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A Problem Too Big to Ignore

Land of plenty: By state, percentage of the adult American population that was obese in 1991 and 2001.

Tom Kelley’s phone rings often. But when it rang one day last spring, the caller had an unusual request: Would he speak at an invitation-only conference called “Healthy Solutions: Industry Responses to the Obesity Epidemic”? He said no. As the COO of design consultancy IDEO, he was no expert on obesity-innovation was his business. When told he could talk more generally about human-centered design implications, though, Kelley acquiesced and found himself slated to speak on “The Silver Lining: Solutions to Obesity through Design.” That was when he started researching and realized just how big the problem is.

According to the Centers for Disease Control and Prevention, 65 percent of American adults are overweight or obese (defined as having a body mass index of 25 or more; see p. 63), and the percentage of the population that can be classified as “morbidly obese” has tripled in the past decade. Roughly 300,000 deaths a year are associated with obesity, and scarier still, 50 percent of children born after 2000 will develop Type 2 diabetes.

In fact, the shift is already happening—companies (and the designers they hire) are eager to meet the new market demand. Consider this: In 1988, Nancy Summer and Bill Fabrey founded Amplestuff, a Bearsville, New York, company that makes and sells plus-size versions of everyday products and others invented specifically for the problems of larger people. When the overweight Summer complained that she needed help reaching certain parts of her body in the shower, for example, Fabrey, an engineer, came up with Sponge on a Stick. Amplestuff now sells close to 100 products ranging from 1,000-pound scales and extra-large umbrellas to airline seatbelt extenders and a little device to help you put your socks on without bending over.

Moreover, Amplestuff’s niche of overlooked consumers is now a market serious enough for Forbes, which recently published a special report on the subject with articles titled “Investing in Obesity” (a roundup of “fat-hedging” stocks) and “Watching the Corporate Waistline” (a look at the $12 billion hit U.S. companies are taking due to obesity-related health problems of employees).

Though obesity hasn’t been celebrated along with “wireless” or “rapid prototyping,” it’s a trend that’s influencing almost every product and creating new ones. You can’t engineer a hospital gown, let alone a chair, without confronting the issue. And then there’s the fast-growing market of medical tools—everything from diabetes paraphernalia to air masks for obstructive sleep apnea, a condition in which the breathing pipe collapses during sleep. From consumer product development to specialized medical devices, from subway cars to tractors—obesity is one of the more important issues in design today.

Designers Take Notice

America’s new dimensions affect all designers, though in different ways, reflecting our culture’s conflicted feelings about size. In general, America celebrates big as a constitutional right. Starbucks built its empire selling coffee in three sizes: big, bigger, and bigger still. Our appetite for SUVs and McMansions is cliche. And it’s tempting to argue that the overstuffed chairs and bowl-sized mugs of Crate and Barrel, not to mention the blobbish forms of the Karim Rashid generation, struck a chord with consumers becoming overstuffed and blobbish themselves.

Lest you think obesity is only an issue in the heartland, the truth is 19.7 percent of New York state residents were obese in 2001, according to the CDC. (For the record, Colorado was the skinniest at 14.4 percent, and Mississippi the fattest with 25.9 percent.)

Unlike marketers, who tend to think in terms of the average consumer, designers need to think about the extremes—the potential users at the ends of the spectrum. Take ergonomic task chairs, for instance, which need to accommodate a 100-pound woman as well as a 300-pound man. To address that problem, Herman Miller decided to sell the Aeron chair in three sizes. “But that created headaches for corporate buyers trying to figure out how many of each size to get,” says Niels Diffrient, designer of the Humanscale Freedom chair. “We took the road of developing a one-size chair that adapts to 90 percent of the population.” Still, the designer is currently working on a new feature for the Freedom chair—armrests that will slide horizontally to give a sitter more room because, as he says, “It’s an ongoing problem.”

The fashion industry was the first to recognize the problem: Twenty years ago, companies convinced the National Institute of Standards and Technology (NIST) to abandon its standard of women’s clothing sizes, and have since adopted a deflationary policy—increasing the actual size of its clothes so that a size-12 woman can still wear a size 8. Think of it as consumer codependency.

One company addressing that group is Brayton International, a Steelcase subsidiary focused on the contract health-care market. Last year, the High Point, North Carolina-based company launched a line of bariatric (a term for the medical treatment of obesity) furniture engineered to support 1,400 pounds of static load. With half a dozen competitors, including Nemschoff and Bari Chair, Brayton is far from a monopoly. But they have eight different models (and more in the pipeline) and plans to dominate the market with offerings ranging from the 35-inch Rave Open Arm to the 50.5-inch Club Grande.

Brayton worked closely with a customer, Pacific Laparoscopy, during development, basing the designs on extensive interviews and videotapes of obese patients trying to get in and out of chairs and beds. For a heavier person, basic activities can be challenging and potentially embarrassing. “The first thing a 375-pound person does is check how sturdy a chair is,” says Brayton designer Rob Easter. “But they don’t want it to look like it was made for fat people.” So Brayton’s bariatric seats resemble its standard line—the Progeny Bariatric chair, for example, looks exactly like the Progeny single seat chair. The legs are the same dimensions and the added cross rails, which would differentiate it from standard models, are hidden from view—though they are all a little higher to give sitters more leverage when standing up. (Those who need extra help can turn to Dynamic Living’s Pride Lift Recovery Chair—a veritable Cadillac of generously sized seating that can hoist a 450-pound person into a standing position “gracefully and easily!”)

“The bariatric line was do or die,” says Jim Martin, manager of special projects at Brayton. “Hospitals bid out project orders worth $500,000 to $1 million, and you could lose that order if you can’t offer bariatric options.”

In hospitals, the issue isn’t just accommodating the heavyset, but ensuring that nurses and orderlies don’t injure themselves trying to lift an obese patient. That’s the idea behind New Care’s Rehab products: the bed, which comes in widths of 39 inches by 86 inches (The Tall Plus) and 48 inches by 80 inches (The Wide Plus); the Big-Turn air mattress that helps roll the patient over; and even the Lift and Transfer 750 for hoisting patients into an extra-wide wheelchair.

The rising scale has had another major impact on the design industry: increased demand for medical devices geared toward obesity-related conditions. Ask any big design firm and you’ll find they’re working on an insulin pen or a metabolic measurement device. And then there’s sleep apnea.

“The market for sleep apnea treatments is growing in excess of 20 percent a year,” says Jay Vreeland of Respironics, a medical devices company that owned the market niche when it introduced the first
sleep apnea treatment system in 1985. Today, the company shares the shelf with 15 competitors, and it’s had to learn the art of consumer marketing. Over the years, Respironics has worked with myriad ID firms to improve the look and functionality of specific products. But the increased competition demanded a more comprehensive approach, a shift in focus from the product to the overall user experience, and so in April 2003, Respironics hired Design Continuum, the Boston-based product design and brand strategy firm.

“In creating products for the obese, there are the standard functional issues,” says Aaron Oppenheimer, principal interaction designer at Design Continuum. “But there are also unique physiological and emotional issues.” To illustrate the point, Oppenheimer describes the Accu-Check Compact glucose meter that his firm designed for Roche Diagnostics. Other meters require the user to insert a small strip of paper into the machine for every test—a challenge for late-stage diabetics who often have poor motor skills. Design Continuum engineered a novel mechanism: essentially a paper-tray that holds enough strips for 17 tests. Additionally, to make users feel less self-conscious about carrying the device around in public, the design team camouflaged the meter as a cell phone, complete with a clamshell form and belt clip.

“A person’s disability is based on the environment. We’d all be disabled if we went to Mars, because that environment is designed for Martians,” says Smart Design consultant Dan Formosa. “You could disable thousands just by printing The New York Times in four-point type. Designers control the environment that defines the disability.” In other words, the more aware designers are of the day-to-day needs of supersize Americans, the less “disabling” obesity would be.

“I don’t tend to think about the fact that we’re designing something for heavier people,” insists Jane Fulton Sury, a human factors expert at IDEO. “The brief is simply to design something, and to do that, you have to think about the people you’re designing for.”

This people-first philosophy is inherently more inclusive. The problem is that such a universal design approach depends on accurate anthropomorphic data, which hasn’t been readily available. “It’s still difficult to find good stats on people of size,” says Allen Cameron, principal industrial designer at Design Continuum, “let alone information on how, say, size affects the sideways motion of a person’s fingers.” In 1941, the United States Department of Agriculture published the results of the first-ever large-scale scientific study of body measurements. That World War II data, though woefully out of date, was the best available until the CAESAR (Civilian American and European Surface Anthropometry Resource) survey finished digitally scanning 4,400 people last year. In late 2003, a 3D scanning company called [TC]? completed the more comprehensive survey of 10,000 adults. “We launched the SizeUSA survey because clothes did not fit,” explains Karen Davis, a marketing and communications specialist for [TC]?. “The waist-to-hip ratio used by clothing designers was out of line with reality.” The SizeUSA findings aren’t surprising. As Davis puts it, “the hourglass shape is history.”

Such data is invaluable to designers in myriad industries, but still, the question remains: Rather than designing for the obese, can the right-brained workers of the world unite to design against obesity? Smart Design took a small step in that direction with the Baker’s Secret line of baking dishes that have portions pre-marked. They’re also working with an undisclosed fast-food company at the strategy level. Other designers concerned about children’s inactivity have produced concepts for pedal-powered televisions and a video-game joystick that engages all of the major muscle groups. BodyMedia, a Pittsburgh start-up, offers a high-tech, high-design solution: the Sensewear Pro2 Armband. The wearable body monitor, which won an IDSA/Business Week gold medal in 2002, helps people balance caloric intake and physical activity.

IDEO’s Tom Kelley points to ways designers can help improve the experience of eating well. “I’ve looked for food products that combine convenience and health, and the offerings are awful. Food companies need to adopt the same seduction techniques used by Cinnabon,” he says, referring to the chain that sells hot, sticky buns in airports.

Echoing Kelley, Niels Diffrient argues that industrial design is about mass seduction—designing products that attract people—and that the food supply is controlled by unethical companies whose only goal is to use those techniques of seduction to sell more stuff. “To me,” Diffrient says, “that is an industrial design problem.”

“Like any good design solution, the answer won’t come in a week,” Allan Cameron says. “But I think in the next five years, you’re going to see a lot of products addressing the issue.”

Jessie Scanlon writes for Wired and other publications. Her profile of Richard Koshalek appeared in the January/February issue of I.D.