Medical Matters

Challenges in care of obese also offer profits

Medicine & Science

October 13, 2003|By Judy Foreman | Judy Foreman,SPECIAL TO THE SUN

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 went out on workers 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. For a CT scan, he had to be taken to a nearby aquarium.

"Toileting," in the discreet phrase of medical professionals, became horrific. Taking his blood pressure was hard, too - he needed extra-large cuffs or a catheter placed into an artery.

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, spokeswoman for the Council on Size and Weight Discrimination in Mount Marion, N.Y., says 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 and Prevention, 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.)

The burden that "people of size" 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 aren't big or strong enough, either. Nor are operating tables. Or chairs. Or walkers, or ventilators, or hypodermic needles. Nurses need stools to reach an obese person's chest. But capitalism being capitalism, the needs of obese patients have also created a growth industry.

In the past 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.

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.

Just as dramatic, the industry that supplies oversized beds, wheelchairs, operating tables and the like to hospitals is growing 20 percent a year, says Lynne Sly, vice president for marketing for Kinetic Concepts Inc. of San Antonio, Texas.

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."

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 says.

Despite such accommodations to obesity, some hospitals still might not be doing enough, says McAfee, who weighs 416. She says they "should look in their hearts and ask, "If that were me, would I really think the hospital was doing enough?"

Judy Foreman is a lecturer on medicine at Harvard Medical School. Her column appears every other week. Past columns are available on www.myhealthsense.com.

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