> Figure 1. Front view of an extra- heavy-duty (750 pounds) bariatric water closet support. All graphics courtesy of Jay R. Smith Mfg. Co.

Bariatric Water Closets What Specifiers Need To Know As obesity increases in our society, plumbing designers and manufacturers must meet the challenge of creating bariatric-friendly environments.

By William M. Smith

uring the past quarter century, Definition we have seen many changes in By definition, the term bariatric is defined by Mr. our industry relative to product Encarta as “the branch of medicine concerned with the design, product capabilities and treatment of obesity.” increased flexibility as manufac- Herein lies one of the problems. According to the turers, designers and specifiers to Department of Health and Human Services – Centers for meetD customers’ need for bariatric accommodations. Disease Control and Prevention (CDC), obesity percent- One area quickly changing is in the water closet car- ages nationwide are increasing to epidemic proportions rier industry. More specifically, the bariatric water throughout the country. closet supports. United States Obesity Trends 1985-2007 (a CDC The growing need for more stable supports has PowerPoint presentation) shows that during the past become a concern of facilities managers within our 20 years there has been a dramatic increase in obesity healthcare facilities, schools, restaurants, office build- in the U.S. In 2007, only one state (Colorado) had a ings, prisons and the like. However, within this arti- prevalence of obesity less than 20%. Thirty states had cle, we will focus directly on the healthcare arena. a prevalence equal to or greater than 25%; three of

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these states (Alabama, Mississippi and Tennessee) had a prevalence of obesity equal to or greater than 30%. Information from The American Insti- tute of Architects, Bariatric Healthcare Facilities states that, currently, more than 59 million Americans (about 31% of the population) are obese, of whom an estimated five to 10 million suffer from morbid obesity. According to an article by the Johns Hopkins Bloomberg School of Public Health, more than 40% of United States’ adults will be catego- rized as obese by the year 2015. Also, these kinds of numbers reflect that facility and/or product design must be able to keep up with the growing demand. Obese patients can encompass a very wide weight range; beginning at around 250-300 pounds to more than 1,200 pounds. > Figure 2. Front view of a bariatric-duty (1,000 lbs.) water closet support. Design When looking at the term “bariat- The manufacturing and design commu- cial buildings and healthcare facilities ric” as it relates to both commercial nity is charged with solving the request to accommodate the obese community and healthcare design of products and for the creation of “bariatric-friendly” when visiting public restroom facili- facilities, the design and manufacturing healthcare environments throughout the ties. In most cases, the availability of industry continues to work closely with United States. supports are usually offered in 300 lbs. healthcare organizations to help bal- Additional design considerations for (standard), 500 lbs. (heavy duty), 750 ance the cost of care with quality staff, healthcare facilities should also include lbs. (extra heavy duty shown in Figure patient safety, morale, and accessibility. areas regarding circulation, equipment, 1 on page 20) and 1,000 lbs. (bariatric The design of products and facilities has clearances, safety and privacy. However, duty shown in Figure 2) to cover what- a direct impact on each of these perfor- within the remainder of this article, we ever the applicable design may require. mance criteria with respect to proper will review the design of bariatric toilet Each industry manufacturer of water care and must apply for all patient bowls and their supports within the closet supports is required to design, types, including the ever-increasing bariatric toilet room. manufacture, third-party test and install bariatric population. Healthcare settings To begin the process of design their respective products per the strict are adapting to new bariatric care prac- review, we shall explore two areas from requirements outlined within the indus- tices, procuring special products, equip- the manufacturers’ viewpoint. First, we try consensus standard, “Floor-Affixed ment and supplies, renovating, and will look at the design considerations Supports For Off-The-Floor Plumb- building new spaces to accommodate that should be given towards the actual ing Fixtures For Public Use” (ASME our morbidly obese populace. bariatric water closet supports and toi- A112.6.1M). In the past, we have seemed to over- let bowls. Second, we will review the It is interesting to note that the load- look the fact that the morbidly obese design considerations surrounding the ing and deflection test criteria covered patient accesses commercial buildings needs within a commercial or health within this standard have not changed and healthcare facilities just like anyone facility bariatric toilet room. for more than 30 years. The current else. As it relates just to the health- static load test requirements are docu- care industry, obese patients, like all Bariatric Water mented as 300 lbs. The current deflec- other patient types, become part of the Closet Supports tion test requirements are documented healthcare delivery continuum through In recent years, the manufacturers as not allowing more than 0.125” inpatient, ambulatory, and outpatient of water closet supports have begun deflection away from the finished wall settings. Their physical needs and con- the process of providing designers with and more than 0.375” deflection down- ditions, however, are highly specialized. bariatric options for use within commer- wards from the front of the toilet bowl

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> Figure 3. Front view of an elongated bariatric- duty wall-mounted toilet bowl – rated up to 1,000 pounds.

toward the finished floor. The truly amazing thing about the design capa- bilities of our industry manufacturers is simply that they have been able to create carriers capable of withstanding this increase in static load capacity and adhere to current stringent deflection allow- ance under such loads. Even more importantly, our industry manufacturers have taken the neces- sary and appropriate steps to serve all members of society regardless of their respective belt lines. You might ask, “Why haven’t industry standard personnel sought to change the static load and deflection requirements within the applicable standards to be reflected appropriately relative to the need for an increase in the loading capaci- ties of our water closet supports?” Actually, our challenge was based around the fact that all the wall construction materials being used haven’t changed much over the same time frame.

> Figure 4. Back view of an elongated bariatric- duty wall-mounted toilet bowl – rated up to 1,000 pounds.

Therefore, we should strive to design and pro- duce our products under those constraints regard- less of the increased load capacity needs. Obvi- ously, we feel the manufacturing design industry has accomplished their goals relative to bariatric water closet support design, based on available testing results. Realizing that the traditional-type water closet supports for wall-mounted toilet bowls are designed for installations behind the finished walls, there have also been many improvements in the design and manufacturing of wall-mounted toilet bowl supports to be installed on the finished wall side of bathroom facilities. Companies are providing new universal type supports that are placed underneath the wall-mounted toilet bowl. For the ultimate in wall-mounted toilet bowl support, there is absolutely nothing wrong with installing both the bariatric water closet support

Circle No. 155 on card. 22 PME02091ASPE.indd02.09 1 1/14/09 8:49:34 AM Bariatric Water Closets

> Figure 5. inches. Once in the toilet room, clear- ance on either side of the wall-mounted toilet bowl should allow for placing a bariatric toilet seat cover over the water closet for the comfort of bariatric patients. The water closet should be mounted with a minimum distance to a flanking wall of 21 inches. Other areas of design concern within the bariatric toilet room would be items and/or areas such as grab bar location and size, toilet paper behind the finished wall, as well as and specified as an extremely strong dispenser location, patient hygiene using in combination a universal-type and beneficial option as a material in equipment, sink or countertop struc- toilet bowl support on the finished wall wall-mounted toilet bowl design. When tural stability, and a larger non-curbed side of the facility. dealing with the bariatric field and the shower that would allow for the Either way, the manufacturing indus- possibility of weights exceeding 1,000 patient to be assisted by two caregiv- try’s design professionals have provided pounds, the use of stainless steel can ers (see Figure 5). the specifying design engineer with be beneficial to assure performance, We have covered the industry intro- more than adequate options to con- rigidity and sanitary conditions, and to duction of new designs for bariatric sider when designing facilities with the safe-guard against catastrophic failure. water closet supports that can handle obese populace in mind. Figures 3 and 4 (pages 22 and 23) 1,000-pound static load testing. We show a couple views depicting one have looked at the continued design Bariatric Toilet Bowls manufacturer’s design offering for a bar- improvements in toilet bowls offered Because the commercial and health- iatric wall-mounted toilet bowl. for bariatric facilities. Finally, we have care bathroom facilities have to be very Just as outlined in our above discus- attempted to convey the vastness of the concerned with more thorough and effi- sion of the bariatric water closet support design elements that must be consid- cient cleaning methods, wall-mounted designs, working in combination, both ered as we continue to build new and/ toilet bowls are most often specified in behind and in front of the finished wall or retro-fit existing commercial and these types of facilities. to support our bariatric populace is of healthcare facilities to welcome, serve For the most part, over the years, utmost concern. and especially care for our growing bar- wall-mounted toilet bowl manufactur- iatric populace. ers have provided bowls in a material Bariatric Toilet Rooms It is plain to see that amid the manu- known as vitreous china, an extremely While researching helpful informa- facturing, design and specifying indus- strong material choice. As we have tion from The American Institute of tries, a unified effort has been taking mentioned, these toilet bowls are tre- Architects, Bariatric Healthcare Facili- place for some time now to begin offer- mendously durable, as the industry ties, as well as www.hospitalconnect. ing every possible opportunity for the standard ASME A112.19.2 requires that com, I reviewed an article written by ultimate in commercial and healthcare all wall-mounted toilet bowls pass a architects James W. Harrell and Bill facilities as it relates to patient safety, 500-lb. static load test. When weight Miller [March 2004 issue of Health morale, and accessibility. is applied onto a wall-mounted toilet Facilities Management Magazine] that bowl, however, a sheering force is served to explain just how detailed we William M. Smith is engineering transmitted to the interface of the toi- must be in our considerations to the manager for Jay R. Smith Mfg. Co., let bowl and the water closet support design of the bariatric patient toilet based in Montgomery, AL. He has been installed behind the finished wall. Due room. As the article states, increased with Jay R. Smith since Nov. 1981. He to the increased stresses provided by size is but one design factor. currently serves on the ASME A112 our obese populace, toilet bowl manu- When we look at the bariatric patient Standards Main Committee, ASPE Board facturers are responding to the bariatric room itself, one of the first areas to of Directors, IAPMO Main Standards issue with new, more robust vitreous review would be clearance require- Committee, IAPMO Industry Advisory china designs. ments. The door just to enter the toilet Committee, ASTM Materials Commit- More recently, stainless steel ver- room must be a minimum of 60 inches tees and many other various plumbing sions are being designed and manufac- in width, where in a normal application industry-related committees. Smith may tured to ASME A112.19.2 requirements one would find an opening from 32-48 be contacted at [email protected].

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