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.