Morbid obesity: A growing trend
Hospitals adjust to accommodate heavy patients

Emma Long | copy editor
elong@smcvt.edu

As hospitals nationwide face an increase in morbidly obese patients, many are forced to adjust equipment and staffing in order to accommodate, according to a Feb. 20 article in the Rutland Herald. According to the Vermont Department of Health Obesity Status Report 2006, "morbid obesity refers to adults who are are more than 100 pounds above their ideal body weight." The report also notes that from 1993 to 2003, morbid obesity rose 367 percent in Vermont. The medical term for the study of such a condition is bariatrics.

How are hospitals dealing?

Treating a morbidly obese patient “requires certain special training and equipment,” says Kevin Robinson, director of communications at Southwestern Vermont Medical Center (SVMC). “For example, morbid obesity makes transferring patients from bed to stretcher, closing a surgical wound, intubation, and IV management more difficult.”

The wheelchair on the left is used for larger patients at Fletcher Allen Health Care in Burlington, Vt. (Izabela Socha, photo)

Although special bariatric
equipment is necessary at hospitals, Robinson says that at SVMC, simply having the equipment is not enough.

“Our ability to treat a patient has many aspects, such as the equipment we have, the range of services we normally provide, the height and weight of the patient, their primary diagnosis, and whether they have other complicating factors besides morbid obesity,” Robinson says.

SVMC has a hover mat, which inflates and sends jets of air underneath, so that a patient can be transferred easier from a bed to a stretcher, or vice versa.

Some pieces of equipment in hospitals do have weight limits, Robinson says, noting that for example, an MRI or CT scan table has a weight limit which simply cannot be exceeded. Similarly, beds, chairs, and stretchers have weight limits — as do ambulances.

Michael Tarbell of the Rutland Ambulance Service (RAS) in Vermont, says the company has made very small changes in the equipment used for morbidly obese patients.

“We use some side-board things and some lifts, some tarps, that help move patients around,” Tarbell says. “We tested out a stretcher run off batteries, and we’re looking at other options, but so far we haven’t made any major changes.”

If RAS medical technicians get on site and realize they are dealing with a morbidly obese patient, Tarbell says they will send an additional crew to assist with transportation, and they will make use of the equipment they already have.

At RAS, employees must complete an agility test before being hired, which serves to simulate various situations they may encounter on the job, Tarbell says.

As an example, he says, test-takers are asked to carry heavy equipment backwards down a set of stairs, or just to handle heavy equipment in a variety of situations.

“It’s physically reproducing all of the job in a testing sense, so if there is a failure [during the practice], it won’t be detrimental to a patient,” he says.

Essentially, with any service, you deal with two kinds of ambulances, Robinson says. One is built on the frame of a van, and the other on the frame of a larger, more durable truck, he says.

“The standard ambulance has a weight limit that’s much lower,” Robinson says, and stretchers, trucks and vans “can only handle so much.”

The surgical option

A community hospital is designed to treat the majority of illnesses, but tertiary care facilities, such as Dartmouth or Fletcher Allen, handle rarer, more complicated patients, Robinson says.

“SVMC can treat some kinds of heart attack and heart disease; for other types, we stabilize patients in our Emergency Department and send them to a tertiary care facility,” Robinson says. “The same is true of patients who have morbid obesity.”

The medical term for the study of obesity is bariatrics. (Izabela Socha, photo)

Laurie Spaulding, director and founder of the Bariatric Surgery
program at Fletcher Allen Health Care, says she is doing her part to combat morbid obesity by offering surgery as an option for extreme weight loss. The program offers three types of bariatric surgeries, including open gastric bypass, laparoscopic bypass, and lap-band.

Within the last year, Spaulding says, the program has developed to incorporate a wide array of dedicated staff, including four registered dieticians, a registered nurse, and a department psychologist.

Although the Rutland Herald article suggests a nationwide increase in the rate of morbid obesity, Spaulding says the bariatrics program at Fletcher Allen was already in need of expansion anyway, and that she has always seen a steady flow of patients throughout her years of experience there.

“I have to follow these patients for the rest of their lives,” Spaulding says, as there is an intense follow-up program for patients who undergo bariatric surgery. As with any medical condition, obesity can lead to other health problems, nutritional complications, and the like, Spaulding says. It’s important to continue to track a patient’s weight loss after the actual surgery takes place.

Due to several discrepancies in patient figures, it is difficult to track the actual rate of success of such a surgery, Spaulding says, as “we tell people that we want to see them for the rest of their life, but often they stop coming to their [follow-up] appointments.”

Although the numbers are not exact, Spaulding says most of her patients who undergo surgery lose two-thirds of their excess body weight, and most manage to keep it off.

The surgery is not something to take lightly, due at least in part to the financial commitment.

“Gastric bypass surgery itself can cost close to $8,000,” Spaulding says. However, “that’s just for the surgery, and doesn’t include the operation room or hospitalization cost,” she says, and when all is said and done, “you’re looking at the $20,000 range.”

Obesity as a medical condition — how can it be prevented?

“It is important to know that morbid obesity is a medical condition that’s all on its own,” Robinson says. Whether or not it may be the result of another condition is defined on a case-by-case basis.

“I’m not sure obesity is a disease,” says Suzanne Kelley of the Get Moving Vermont! program, which operates within the Vt. Department of Health. “It is a risk factor for numerous other diseases such as diabetes, cardiovascular disease, some cancers, etc.”

"It is important to know that morbid obesity is a medical condition that's all on it's own." -Kevin Robinson, SVMC

The goal of Get Moving Vermont! is to “improve the overall health of Vermonters by encouraging and supporting people of all ages to get at least 30 minutes of physical activity most days of the week by providing tip sheets, tracking sheets, and awards for participants,” Kelley says.

Being morbidly obese increases the risk of rapid, life-threatening complications from even the most minor hospitalizations, Robinson says.

“These complications [can] include breathing problems, kidney problems, skin ulcers, diabetes, stroke, and heart attack,” he says.

Physical activity is a key way to help prevent people from becoming overweight in the first place, Kelley says, and in Vermont, “there is tons going on state-wide to reduce obesity in different groups and areas like schools, worksites, communities, etc.”

Vermont’s obesity prevention program, Fit and Healthy Vermonters, led by the Vermont Department of Health, has a central goal of “getting people active,” Kelley says.

Morbid obesity is not really a new condition, Robinson says.

“However, medicine only recently has come to understand the full extent of how morbid obesity really complicates conventional treatment. Because more of our citizens fit this category, we are confronting these problems more frequently.”