By Carolyn Crist

(Reuters Health) – International travelers who are obese may face difficulties with flights, hotel access and certain leisure activities, say researchers who suggest the travel industry and travel health specialists should address these issues.

Based on interviews with severely obese men and women about their experiences with international travel, the small study found that airport facilities and procedures, physical discomfort and embarrassment on flights, and limitations associated with obesity were recurring themes, according to the report in the Journal of Travel Medicine.

“Obesity is a common condition and we know that obese individuals are subject to physical restrictions and weight bias in their everyday lives,” said lead author Dr. Gerard Flaherty of the School of Medicine at the National University of Ireland Galway.

“There is a dearth of research relating to the actual travel experiences of travelers with chronic medical illness, how their underlying conditions impact their travel or how travel affects the management of their pre-existing illness,” he told Reuters Health by email.

Flaherty and colleagues interviewed 12 patients who were attending a bariatric lifestyle modification program in Ireland. Most were in their 50s and each had a body mass index in the “obese” or “severely obese” category.

The participants talked about having to build in extra time to traverse the long distances between check-in counters and departure gates in airports and the lack of wheelchairs sized to fit larger travelers.

They also discussed embarrassment during air travel, the discomfort they feel on flights and bias they sense from other passengers. Participants mentioned the narrow aisles, standard-sized airplane seats, the need for seatbelt extenders – which are often a conspicuous bright orange – and being barred from sitting in the emergency exit rows.

Several expressed a preference for cruise ship travel because it is more comfortable and seems to better accommodate the needs of obese travelers.

Participants also sometimes had challenges with accessing hotel rooms and raised concerns about fire evacuation procedures for obese guests. They also faced heat issues in travel destinations with hot weather, and tended to restrict their choices in leisure activities such as historical walking tours. This limited their ability to enjoy activities with family members on the trip.

A few interview participants said medical evacuation insurance was essential because of the logistical difficulties they could face if medical emergencies occurred in a remote destination.

Overall, the group saw benefits in travel, but also regarded obesity as a barrier to international trips. They discussed greater cultural openness toward the needs of travelers with obesity in the U.S. and Asia but more discrimination in northern and western Europe, which led to much greater self-blame and self-deprecation.

One interviewee said of international travel, for example, “So suddenly . . . your weight problem really magnifies . . . it just hits you psychologically and physically.”

Another said, “I haven’t traveled much due to obesity, I traveled to Turkey twelve years ago. I think that was my last major holiday. That was hard going. It was just exhausting, and embarrassing. Having to ask for a seat belt extender and you looked like a lower class citizen, and I didn’t travel again after that.”

Pre-travel health consultations could be a great time for doctors and travelers to talk about their itineraries and any concerns during the planning process.

“Obesity is a subject which unfortunately tends to get ignored in some clinical settings, but this does not serve the needs of the patient well,” Flaherty said. “An open and supportive discussion about the potential challenges faced by the obese traveler would surely benefit them.”

Another next step is to increase awareness among travel companies and consumers, who can help fellow travelers feel comfortable.

“Obesity is a disease, which is often not considered by airlines or other companies involved in the travel business,” said Dr. Carel le Roux of University College Dublin, who wasn’t involved in the study.

“We should as far as possible facilitate people with diseases to participate in international travel, not because it is their right, but that is what good people do in a civilized society – we care for those who are less fortunate than us,” he said in an email.

SOURCE: Journal of Travel Medicine, online March 22, 2019.