This month, let’s start a discussion on seating and mobility considerations for individuals who are bariatric. According to Mosby’s Medical Dictionary, bariatrics is “the field of medicine that focuses on the treatment and control of obesity and diseases associated with obesity”1. The first thing to remember when working with individuals who are bariatric is that there is no “one size fits all”. This month’s article will focus on body shape. People come in different shapes and sizes and it is a person’s unique shape and weight distribution that must be evaluated when assessing for seating and mobility.
There are several different types of body shapes and weight distribution. Each may have a different impact on seating and mobility.
Anasarca is a medical condition in which there is severe generalized edema. Body fluid builds up in the extracellular space and is not removed via the lymphatic system. This can result in decreased range of motion of the joints and a shift in the person’s centre of gravity towards the knees when seated.2 There may be increased perspiration (i.e., perfuse sweating) due to decreased heat dissipation. This will have an effect on skin integrity, as will the increased susceptibility to skin shear and tears.2
Apple or Apple Ascites Distribution
When someone is described as being apple-shaped, it means that that the waist to hip ratio is high; the waist measurement exceeds the hip measurement. Ascites is an accumulation of fluid in the peritoneal cavity. Someone who presents with an apple ascites distribution has a rigid abdomen as a result of fluid. The size of the legs may be relatively normal. Frequently, someone with an apple ascites presentation has intact hip and knee flexion and limited trunk flexion.2
Apple Pannus Distribution
Rather than the rigid abdomen associated with the apple ascites distribution, the apple pannus distribution is associated with a mobile abdomen, in which the belly button can wander and the abdomen can hang. Often, hip and knee flexion remains intact and leg size may be relatively normal.2 The pannus, or panniculus, is graded, depending upon the extent the abdomen hangs. A Grade 1 pannus covers the pubic hairline but not the entire mons pubis. A Grade 2 pannus covers the entire mons pubis. A Grade 3 pannus covers the upper thigh. A Grade 4 pannus extends to midthigh and a Grade 5 pannus extends to the knee and beyond.3
Pear Adducted Distribution
A pear-shaped person carries weight predominantly below the waist. When the excess tissue is carried on the lateral aspect of the thighs, allowing the legs to be aligned parallel when sitting, the weight distribution is pear adducted. There may be range of motion limitations in hip and knee flexion, causing the knees to be extended when sitting.2
Pear Abducted Distribution
When a person with a pear-shaped weight distribution carries excess tissue on the medial aspect of the thighs, preventing the thighs from aligning parallel when sitting, the distribution is described as pear abducted. Limitations in hip and knee flexion may be present. In sitting, the individual will present with the legs abducted, or spread.
Bulbous Gluteal Region
Excess buttock tissue can create a “posterior protruding shelf”2 (p. 64). In sitting, the gluteal shelf created by the excess tissue of the buttocks extends beyond the posterior aspect of the trunk.
As we have seen from the above descriptions, there are differences in how people carry their excess weight. It is by understanding the person’s unique body shape that optimal seating and mobility solutions can be found. There is no one size fits all solution!
As always, please provide your comments, questions and suggestions regarding Clinical Corner on my blog. I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, OT Reg. (Ont.)
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2015 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.
- Bariatrics. (n.d.) Mosby’s Medical Dictionary, 8th edition. (2009). Retrieved from http://medical-dictionary.thefreedictionary.com/bariatrics.
- Corbyn, C. & Rush, A. (2010). Challenges of wound management in bariatric patients. Wounds UK. 6(4), 62-71.
- Gallagher, S. (2004). Panniculectomy: More than a tummy tuck. Nursing, 34(12), 48-50.