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Researchers developed a clinical environment checklist to ensure physicians are properly equipped to accommodate patients and combat obesity stigma.
Studies have documented the negative repercussions that an inaccessible healthcare environment can have on patients with obesity. Barriers to care can range from an inhospitable waiting room that lacks sturdy armless chairs to medical equipment that cannot accommodate a patient with obesity. Each contributes to dissolved trust and can prevent a patient from seeking wellness care or recommended screenings.
Although clinical environment checklists for accommodating patients with obesity do exist, they are not updated to incorporate patients with severe clinical obesity, and this patient population is increasing. To address this need to improve treatment protocols, Wesley Boland, MD, and colleagues developed a clinical environment checklist for accommodating patients with obesity in ambulatory settings. The results of this work were published in Obesity Science and Practice.
To develop an updated checklist, Dr. Boland and colleagues reviewed architectural statements, recommendations developed by government organizations, and available scientific research. Based on their findings, the researchers developed a comprehensive checklist targeting the needs and barriers to care faced by patients with obesity. Dr. Boland and colleagues piloted the checklist across eight ambulatory clinics in a large Midwestern urban location (Figure).
Dr. Boland spoke with Physician’s Weekly (PW) about the results of their work.
PW: How is ambulatory care particularly challenging in patients with obesity?
Dr. Boland: Despite over 42% of US adults now living with obesity, many medical facilities remain ill-equipped to provide dignified, effective care for these patients. Ambulatory settings present unique obstacles—from the moment a patient enters the waiting room, they may encounter inadequate seating, narrow doorways, or scales that can’t accommodate their weight.
Medical equipment like standard examination tables, blood pressure cuffs, and gowns are often unsuitable. These physical barriers compound with potential stigma from healthcare professionals, creating an environment where patients may feel unwelcome or unable to receive proper care.
What are the most important findings from your study, and how can these findings be incorporated into practice?
Our assessment revealed significant disparities in equipment availability across clinics. While newer facilities showed better preparedness, many lacked essential items like wheelchair-accessible scales, appropriate blood pressure cuffs, and patient transfer devices. Staff expressed distress about their inability to provide optimal care due to equipment limitations.
The checklist highlighted critical gaps that might not be immediately apparent to healthcare professionals. Clinics can use our comprehensive checklist as a practical audit tool to evaluate their readiness to serve patients with obesity and prioritize equipment upgrades and modifications.
Is there anything else that clinicians would benefit from knowing about your research?
What’s particularly noteworthy for clinicians is that the identified barriers can be addressed incrementally. While some changes require significant investment (like specialized examination tables or imaging equipment), others are more readily achievable.
For instance, ensuring the availability of appropriate-sized blood pressure cuffs or implementing private weighing areas can make an immediate difference in patient care quality. Additionally, it is important to note that seemingly minor barriers, like inadequate seating or public weighing areas, can be experienced as a profound stigma by patients with obesity, leading them to delay or avoid future care despite a physician’s best intentions.
By understanding how these often-overlooked clinical environment factors impact the patient-professional relationship, physicians can make informed changes to their practices that enhance patient confidence, improve appointment adherence, and ultimately lead to better health outcomes for this vulnerable population.
