The United States is growing. That is, its individual inhabitants are getting bigger. Depending on the source, anywhere from 30% to 50% of the American population is now obese.1-3 By all accounts, the percentage of obese adults in our country has risen considerably over the past two decades and continues to rise.
When asked about challenges in treating the obese patient, many medical professionals will expound on bariatric treatments and surgeries—programs designed to help patients lose weight. Addressed far less frequently are the challenges faced by physicians—specifically hospitalists—in treating the obese patient for a routine or emergency medical problem or traumatic injury.
Obesity is a contributing factor to a myriad of medical problems. The American Heart Association lists obesity as one of several modifiable independent risk factors for cardiovascular disease.4 Overweight individuals are also at higher risk for a long list of other diseases, including high blood pressure, high cholesterol, type 2 diabetes, stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and certain types of cancers.5 There is also growing evidence that obesity may be a risk factor for asthma.6
Obese patients may delay seeking medical care for a number of reasons, including self-consciousness about their weight, fear of negative comments from physicians and staff, or past negative experiences with hospitals or staff.2 When patients delay seeking appropriate preventive care, they are more likely to end up in the emergency department or be admitted to the hospital and, consequently, under the care of a hospitalist.
The Transport Conundrum
Furniture, equipment, medical supplies, and everything else commonly used in the hospital are designed to accommodate the average-size adult. In fact, for many morbidly obese patients, the difficulty begins immediately upon arrival at (or even before reaching) the hospital.
When a patient suffers an acute illness or traumatic injury, the logical reaction in many cases is to call an ambulance for transport to the hospital. For a large person, this can create the first dilemma in receiving care. Many ambulance companies now have stretchers with weight ratings of up to 700 pounds. However, moving a stretcher loaded with several hundred pounds of patient can be quite a challenge for ambulance personnel—even with extra crew members available.
If the patient is not ambulatory, the crew must find a way to place the patient onto the stretcher and then to move the stretcher into their ambulance. They can face the difficulty of not only lifting and moving such a heavy load, but also moving through doorways, down stairs, and across uneven surfaces. Simply dealing with the logistics of moving the patient safely can be time-consuming and can cause a delay in administering emergency care to the patient.
Upon arrival at the hospital, the same dilemmas will arise in transferring the patient from the ambulance stretcher to a hospital bed. Many devices designed to aid in lifting and moving patients are not rated for use with the morbidly obese patient. There must be sufficient staff on hand to facilitate transfer of the patient, and the staff must be well educated in lifting and moving techniques safe for staff and patient.
The issues regarding the lifting and moving of obese patients present significant safety implications for hospital employees. Michael Allswede, DO, residency program director for Emergency Medicine Residency at Conemaugh Health Systems in Johnstown, Pa., says that this particular issue is compounded by the fact that many hospital employees are overweight themselves. “You basically have obese people trying to lift obese people,” he says.
In a Novation survey of VHA member hospitals released in December 2004, 28% of respondents reported an increase in workplace injuries—primarily back injuries—related to lifting obese patients.7 The National Council of Compensation estimates the average cost per healthcare worker injury to be $8,400.8 This increase in worker’s compensation claims clearly has a significant financial impact on hospitals.