is classified as “heavy
duty”; a 450-600 lb. capacity is classified as “very heavy duty”; and, a greater than 601 lb. capacity
is classified as “extra heavy duty.” (Medicare does now allow a 5% tolerance, so one who weighs 286 lbs.,
for example, can qualify for a “heavy duty” model.)
However, beyond weight capacities, Medicare
and other insurer funding levels don't reflect the true needs of the "bariatric” market. Because “bariatric”
isn't a condition or diagnosis recognized by insurers toward mobility products, a recognized diagnosis
must exist in order for one to qualify for a power wheelchair – that is, a diagnosis beyond obesity.
Statistically, “bariatric” power wheelchair users qualify based on Group-2 funding criteria, as in conditions
like COPD or diabetes (as opposed to qualifying for a Group-3 power wheelchair, where the funding criteria
requires limitations due to neurologic, myopathic or congenital skeletal abnormality [cerebral palsy,
muscular dystrophy, paralysis, multiple sclerosis, ALS, or such]). As a result, most with bariatric needs
don't qualify for the type of higher-end technologies that they truly need, but are restricted to the
Group-2 rental category in many cases (there are Group-2 heavy duty, very heavy duty, and extra heavy
duty models, but they often lack the more advanced features needed by “bariatric” users). Clinicians
argue that “bariatric” users should qualify within Group-3 rehab funding, as they require higher-end
products, special positioning component, and services that extend beyond the Group-2 funding class. Yet,
most insurers fail to meet this need. Therefore, unless a person of size has a recognized Group-3 diagnosis,
it can be difficult to get higher-end technologies funded.
Considerations for Consumers of Bariatric
An outdated approach to fitting bariatric power wheelchairs to consumers was to
simply place them on large “captain's” seats. However, those of size have very specific seating needs,
where areas of proper support and relief are needed. Whenever possible, a clinical evaluation should
be performed by a bariatric specialist where seating surfaces, leg support, and so on should all be considered
in addition to the power base weight capacity.
The Right Application
When choosing a bariatric
power wheelchair, weight capacity should never be the only consideration. Seating and positioning are
equally important to consider, from bariatric pressure management cushions to proper leg support. Yes,
funding can be challenging. However, the right clinical evaluation can often not only obtain the appropriate
technologies, but also the most thorough diagnosis toward appropriate funding.
Published 5/2011, Copyright 2011, WheelchairJunkie.com