Overweight patients go through many humiliations in health care, says Nancy Burden, RN, who might be uniquely qualified to know such a thing. Not only was Ms. Burden a gastric bypass patient, but also she's the director of a surgery center. Kill them with kindness and compassion, she says of the greater number of larger patients your facility is likely treating nowadays.

"It was important to me when people were kind and personable and smiled," says Ms. Burden, the director of ambulatory surgery at BayCare Health Systems in Tampa, Fla. "When treating the physical side, remember how emotionally vulnerable your patients are. We can do a lot to bring more humanity and comfort to the obese person's care."

Think big
To increase sensitivity for the overweight, "Walk through all the places where they will be — admitting areas, operating rooms and waiting rooms," says Bobbie Lou Price, RN, BSN, bariatric nurse coordinator at Southern Surgical Associates in Greenville, N.C. "Make sure seating, doorways and bathrooms are wide enough." She recommends floor-mounted toilets; a patient weighing more than 350 pounds can pull a toilet from the wall.

In your waiting room, armless chairs can accommodate corpulent individuals comfortably. Space chairs widely, so larger patients don't crowd each other. Throughout Sacred Heart Institute for Surgical Weight Loss in Pensacola, Fla., "We make sure to have appropriately-sized and weighted furniture that coordinates with and complements regular furniture, so obese patients don't feel conspicuous," says Janet Carlo, RN, BSN, the facility's bariatric program manager.

Obese patients are often self-conscious. To minimize embarrassment, weigh them in rooms with doors, on scales with broad, low platforms. "Patients with wide legs may not be able to step very high," says Ms. Price. A sense of privacy will also encourage greater candor.

Buy large blood pressure cuffs and gowns ample enough so just one provides complete coverage. Patients won't say anything because they're used to it, says Ms. Price, but they wince when someone leaves to find bigger items. Stretchers, recovery chairs and operating tables should be certified to support extreme weight.

For surgery, laparoscopes and related instruments must be long enough to accommodate greater girth. Extra layers of fat impede less invasive procedures, or even finding veins for an IV drip.

"With morbidly obese patients, it's often more challenging to accomplish the surgical goal through small incisions," says orthopedic surgeon Michael Parks, MD, of the Hospital for Special Surgery in New York City, who frequently performs minimally invasive arthroscopy. "Fat around the knee or shoulder can make it difficult to get into the joint."

Obese patients have higher rates of wound drainage, and raise concern about post-op effects of heart disease and diabetes. "You have to be prepared to convert an outpatient to an inpatient if a problem develops," says Dr. Parks.

Words and interactions
"Every person who's overweight knows it," says Ms. Burden. Thoughtful language is welcome, and soothing. "Instead of saying, ???Oh, I have to get a bigger cuff,' say, ???I need a different cuff.'" Shun the word "fat." Ms. Carlo chooses phrasing like, "People with extra weight have increased risk of a blood clot." Dr. Price frames being overweight as having a disease, saying, "You have obesity." He asks staff members, "Will you be able to work with patients who are obese without speaking in a derogatory manner?"

Bias comes out eventually, says Ms. Price. "We make sure each staff person is trained appropriately and stays on top of new treatments, screenings or protocols in our office at monthly staff meetings," she says. Southern Surgical's sensitivity training covers such common obesity-related problems as use of special equipment, like larger lifts or beds, and obesity's effects on serious conditions, including cardiovascular disease.

At Sacred Heart's monthly staff meetings, "We remind them how we want to be perceived [by patients]. When I find magazine articles showing insensitivity, we discuss better ways to handle each situation," says Ms. Carlo. Sacred Heart has mandatory annual sensitivity training about dealing with obese patients.

BayCare's "cultural sensitivity" orientation requires treating everyone with dignity and respect, regardless of different religions, nationalities or weight. Its health system has an online cultural competency education program, including a test that poses questions about sensitivity.

"It's normal to flag a chart with alerts, like an allergy. When you obtain a patient's height and weight in a pre-op phone interview, cue other staff members about special needs you might suspect," says Ms. Burden. "Communicate with them verbally, and with a note inside the chart."

Offer encouragement. For any banding surgery patient, who has typically lost 60 to 100 pounds, Edward Domanskis, MD, of Newport Beach Calif., and president of the American Society of Bariatric Plastic Surgeons, "congratulates her for the tremendous self-accomplishment step. I know they're extremely motivated — going through any kind of elective surgery is a big deal." He shares the good news that obese patients' scars heal better, because of less tension around wounds.