Bariatric Rehab: Championing Care for Patients of Size

In this podcast episode, I had an insightful discussion with Susan Gallagher, the CEO of BariSolutions, about the often-overlooked population of patients with obesity and the challenges they face in accessing equitable care. Susan highlighted how BariSolutions, building on a 25-year legacy with Celebration Institute, is dedicated to creating safe environments for patients of size through various initiatives, such as launching webinars and national conferences. A significant focus of their work is addressing the psychological and physical barriers obese patients encounter in therapy settings, emphasizing the importance of equipment like high-low mat tables and standing frames that facilitate independent exercise, which can significantly boost a patient’s self-confidence and motivate them to participate actively in rehabilitation.

The conversation also touched on the evolution of medical interventions for obesity, with an expanded toolkit including metabolic surgeries and new pharmaceuticals aimed at weight management. Susan shared insights into how comorbid conditions often drive patients to seek these metabolic surgeries, which are now seen as a way to manage and improve overall health rather than just for weight loss. We discussed the advancements in medical technology, which help reduce occupational injuries for healthcare workers and offer patients a sense of security and independence during their rehabilitation journey. This highlights the importance of investing in modern therapeutic solutions as a means of enhancing patient care and safety.

Susan also elaborated on the upcoming BariSolutions conference, which aims to address and stimulate innovation in bariatric care by bringing together healthcare professionals from multiple disciplines to learn from each other. This event underscores the broader impact of BariSolutions‘ philosophy in fostering conversations around health, economics, and patient care improvements across the industry. Our conversation reaffirms the need for continuous dialogue and collaboration in occupational therapy to enhance care delivery and ensure that everyone, regardless of size, receives the support they need for recovery and a better quality of life.

 

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Transcript:

 

Laszlo Bayer: So today I’m joined by Susan Gallagher. She is the CEO top person at BariSolutions, and this is going to be a very important discussion because we’re going to be talking about a population that, in my opinion, has not been well-served over the years and we’re gonna bring some light to that. So Susan, thanks for joining us today. I’m excited about this interview. Tell us just a little bit about BariSolutions.

Susan Gallagher: Alright, thank you so much and it’s wonderful to be here on the call with you. So BariSolutions is a company that has a 25-year legacy with Celebration Institute, so rolling that over into BariSolutions. We have a lot of things going this year. We have podcasts which we’re launching, we have webinars that we’re launching and we’re launching an E-journal. Our goal is really to provide safe, equitable care for our patients of size. And there are a lot of initiatives that are driving that. We know that even though we have a lot of therapeutics, new pharmaceuticals that are helping with weight management, we still have about 42% of individuals in the US who have a BMI greater than 30. So you know we don’t like to use BMI as a term any longer, but it is something that helps us kind of identify demographically what we’re looking at in terms of how we as healthcare providers need to start thinking about doing a better job with reasonable accommodation for certain patient populations. Back to Barisolutions we have, our national conferences as our third year. First year was incredibly successful. Second year we doubled everything except our vendors, which increased greater than double.

Susan Gallagher: And so with that said, I just think there’s a lot of interest around how we can do a better job working with individuals of size.

Laszlo Bayer: So you know thinking back, I’ve been in this field for about 17 years and I remember you know when I first got started, I didn’t see a lot of bariatric patients being treated in the therapy gym. And when I did see them being treated, they were handled by three or four, sometimes five therapists to lift them up, to hold them standing. It looked terribly uncomfortable for everybody. So that was one of the reasons why we looked at the products that we make and decided, well, we need to have a high, low mat table standing frame situation that can support a thousand-pound patient. And so we put that out there and it’s been very well received. The question I have for you is, besides the physical aspect of rehab for an obese individual, what psychologically happens with them when they’re able to do things independently of other people holding onto them, lifting them? What happens to them psychologically?

Susan Gallagher: So a couple of things. It’s a great question. You know Ms. Tracy Carr has been, was at our conference last year and she kind of talked about Tracy Carrp. You don’t know who she is, she’s lovely. She weighs between about 480 and 520 pounds. I don’t know for sure, but I think that’s what she would tell us. She’s more than willing to share her lived experience. And what she says is she’s always worried about breaking equipment, but she’s horrified at the thought of injuring healthcare worker. And so I think that’s foundational to this you know how do patients feel about care? For example, in the situation that you described in the rehab setting, if we don’t have the proper equipment or we have three four or five people trying to lift a patient.

Laszlo Bayer: Right.

Susan Gallagher: The patient is thinking, oh, you know what if there’s a career-ending injury and I’m responsible for that person? So I think that’s first and foremost. The next is I don’t think we had technology like that previously. And the problem is then we would have to not see patients. So they didn’t receive the rehabilitation and the outcomes were just so poor because of that. Patients became immobile when they were hospitalized because we didn’t have resources and then we didn’t have rehab to help them get back to their pre-hospitalization state. Does that kind of answer your question?

Laszlo Bayer: It does. It does. And the reason I asked that question is because I had an experience a number of years ago with a gentleman by the name of Carlos. I was at a facility in the Phoenix area and I had just delivered our thousand-pound table to this facility just to let them use it. And I asked them, do you have anybody here who would really benefit from using our product? And they say, well, we don’t really treat bariatric people per safe, but we do have one patient, but I don’t think he’ll come out of his room. And that really struck me that he wouldn’t come out of his room. So I asked if I could go in and talk to him, which I did. And I was shocked because I went into the room. It was very dark, you know no light in the room at all, and he was just covered with a sheet.

Laszlo Bayer: He didn’t have anything on just the sheet. So I sat and talked with him and I have some powers of persuasion, so I persuaded him to just do me a favor and come out and trial the equipment, which he did. And he was very successful with being able to do a transfer and all of that. So I know that it changed his countenance. I know that it changed his attitude. And I think that’s probably one of the most important things that we can do is to provide this ray of hope. I don’t have to live like this for the rest of my life.

Susan Gallagher: : Right right or be immobile because that’s part of it too. I mean, how would it feel to not be able to get up and out of bed either because person’s deconditioning over time or they just don’t have the equipment to support themselves and you know they refuse care sometimes because they think, well, what if I injure someone? So sometimes we don’t ask that question. Why are you refusing, I don’t know if you asked that of Carlos, but you know to get to the heart of what is this missed opportunity about? Is it because the patient’s refusing care because like Carlos, He might be concerned about injuring someone? What are your thoughts on that?

Laszlo Bayer: Well, I haven’t come at it from that perspective.

Laszlo Bayer: I’ve only come at it you know dealing with morbidly obese patients from the perspective of we can help you. This is going to be safe, don’t worry about it. You’re not gonna fall. We’re going to let you work independently. And when they see that, I think it triggers them in a way of saying, oh my goodness, you finally have a piece of equipment that is safe. No one has to hold onto me. And that has always been a big relief. So I have another question for you, and that is, have you seen bypass surgeries increase over the years? That’s kind of a solution for people that you know are over the BMI of obviously if you’re close to 30, you’re not gonna, there’s other ways to lose weight, but I’m talking about people that are between four and 700 pounds.

Susan Gallagher:  Right, So couple of things. So patients are four to 700 pounds, You know I can’t speak to that because that is the high end of weight for weight loss surgery for those patients, with and I still use BMI because that’s what the groups are using right now. But you know who are that BMI 40 or actually 35 to 40 with certain criteria and then 40 or greater you know for patients who have that surgery who do well with it? It is life-changing for them. Not every patient will want to have weight loss surgery and I think metabolic surgery. And I think we as healthcare professionals think it’s important for us to recognize that, and think of it as a toolbox. There are gonna be some folks who will never lose weight their entire life. Everyone has pressured them to lose weight and they’ve done this yo-yo kind of dieting and it’s very, very hard. It’s a subject all in itself, but for that patient population to have the person become as healthy and mobile as they can be. And we have people five, 600 pounds who are in the workplace. They work every day. They have cars, they drive their cars, they have regular, very high quality of life, and then we have others who don’t. Now for the high end, BMI, what’s interesting is some of the new GLP one agonist drugs, GLP one drugs have been really great to reduce that initial body weight. And when the patient gets to the weight where they can safely have surgery, then they have one of the metabolic surgeries. So just a lot of tools in the toolbox. And I wonder, does that answer your question, or is that the question you were asking?

Laszlo Bayer: Yeah, yeah. Now do you find that a lot of these patients have comorbidities that have to be dealt with as well, like diabetes or you know some other issue, heart disease, high blood pressure, all of those factors?

Susan Gallagher:  Yeah, an article just came out 2025 article that again summarized, and I’m sorry I don’t recall the author’s name, but it is in a chapter that we’re putting together on skincare. But a lot of patients, that’s the deciding factor. So they may have a high BMI throughout their life and they’re fine with that. They’re able to have a high quality of life, as I said before. But once those comorbid conditions, if they do begin to happen and there is an increased rate and a lot of comorbid conditions besides cardio, lipid, you know diabetes, those kinds of things, we think that’s the deciding factor where a person says, I want to live the second half of my life in a different situation and I want to manage the comorbid conditions. And you know that’s why we no longer call weight loss surgery. Weight loss surgery, right? It’s metabolic surgery because it really does have that metabolic benefit for patients who have that particular procedure. So yeah, a higher rate of comorbid conditions. And it’s important for us to recognize that as healthcare professionals.

Laszlo Bayer: Now here’s the tough question.

Susan Gallagher: Okay,

Laszlo Bayer: How do we get the administrators of the world, You know these guys that sit back, I hate to refer to them as bean counters, but it’s an important job, right? You’ve got to balance your budget. How do we get them to understand that investing in technology that prevents injuries to both patients and therapists is a wise investment? How do we get them to pay attention to that?

Susan Gallagher: There are a couple of ways to answer that. First, Dan Drake and his team did a paper I think in 2009 at East Carolina University. And he looked at the time, 10% of the patient population had a BMI greater than 35, and that represented 30% of injuries, occupational injuries, time away from work, and restricted time. It was a really important paper and it was based on the OSHA 300 logs. And so I think when we think about the increased demographic of obesity over time than we see more and more with occupational injury, I think there’s a lot of interest in that safe patient handling programs get put in place. And my opinion in that second year, once we’ve kind of you know managed what I call the garden variety injuries, then we find that a lot of those are associated with healthcare professionals just feeling like they need to get it done and they get the patient up out of bed and they end up injuring everyone.

Susan Gallagher:  So there is the occupational injury side, but you know CMS has updated the 1973 Rehabilitation Act, and within that section 504, there are seven places that talk about reasonable accommodation for patients with obesity. And so that was put in place in June last year, and then hospitals will have to be able to show reasonable accommodation for patients with obesity as of January 2026. So hospitals now are really looking at that. But when we think about, and there are return on investment studies, this is what I would love for you or one of your clinical partners to do, is to really look at what is your average length of stay before you put together an active mobility program, and what is your average length of stay after? And we did a study in New Zealand, it was published in 2017, and that’s exactly what they did. They were able to save a tremendous amount of money and hardship for the patient because they saw the patient immediately. They didn’t wait for a week or try to figure it out or they didn’t have equipment in place. And so when I say equipment is foundational, I think leadership is more and more interested in that. And sometimes it’s that one special injury you know that touches our heart and then we say, oh, we can never let this happen again.

Laszlo Bayer:  Exactly.

Susan Gallagher:  We don’t want that to happen. We want to be proactive, don’t we?

Laszlo Bayer: Right. Yeah, absolutely. Now you mentioned New Zealand. Where does the United States fall in a safe patient handling and you know forward-looking in the medical field for rehab and for treating obesity. Are we far down on the list compared to other countries like Japan, France, and the European countries? What’s your opinion on that? Where are we? Are we falling behind?

Susan Gallagher:  Yeah, in my opinion, we’ve got a pretty high rate of obesity, as does Australia, New Zealand, and some of the other countries, there’s some countries, for example, Denmark, very low rate. But when they do have patients of size, then they do struggle. Like all of us, right? I think because of the volume of patients we see, there’s more of an awareness. But gosh, I think a lot of this has to do with the bias. You know, If the patient can just push away from the table, we don’t have to have this discussion. That is such a hurtful and harmful way of approaching this. And I also say you know with a rate of 42%, most of us have someone at home or someone we dearly love who is in that weight category.

Laszlo Bayer:  Exactly

Susan Gallagher: So I think, like I said, sometimes it just doesn’t touch our hearts. Or even many of my colleagues who may be thin today may have had a very high BMI before they had some type of intervention. So again, but where do we fit? I think we’re probably average. I think we’re struggling. And there’s a lot of opportunity, which is kind of exciting too, right? Because it is an exciting population and a lot of exciting technology.

Laszlo Bayer: How many rehabilitation facilities are there in the country that specialize in a morbidly obese patients?

Susan Gallagher: So there…

Laszlo Bayer: Because it’s a whole array of equipment. It has bariatric wheelchairs, you have to have a Hoyer lift that can lift that type of weight. You have to have a bariatric bed, and you have all these things that you have to have. And I’m just curious how many facilities are there that have gone and done this and specialized in that?

Susan Gallagher:  I think very few have specialized unless they’re part of an IDN. And if they are, then the entire health system is interested in keeping patients healthy in the lowest level of care, right? We don’t want someone to come into acute care and then end up having to be placed in a nursing home for the rest of their life. It’s very costly. So we’re talking about economics.

Laszlo Bayer: Right

Susan Gallagher:  So some of those groups have put together centers for their patient population. And I was visiting one in Northern California, I was so impressed. You know, I talked to the CNO and she said, no, we don’t have turnover in our bariatric rehab area because the staff members have what they need to provide rehabilitation, and they love the patient population and the patients feel good about it. And what they said to me is, when we have a patient admitted who weighs 700 pounds, it’s nothing for us. We’ve got that. We’ve got the equipment, we know how to do it, we know how to interact with the patients. And I thought, what a beautiful way to look at it. And so they’re looking at it. In my opinion, leadership is from an economic perspective. You know, if we can get the patients out of acute care into the rehab in-home, that’s the best thing.

Laszlo Bayer: Absolutely.

Susan Gallagher: And I meant accountable care organization, I think I said something different, but the accountable care organizations are doing that, right? As compared to a hospital that’s saying, you know we can’t afford equipment. Then the patient has a longer length of stay, then they can’t get into rehab and then they’re in long-term care and never can go home. So I think those who have done a good job or those who are part of a system that follows the patient throughout their healthcare.

Laszlo Bayer:  Is there any kind of education for the caregiver at home or the family at home when the patient is discharged from a facility, let’s say they’ve gotten a really good start and now they’re ready to go home. Is there some sort of instruction for the family members or family member on, okay, this is how you should be dealing with your loved one when they get home?

Susan Gallagher: You now a lot of the patients, they were high BMI before they came into the hospital, so they probably had some kind of system at home.

Laszlo Bayer: Right

Susan Gallagher: So really what family members need is just a bridge from either acute care to home or rehab to home that reinforces to the patient and the family to continue to move. And I know I have a very dear friend. She was hospitalized, did not get out of bed for four days, older lady, and they said, do you want to go to a nursing home or do you want to go back to your own home? I said she’s going back to her own home. I’m gonna speak for her. And we got her home and I said to her, use your walker and just keep walking around your dining room table every day. You do eight times a round and then sit up, get up in four hours, and do the same thing. Family members need to be taught that it’s okay to say to their family members, you know get up. It’s time to walk around whatever space they have inside their home safely to continue with that mobility. The worst thing family members can do is bring the patient home from the hospital, tuck ’em in bed, and leave them there for three weeks because then they’ll be back again. So I do think that the acute care that moves to the rehab or even rehab in acute care, getting the patient home and continuing with the mobility plan is key to keeping our patients home and safe.

Laszlo Bayer: Yeah, I totally agree with you because if you stop doing the things that you learned how to do right? In whatever environment that you’re discharged from, you lose what you gained and you don’t want to lose what you’ve gained. You want to continue to continue. So you have a conference coming up, correct?

Susan Gallagher:  We do, yep. November 4th to the 7th. Again at Fort Worth, Texas. We had the conference there last year. We like to move to different cities, but you know the feedback was amazing. So we’re gonna stay there one more year at Fort Worth. We’ll go someplace else in 2026. Again, great conference. We’ll have pre-conference conferences with a lot of hands-on activity that’s tied to skincare and health and wellbeing, critical care, patient mobility, and safe patient handling. And then we have a lot of really great keynotes. We have some keynotes that are talking about specific case scenarios because we can learn from others. We have some on health and wellbeing because I think it’s important for us all to understand that, especially when patients are asking those questions, we do not focus on weight loss because there are so many other groups that do that well. We focus on all those others. We have a lot of our pre-conference hands-on, and then we have simulation within the context. Gosh, we have a lot of simulation models. We have wearable suits. We have the R 42 will be there, the Ruth Lee model will be there. So we have a lot of different ways of simulating care that also gives our attendees an opportunity to learn about what they can take back to provide training in their facilities. So we’re really excited about it. And like I said, we’ll address those five pillars of bariatric care. And you know it’s more than just training. It’s really talking with one another. And I think that anyone at that conference is there because they have their heart in the right place to provide care for patients. And we do talk about the return on investment model, economic issues, and how to have those hard conversations as you mentioned early in the interview. You know how do we talk leadership into helping provide for our patients, whether it’s time to sit on committee meetings or equipment or whatever it might be? So we talk about that because we really want to equip attendees with the opportunity to go back to their facilities and say, this is what I learned and this is how it’s going to help us from an economic perspective, and then begin to execute some of those ideas.

Laszlo Bayer: Right right. I heard this number of years ago that it is less expensive to prevent an injury than it is to deal with the injury after it occur.

Susan Gallagher:  Yeah. Especially with them.

Laszlo Bayer: So now I would imagine all disciplines can come to the conference, whether you’re director of nursing, whether you’re director of rehab, whether or not you’re even an administrator want to learn what’s going on and what the latest techniques may be so anybody can go, correct?

Susan Gallagher: Absolutely. And you know what’s great is that very first year that I even learned this is that I myself am a WOC nurse, have a master’s degree in wound ostomy, and continence nursing, and then of course I’m certified in safe patient handling. So I kind of see those two blending always. I’ve never seen them separate, but we had skincare professionals at that conference alongside safe patient handling professionals and the safe patient handling professionals were saying, I had no idea all this about skincare and Skincare People were saying, I had no idea safe patient handling could help me with my skincare. So we do. We look at all the different disciplines, as I said, critical care and others. And then we have had a lot of leadership. So corporate leadership individuals attend, and I think that’s great, all working side by side as we work through case studies and we do interactive activities, and then we have our hands-on. So absolutely a lot of insurance carriers and like you said, leadership teams, ideas, et cetera, that have worked with us around improving care. So it’s very exciting.

Laszlo Bayer: Well, I know one thing. I know that we’ll be there.

Susan Gallagher: Good, good.

Laszlo Bayer: For sure. So you know what, I can’t thank you enough for this interview. I mean, I’ve learned some things and we’re just proud to partner with you, and anything that we can do now and in the future, we’d be happy to do so.

Susan Gallagher: Thank you so much. Yeah, it’s a great partnership. We do consider you one of our industry partners. We love to talk about the Barihab at BariSolutions, so absolutely. Thank you so much.

Laszlo Bayer: Thank you, Susan. Bye now. Bye.