From extended blood pressure cuffs to roomier dental exam chairs and wider terry cloth hospital slippers, the health care industry continues to adapt to larger patients as America's obesity rate climbs.
In Lake County, 36 percent of adults are considered obese, defined as having a body mass index greater than 30, according to the Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute most recent County Health Rankings.
"We are one of the most weight-challenged counties in a state that ranks 13th in the nation," said Kathy O'Donnell, a nurse and manager of the Midwest Bariatric Institute at Franciscan St. Margaret Health hospital in Dyer.
The same report shows 29 percent of Porter County adults and 32 percent of LaPorte County adults are obese.
Patient care, from the operating table to the MRI unit, has to accommodate bigger patients, O'Donnell said.
"When you sit in a chair, you assume – as a thin person – that a chair will support you," she said.
If that chair were to collapse, a person could get hurt and feel humiliated.
"When a patient sits down, they need to know they'll be safe," she said.
Safety is taken into consideration in the planning phase.
"As we revamp all of our physicians offices and same-day surgery center, we're designing it around bigger weight limits, because we know that the population now is much larger than it was 25 years ago," she said.
That means sturdier waiting room chairs, wider wheelchairs and floor-mounted toilet bowls. Wall-mounted toilets are easier to clean, but they cannot support as much weight as a toilet braced by the floor, she said.
The hospital also has a system to differentiate equipment and gowns made for larger patients and can choose it without embarrassing patients.
"Staff can identify what the weight limit is on any piece of equipment, so you can ensure patient safety," O'Donnell said. "And patients won't know. It's done in a process that only staff can recognize what that is. You just always want to keep patient safety at the forefront of your mind."
Curtis May, director of supply chain for Methodist Hospitals, said most hospitals have long since geared up for bigger patients.
"Probably about 10 years ago, hospitals started to become aware of the need to have on a regular basis different items to accommodate patients beyond the normal size," he said.
A standard wheelchair can support 300 pounds, but models made for 750 pounds came on to the market about a decade ago. When hospitals buy wheelchairs, they order a certain percentage with at least a 500-pound capacity, he said.
The standard width on a wheelchair seat is 19 inches. The ones to accommodate larger patients have 22- to 23-inch wide seats and often have a removable side arm, he said.
Beds, stretchers, operating tables, MRI machines and even shower chairs are built in varieties that can withstand heavier weights. Lifts are becoming more common, to either lift obese patients or help lift them, May said.
"Those lifts will often have a capacity of 1,200 pounds or more," he said.
Bigger equipment and sizes come with a heftier price tag, often costing twice as much as standard items, May said.
They become necessary as Americans grow more obese.
O'Donnell said there is more awareness now and more focus on weight as an indicator of health. Doctor's offices measure height and weight to calculate body mass index and lead a discussion about related risk factors.
"When you are bigger, your risk factors go up for so many issues," she said.
O'Donnell thinks the next evolution will be private rooms for checking a person's weight.
The prospect of getting weighed in a hallway and the possibility of the number being read aloud or the scale unable to register the full weight is enough to deter obese patients from going to the doctor, she said.
"It is paramount to never have that humiliation," she said. "I think it can become a barrier to access to health care. The most common complaint I see from women is that they don't want to go the gynecologist for routine checks, because they don't want to get weighed."
She knows from working with bariatric patients that most insurance companies want to see a history of obesity for at least five years before covering weight loss surgery. But, if people never get on the scale, there is no record of their weight, she said.
O'Donnell said it is unfortunate the attitude many people have about those who are obese.
"Obesity is one of the last prejudices we have in this country that's acceptable," she said. "It's acceptable to laugh at the person who can't fit in the chair or to think people who are bigger are lazy. It's something society does not seem to find offensive."