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The
Impact of Obesity on Hospitals The patient was
so obese – more than 700 pounds - that it took seven nurses to
turn him over. Three nurses at the New England hospital where he
was in intensive care went out on workman’s compensation after
injuring their shoulders and backs trying to move him. Because it was so
hard to turn him over, he developed bedsores that got so large
“you could see his colon – you could have put a basketball in
there,” recalls a nurse. During one admission, when the man
needed a CT scan, he had to be taken to a nearby aquarium. “Toiletting,”
in the discreet phrase of medical professionals, became horrific.
A urinary catheter solved one problem, but the man couldn’t be
moved onto a bedpan, so doctors put in a rectal tube to withdraw
his bowel movements. Taking his blood pressure was hard, too
– he needed extra-large cuffs around his lower arms or
legs or a catheter placed into an artery in his arm. America’s
obesity epidemic is creating a nightmare for hospitals, both
medically and economically. It’s no day at the beach for
patients, either. Lynn McAfee, a spokeswoman for the Council on
Size and Weight Discrimination in Mount Marion, N.Y., says obese
patients often face hostility and discrimination from health
professionals. “No
matter why we are fat,” she says, “right now we exist. And we
deserve the best possible medical care, just as anyone else is who
is another size.” According to the federal
Centers for Disease Control, 64 percent of adult Americans, or 135
million people, are overweight or obese. One third of all
Americans – 68 million – are obese. (Overweight is defined as having a body mass index, or BMI,
of 25.0 to 29.9. Obesity is defined as having a BMI 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.) People with a BMI of 40 or
more are now called severely or extremely obese, a category that
includes 12.3 million
people, says Dr. George Blackburn, director of the center for the
study of nutrition medicine at Beth Israel Deaconess Medical
Center in Boston. “Super morbid” obesity is defined as a BMI
of 50 or more, a category that includes 5.9 million Americans, and
“mega obesity” as a BMI of 70 or more, which includes 1
million Americans. The burden that “people of
size,” the politically correct term for obese people, is putting
on hospitals is huge. It takes special expertise to get an
intravenous tube in a place “where you can feel the vein,”
Blackburn says. “You can’t feel the liver. Bowel sounds are
distant. Detection and treatment of pneumonia are more challenging
because you can’t hear breath sounds as well. You can’t see
subtleties on X-rays because the thickness of the fat creates a
haze on the image.” Regular beds are nowhere near big or strong enough, either. Nor are operating tables. Or chairs. Or walkers, or ventilators, or hypodermic needles. Nurses need stools to to reach an obese person’s chest. But capitalism being
capitalism, adaptation to the needs of obese patients has become a
growth industry. In the last six years, the instruments needed for bariatric surgery (in which most of the stomach is stapled off and the remaining 5 percent is connected to the small intestine) have gotten larger as patients get heavier, says Dr. Michael Schweitzer, assistant professor of surgery at Johns Hopkins University. Surgeons have needed ever- larger instruments for laparoscopic surgery – done through several small incisions rather than one large one - and “companies have responded.” Bariatric surgery itself is
booming, too. According to the American Society for Bariatric
Surgery, there are now more than 100,000 such operations a year.
Five years ago, it was 25,800, and five years before that, 16,800. Just as dramatic, the industry
that supplies over-sized beds, wheelchairs, operating tables and
the like to hospitals is growing, by about 20 percent a year, says
Lynne Sly, vice president for marketing for Kinetic Concepts,
Inc., based in San Antonio, Texas. Demand is growing for bari-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, clinical manager
of the medical Intensive Care Unit at Rhode Island Hospital, says
caring for obese
patients is “a challenge, let me tell you.”
One woman had so much fat hanging down her legs she
developed a fungal infection in the skin folds. Just 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.
The cost just for the extra-large bed needed for the 700-pound New
England man was $5,568, for less than a month. Renting an extra-large bed
runs an extra $650 a day, says Dawn Arthur, a nursing director at
the Santa Monica-UCLA Medical Center in Santa Monica, CA.
Normal wheelchairs cost $750, she says; super-sized ones
cost $1200. But the demand for such
products is clearly growing. Since the Stryker Corp. in Kalamazoo,
Mich. introduced its 650-pound capacity cot for ambulances last
year, it has become a top-seller, says Dean Bergy, chief financial
officer for the company. Despite such accommodations to
obesity, some hospitals may still not be doing enough, says McAfee
of the size and weight council.
McAfee, who weighs 416, says hospitals “should look in
their hearts and ask, “If that were me, would I really think the
hospital was doing enough?” The ramifications seem endless. Well, not quite. As the New York Times reported recently, even the funeral industry is having to adapt to obese bodies – with extra-large coffins, and super-sized burial plots.
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