Who are you since those are your only 3 posts on this board? Are you even an attending, you sound like a resident/fellow?
Are you using the second version of the Oakworks frame? It specifically adjusts/caves in to fit in larger bellies/breasts. The first version doesn't have this.
You must be at a university. Anyone I see with a BMI over 40 doesn't get procedures. They get referred to a local nutritionist/bariatric center.
I don't waste time doing procedures on patients who require a needle 3 times longer than anyone else. They're overweight, they hurt because they're overweight, and until some actually puts their foot down, they'll blame everything and everyone else and want a pill or procedure to fix what only they themselves can fix.
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Sorry you don't like the oakworks frame but 80% percent of my patients love it and are more comfortable than on pillows/wedges. For that 20% that don't, I've got pillows/wedge in the room.
What option do you have for your patients that don't like your wedge? Nothing I'd wager.