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The rising trend of obesity among Americans will continue to pose increased clinical challenges for nursing home operators, experts say.

Since 2018, the number of states with 35% or more obese citizens has nearly doubled, the Center for Disease Control and Prevention reported Wednesday. And the growing prevalence of obesity among long-stay nursing home residents appears to be mirroring that trend.

In general, extra weight in the nursing home population is not necessarily a problem, said Karl Steinberg, M.D., President-Elect of AMDA – The Society for Post-Acute and Long-Term Care Medicine. And it’s no surprise that the general public may have put on weight in the past 18 months during the pandemic, he added.

“Extra padding can be a good thing,” and there’s some evidence that being a little more overweight gives you some protection against fractures and other risks of frailty for example, Steinberg told McKnight’s Clinical Daily. Long-term care clinicians therefore do not typically focus on caloric restriction for older residents. “We start worrying when people begin losing weight,” he said.

But some long-term care clinicians have witnessed an uptick in bariatric (clinically obese) residents who are too functionally impaired to return home to the community, Steinberg noted. 

In fact, the number of bariatric residents in long-term care has been rising for some time. One study found that prevalence rose from 22% in 2005, to 28% in 2015, researchers from the University of Massachusetts Medical School reported in 2019. And Class III obesity — with a body mass index of 40 or higher — increased from 4% to 6.2% in that time, study lead Jerry H Gurwitz, M.D., and colleagues wrote.

Among these newer residents are an influx of younger adults who have begun to seek the services of long-term care in greater numbers over the last decade or so, Steinberg said. 

These residents do not fit the typical profile of a long-term care resident. In fact, investigators with the Massachusetts Medical School study found that facility residents with obesity were younger and less likely to be cognitively impaired, but with higher levels of mobility impairment. They were also more likely to have important medical morbidities than the traditional elderly cohort, Gurwitz reported.

This newer bariatric population can present special challenges for staff, more of whom may be required to assist residents physically, Steinberg said. This might include turning residents in bed, for example, or helping them into a lift. There may be special durable medical equipment needed to properly accommodate additional size and weight in these cases, such as wheelchairs and beds. 

Some facilities are not yet equipped to provide the level of care these residents deserve, and pandemic-era staffing issues are contributing to the problem, he added.

The medical and functional characteristics of residents with obesity may continue to require increased accommodation from facility operators, “putting financial and staffing pressure on nursing homes,” Gurwitz and co-authors wrote.

Another investigative team foresaw the burgeoning problem back in 2005. “Substantial variation of obesity prevalence within [U.S.] facilities raise concerns about nursing home preparedness and access,” they warned.