Seating and Mobility Considerations for Individuals Who Are Bariatric, Part 1: Body Shape

Canadian Clinical Blog by Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.) - Sunrise Medical

Hello all!

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., profuse 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!


  1. Bariatrics. (n.d.) Mosby’s Medical Dictionary, 8th edition. (2009). Retrieved from
  2. Corbyn, C. & Rush, A. (2010). Challenges of wound management in bariatric patients. Wounds UK. 6(4), 62-71.
  3. Gallagher, S. (2004). Panniculectomy: More than a tummy tuck. Nursing, 34(12), 48-50.

As always, please provide your comments, questions, and suggestions regarding Clinical Corner. Please email me at I look forward to hearing from you!

Sheilagh Sherman BA, BHScOT, MHM, OT Reg. (Ont.) - Clinical Education Manager, Canada

Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)

Sheilagh Sherman joined Sunrise Medical Canada in 2010 as a Clinical Educator. Prior to joining Sunrise, Sheilagh gained extensive clinical experience working in a variety of settings, including neurological rehabilitation, complex continuing care, and community rehabilitation. As the Clinical Education Manager, Sheilagh is a clinical resource for therapists across Canada involved in seating and mobility. She leads workshops, seminars, and webinars on the clinical aspects of seating and mobility. In addition, Sheilagh has presented at national and international conferences on seating and mobility.

Sheilagh also has an educational background that makes her well suited to the role of Clinical Education Manager. Sheilagh earned a Bachelor of Arts degree in Political Science from the University of Toronto in 1988, which enables her to understand healthcare policy and policy changes. Sheilagh graduated with a Bachelor of Health Sciences (Occupational Therapy) degree from McMaster University in 1994. In 2012, Sheilagh earned a Certificate in Adult Education/Staff Training from Seneca College. She applies adult learning principles to the workshops she leads. Finally, she also has a Master of Health Management (MHM) degree from McMaster University after graduating in 2015. Courses that Sheilagh completed during the MHM degree, such as Knowledge Translation, Evaluating Sources of Evidence, and Quality & Safety in Healthcare, assist Sheilagh in using an evidence-based approach in her work.

In her free time, Sheilagh enjoys running, in addition to practicing yoga.

Date: 2015-03-30

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