At least one-third of adults in the UK will be obese by 2020 if current trends continue, yet there is little guidance, or even recognition, of this in healthcare estate design. Paul Willetts and Morag McGill say it is time to act

With figures indicating that over half the UK population is either overweight or obese, if current trends continue at least one-third of all adults in the UK will be obese by 2020.

The definition of obesity is having a body mass index of over 30. A BMI over 35 indicates morbid obesity and those with a BMI over 40 are termed bariatric.

Obese and bariatric patients may present with a variety of problems - extra weight increases susceptibility to conditions such as diabetes, heart disease, asthma, osteoarthritis and high blood pressure, as well as associated psychological issues. Obese patients may be admitted to almost any ward or department in a general hospital.

The healthy living initiative launched earlier this year is a programme to help families lead healthier lives and the obesity public service agreement of 2004 commits the Department of Health to halt the year-on-year increase in obesity in children under 11 by 2010, while also tackling obesity in the population as a whole.

However, the need to care for those who are already obese and the likelihood that the trend will continue upwards for the medium term means our health service will have to adapt to this new range of problems.

While health delivery strategies and care models will need to be modified, the actual physical healthcare estate will also require adaptation if it is to be able to provide facilities for heavier people.

As our obesity statistics appear to be following closely in the footsteps of the US - it has been projected that 73 per cent of US adults could be overweight or obese by 2008 - it is relevant to look at how hospitals in theUSare beginning to address this issue.

Special equipment

Manufacturers have taken the lead in providing for larger people and a whole range of specialist equipment is now available.Ceiling hoists in hospitals are becoming commonplace, but these are now also being developed to cope with weights of up to 1,000lb (450kg) and greater.

Stretchers and wheelchairs are being manufactured with an increased weight capacity, a wider patient surface and powered motion. Larger beds are being developed with built-in scales that can also convert into chairs to minimise patient transfer.

The issue of specification of specialist furniture and fixtures is a sensitive one. While designing a facility that caters for the larger patient, the interior design element should still be considered to avoid the patient feeling stigmatised or alienated, while at the same allowing them to feel safe and supported.

Public seating provision in the form of two-seater settees avoids the appearance of typical 'big chair' furniture but has the advantage that everyone can sit there.

Careful specification of sanitary fittings not only to support increased weight but to acknowledge the physical difficulties of washing, for example increased bidet provision and hand-held shower fittings.

The need to accommodate the equipment mentioned above means there are significant space-planning implications.

Access to and design of patient areas should recognise the increased space requirements of obese patients. Corridors and doors need to be wider and bedrooms and ensuite facilities increased in size to be able to deal with patient handling.

Even waiting and family areas require extra space to accommodate wider chairs, and here it must also be remembered that it is often the case that obesity will run in a family. Therefore, carers as well as patients must be appropriately accommodated.

A pleasant walking circuit needs to be planned for patients who are mobile so they can have the benefit of exercise to increase heart/lung capacity and reduce the risk of poor circulation-related illness such as pneumonia and thrombosis.

Service planning is also a consideration. Obese patients typically have an increased sensitivity to temperature, so additional patient controlled air conditioning/ventilation is often required to keep patients and families comfortable.

The likely scale of the requirement for obese and bariatric care means that what now is termed special design may soon become part of mainstream design requirements. While at this time it may be excessive to provide for the full range of bariatric needs, it would be shortsighted not to recognise the long-term implications of this patient trend.