March 2013
Class III Obese Patients: Is Your Hospital Equipped to Care for You?
Emergency Medicine; Internal Medicine and Subspecialties; Nursing;


In a recent study, 28.6% of Pennsylvania’s population was obese. Obesity is an increasingly prevalent problem that affects the healthcare system as well as patients. Not all obese patients require special care and equipment, but class III obese patients have different needs. The Pennsylvania Patient Safety Authority analyzed 1,774 adverse events submitted over five years that identified class III obese patients. The analysis showed that Serious Event reports (reports that harm the patient) accounted for 24% of adverse event reports for class III obese patients whereas Serious Events accounted for four percent of Serious Events for the general patient population reports over the same time period. Another study of the data showed a higher-than-expected number of equipment-related reports (10%, n=180) compared to reports for the general patient population (0.8%). 

Definition of Class III Obesity

Class III obese patients are identified as having a body mass index (BMI) greater than 40 or weighing 100 pounds or more than their ideal body weight.

What Class III Obese Patients Should Know About Their Healthcare Facility:

Healthcare facilities need to be prepared to provide safe general medical care to class III obese patients whose size is more than the capacity of their equipment. If you or a loved one, who is identified as class III obese, must use the healthcare system you may want to know the following:

  • Ask your healthcare facility if they have class III obese patient hospital policies and procedures; and if so, if they are followed. 
  • Ask your healthcare facility if it has the right equipment (equipment that is big enough and strong enough to accommodate you, also known as bariatric equipment).
  • Ask if staff at your healthcare facility is properly trained on how to access and use the bariatric equipment. (e.g., if they know about weight capacity and how to obtain the equipment)
  • If your healthcare facility does not have its own bariatric equipment, find out how long you would have to wait for them to rent the proper equipment to accommodate you. (Renting bariatric equipment  could take up to 12 hours and delay your treatment.)
  • Ask your healthcare facility if they limit care of obese patients to the emergency room because of safety concerns.
  • Ask your healthcare facility if they have a policy in place for obtaining a baseline height and weight for every patient. Healthcare facilities that keep track of each patient’s height and weight will have a better understanding of whether or not they can meet your needs. A waistline measurement  should also be noted.
  • Ask your healthcare facility if they provide education and training to staff about how to be sensitive to obese patients (e.g., just as healthy weight patients do not want their weight spoken out loud; obese patients should expect the same respect).                              
  • Make sure your healthcare facility or doctor’s office has the proper equipment for obtaining accurate vital signs (e.g., if a blood pressure cuff is too small, it will give the wrong information).
  • Ask about the availability of other bariatric-related equipment, e.g., longer tourniquets, larger gowns, longer identification wristbands and longer needles.
  • Make sure your healthcare facility has lifts and transfer devices to assist you when turning, moving or transferring. Without the proper lifts, multiple staff members are often asked to help in moving obese patients. This situation can put both the patient and staff members at risk for injury, as shown in Authority reports. (The National Institute for Occupational Safety and Health recommends that if a healthcare provider needs to lift more than 35 pounds of another individual’s body weight, an assistive device should be used).
  • Make sure your healthcare facility has adequate space for you. Ask about whether the door widths and shower stall widths are wide enough to allow you or your wheelchair, bed or other equipment to fit comfortably through a doorway or into a shower stall.
  • Ask your healthcare facility if you can be placed on a unit near the ground level or close to an exit, or if you need imaging studies, near radiologic departments for easier transport for testing, admission and discharge.
  • Ask your healthcare facility if they do mock disaster drills where patients must be carried downstairs. If not, you may want to consider asking if there is a room near the ground floor or near an exit. 

For more information about the risks for class III obese patients, go to the March 2013 Patient Safety Advisory article, “Class III Obese Patients: Is Your Hospital Equipped to Address Their Needs?” at the Authority’s website 

©2018 Pennsylvania Patient Safety Authority