Hi Webbie,
Manual BP has the same problem i.e. getting a large enough cuff with a bladder that complies with the 80/40 rule to fit around the arm. In addition you also have the issue of reduced K sound in the brachial artery due to adipose tissue. The other problem you have is patient compliance due to discomfort caused by compressing adipose tissue with the cuff. It is not an easy thing to do either manually or using automatic devices.
Richard
