Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2026

Size-inclusive hospital care and workforce safety: A district-wide audit of bariatric service readiness across three Aotearoa New Zealand hospitals (#117)

Caz Hales 1 2 , Prakash Sharma 2 , Eleanor Barrett 1 , Dale Luke 1 , Gajan Sirikumaran 1 , Brendan Ng 1
  1. Health New Zealand -Capital Coast Hutt Valley, Wellington, New Zealand
  2. Victoria University of Wellington, Wellington, New Zealand

Background and Aim

Patients requiring bariatric-level care have needs shaped by body size, mobility, equipment access and the built environment (1–3). Previous audit work identified service gaps (4); updated evidence was needed to inform size-inclusive healthcare design and workforce injury prevention.

Methods

A prospective cross-sectional point-prevalence audit was undertaken across adult inpatient wards at Kenepuru Hospital, Hutt Hospital and Wellington Regional Hospital in March 2026. Patients were classified as requiring bariatric-level care if they met criteria related to body mass index, weight, physical dimensions and mobility limiting moving and handling practices. Patients were assessed against standards for room preparation, equipment provision, space and facility design. Mobility status and 12-month moving and handling injury reports were examined.

Results

Of 545 adult inpatients, 35 (6.4%) patients required bariatric-level care (Kenepuru 9.4%, Hutt 8.2%, Wellington 4.4%). Identification of patients requiring bariatric care by clinical teams was poor: 51% were identified through audit processes only. Māori and Pacific Peoples comprised 29% and 23% of the bariatric cohort, respectively. Mobility dependency was common: 23% of patients were hoist-dependent/bedbound, 17% required two-person assistance and only 40% were independently mobile. Only four of 32 (12.5%) bed spaces met the required safety standard, and all assessed bathroom doorways failed design criteria. Workforce safety concerns were substantial: 24.8% (41/165) moving and handling injuries involved patients of larger size, despite patients of larger size requiring mobility assistance representing only 3.5% of the inpatient population. This equated to an estimated injury rate ratio of 7.1.

Conclusion

Patients requiring bariatric-level care represent a small but predictable inpatient cohort with substantial mobility requirements and disproportionate workforce injury risk. Size-inclusive hospitals require coordinated investment in early identification, fitted equipment, infrastructure and injury prevention. Bariatric care should be recognised as a system-wide patient safety, workforce safety and equity issue.

  1. Accident Compensation Corporation. Moving and handling people: Bariatric clients [Internet]. Wellington; 2012. p. 387–406. Available from: https://www.acc.co.nz/assets/provider/acc6075-moving-guide-bariatric.pdf
  2. Hales C, Curran N, deVries K. Morbidly obese patients’ experiences of mobility during hospitalisation and rehabilitation: A qualitative descriptive study. Nurs Prax N Z. 2018;3(1):20–31. doi:10.36951/NgPxNZ.2018.003
  3. Hales C, deVries K, Coombs M. The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study. Aust Crit Care. 2018;31(1):37–41. doi:10.1016/j.aucc.2017.02.070
  4. Yee B, Barrett E, Jeffreys M, Haase A, Hales C. Improving health services for patients with extreme obesity requiring bariatric level care at Wellington Regional Hospital: A clinical audit. N Z Med J. 2022;135(1562):10–24.