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Obesity strains the care system

Doctors, hospitals and emergency rooms are using new equipment and creative procedures to accommodate overweight patients.

October 13, 2003|Judy Foreman | Special to The Times

America's obesity epidemic is creating a serious problem for hospitals, both medically and economically.

At one New England hospital a patient was so obese -- more than 700 pounds -- that it took seven nurses to turn him over. Three nurses claimed they injured their shoulders and backs trying to lift him and had to take a medical leave.

Something as basic as taking the patient's blood pressure was difficult because he needed extra-large cuffs around his lower arms and legs, or a catheter placed into an artery in his arm. When the man needed a CT scan, he had to be taken to a nearby aquarium, which had a large machine used for marine animals.

Patient advocates say the surge in obesity is leading to a backlash against severely overweight patients. Obese patients often face hostility and discrimination from health professionals, says Lynn McAfee of the Council on Size & Weight Discrimination in Mount Marion, N.Y. "No matter why we are fat," says McAfee, "right now we exist. And we deserve the best possible medical care, just as anyone else [does] who is another size."

According to the federal Centers for Disease Control and Prevention, one-third of all Americans -- 68 million -- are obese. (Obesity is defined as having a body mass index of 30 or more. BMI is calculated by taking weight in pounds and multiplying by 703; this number is then divided by height in inches squared.)

The burden that the severely obese is putting on hospitals is being felt in many ways, health care officials say.

Regular beds are nowhere near big or strong enough. Nor are operating tables, chairs, walkers, ventilators or hypodermic needles. Nurses sometimes need stools to reach an obese person's chest.

Gradually, however, hospitals and the health care industry are adapting to the change.

In the last several years, the instruments needed for bariatric surgery (in which most of the stomach is stapled off and the remaining 5% is connected to the small intestine) have gotten larger as patients got heavier, says Dr. Michael Schweitzer, assistant professor of surgery at Johns Hopkins University in Baltimore. Surgeons have needed ever-larger instruments for laparoscopic surgery -- done through several small incisions rather than one large one -- and several companies have begun supplying such equipment.

Indeed, the industry that supplies oversized beds, wheelchairs, operating tables and the like to hospitals is growing by about 20% a year, says Lynne Sly, vice president for marketing for Kinetic Concepts, based in San Antonio.

Demand is growing for bariatric beds with "pressure relief" air mattresses -- the mattress inflates and deflates section by section to relieve pressure sores. Gore-Tex sheets allow a patient's skin to "breathe," which helps prevent skin breakdown. There's even a device called "AirPal" that helps heavy patients slide from one bed to another.

Susan Ross, a clinical manager at Rhode Island Hospital, says caring for obese patients is "a challenge." For example, feeding obese patients -- often through intravenous lines or naso-gastric tubes -- is a major task because "these people require thousands of calories a day," she adds.

All of this gets expensive. Renting an extra-large bed required for a severely or morbidly obese patient can run an additional $650 a day, says Dawn Arthur, a nursing director at the Santa Monica-UCLA Medical Center in Santa Monica. Standard-sized wheelchairs cost $750, while those needed for the heaviest patients can cost $1,200, she says.

Despite such accommodations to obesity, some hospitals may not be doing enough, says McAfee of the size and weight council. She says hospitals "should look in their hearts and ask, 'If that were me, would I really think the hospital was doing enough?' "

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