Care Comment




    Yet again obesity has been in the headlines (does it ever go away?). For the care industry, the growing need to help obese clients puts strain on equipment and people, especially when going to the loo.


    Toileting difficulties are not an obvious problem when one discusses obesity, but it’s a big (excuse the pun) problem. We go to the toilet on average eight times a day, so it impacts on clients and carers probably more than any other ADL (activity of daily living). Indeed, toileting is specifically itemised as one of the five key ADLs.


    There’s the physical issue of helping the client on and off the toilet if they need support or help. Once sat there, are they in the right position over the bowl? The body mass potentially puts them forward on the seat, so they could miss the pan. And what about the strain on the seat fittings- and the bowl itself- from the additional load?



    Normally, one would possibly position the washbasin within reach to act as a support, or fit support arms, grab rails, if someone needed help to get on and off the loo. The extra loading with a bariatric user means that a whole raft of additional considerations comes into play: is the wall strong enough to bear the load? Are the fixings strong enough?


    A toilet lifter may be a viable alternative, requiring no fixing to the wall. It also helps the user get on and off, automatically lowering them over and raising them up from the WC. Again, bariatric versions exist to accommodate the load bearing and body mass.

    A hoist may be a more appropriate alternative, but again it needs to withstand the load. A ceiling track version provides optimum stability and lifting capability; versions area available with floor-mounted support stantions if required.


    The toilet itself needs to bear the load too: we know of situations where the WC has broken and gone through the floor because of the user’s weight! Conventional WCs- and most automatic shower units, wash & dry toilets cope with up to 127kg/ 20st. The standard Closomat Palma Vita wash & dry toilet is proven to 190.50kg/ 30st.


    Once on the toilet, as outlined above, is their bottom in the right position over the pan? Carers have enough to do without having to clean urine from floors, carpets because the bowl has been missed. Sometimes something as simple as changing a conventional seat for a horseshoe shape can be of assistance, particularly for male clients. In more ‘extreme’ circumstances, a ‘monks bench’ aid over the toilet helps position the user’s bottom in the right place, and give the physical support to their body as they ‘go’. Inbetween, a bespoke bariatric toilet seat is appropriately proportioned to support the user, their bottom and position them over the pan: Closomat’s bariatric seat (Big John) on a Palma Vita takes the weight limit up to 362kg/ 57st.


    When they have finished, how do they- or their carer- manage to reach those intimate areas to clean them effectively? Shower toilets deliver optimum hygiene for bariatric clients and their care support, as the need to manually reach and wipe clean is eliminated- the built-in douching does it instead.


    Even here, weight has an impact. There needs to be adequate clearance between the user’s bottom and the douche for the washing to be effective. The douche spray pattern needs to be wide enough to reach all potentially contaminated areas. The amount of water needs to be adequate too to cleanse efficiently- units vary in their flow rates from as little as 2l/minute up to 8l/minute. The douche may need to extend further to reach the user’s anus and rectum, as their body mass positions them further forward.


    Consider too that not all shower toilets wash & dry- some only wash, so the user still has to be dried to avoid soreness and other skin conditions.


    Whatever, with 25% of the population now classified as obese- a figure that has tripled in the past 30 years- it’s a problem that is not going away, and needs to be addressed in our toileting care provision.


    To help make the right decision, there is a useful white paper on considerations in appropriate toilet provision for bariatrics. It’s available for free download here: