U.S.'s Obesity Woes Put a Strain On Hospitals in Unexpected Ways

U.S.'s Obesity Woes Put a Strain On Hospitals in Unexpected Ways

When an extremely heavy man spent several weeks at a Kaiser Permanente hospital in Fresno, Calif., two years ago, employees suffered a string of injuries providing routine care for the nearly 500-pound patient.

"We can document five injuries, but there may have been as many as 11 from anecdotal evidence," says Barbara Smisko, director of Western environmental health and safety services at Kaiser, the Oakland, Calif., health-maintenance organization. "It's a dramatic story, but it characterizes the kinds of things that happen to patients and staff every day."

The fact that more Americans are obese is putting a new strain on the nation's health-care system in some unexpected ways. Standard beds, wheelchairs, operating tables, imaging equipment and even scales aren't designed to accommodate the growing number of extra-large patients. In addition, injuries are rising among the hospital staffers who care for them.

Todd Zortman, a 240-pound physical therapist in Indianapolis who stands 6 feet 3 inches tall had surgery in September on a shoulder muscle that tore when he was moving a 450-pound patient who "decided to hang onto my right arm," he says. "One of the problems is that there isn't a lot of equipment out there that fits what we need and the expense of purchasing it is unbelievable."

Obesity among American adults has nearly doubled during the past two decades, but the jump in the number of morbidly obese people -- those who are 100 pounds or more overweight -- is even more disturbing. About one in 80 men weighs more than 300 pounds, a 50% increase between 1996 and 2000; one in 200 women weighs more than 300 pounds, a 67% increase during the same four years, says Roland Sturm, an economist who studies obesity trends at Rand, a Santa Monica, Calif., think tank.

In addition to renting and buying extra-wide wheelchairs and big sturdy beds, hospitals are forming "lift teams" and hiring coaches to teach attendants safe ways to move "bariatric" patients, a medical term derived from the Greek word "baros" meaning "weight." Some hospital architects have designed bigger toilet rooms for patients who need one or two persons assisting them. Kaiser alone is planning 30 medical buildings in California; each will have two to four extra-large rooms for obese patients and others with special needs.

Obesity advocates say such accommodations are happening too slowly, raising the specter of discrimination lawsuits against hospitals. "I'm terrified of needing emergency medical care," says Judy Freespirit, a 66-year-old activist in Oakland, Calif., who describes herself as "a very, very large woman" who needs a motorized scooter to get around. When she had an asthma attack a couple years ago, she had to crawl into the back of an ambulance because the paramedic team didn't have a gurney to hold her. Ms. Freespirit says she hasn't gotten regular physical exams because "I can't figure out how to get up on the exam table, using that little step that pulls out a few inches."

Other larger-size people have been denied imaging scans for cancer and other diseases because diagnostic facilities can't accommodate them, says Walter Lindstrom Jr., founder of the Obesity Law and Advocacy Center in San Diego. "I get calls and e-mails on an average of five to 10 a month" from people who "sought treatment at a hospital and were told that it couldn't take care of them," he says.

Certainly, some hospitals view the growing popularity of weight-loss surgery as an opportunity -- both to build business and to improve obesity treatment in their communities. They are setting up bariatric wings for gastric surgery, which reduces the capacity of a patient's stomach. The American Society for Bariatric Surgery estimates there were 57,200 procedures last year, a 29% increase from 2000. "We don't see it slowing down anywhere," says Georgeann Mallory, executive director of the Gainesville, Fla., association. The average hospital cost for bariatric surgery is about $20,000, she says.

More commonly, though, hospitals worry about the safety of nurses, physical therapists, and other attendants helping bariatric patients -- as well as the strain on their limited budgets.

Salem Hospital in Salem, Oregon, has historically rented special beds, wheelchairs, lift devices, and other equipment to care for the occasional bariatric patient. It has improvised at critical times, wiring two operating tables together for surgery patients, for instance. Now it is considering adding $100,000 to the capital budget so it could buy equipment to care for two large patients at the same time. "We used to have maybe one or two every six months or so. Now we are seeing upwards of three or four a month, and sometimes as many as five at once," says Judy Manselle, vice president of patient care.

Sacred Heart Medical Center, which is planning a 500-bed hospital near Eugene, Ore., has asked its architects to include ceiling-mounted bariatric lifts above all beds; the lifts are used for moving patients from a bed to a stretcher for surgery or tests. Portable lifts don't avoid injuries because nurses don't always bother to fetch them, a spokeswoman says. A few years ago, Kaiser began installing floor-mounted toilets in some facilities in Hawaii and California after managers reported very heavy patients were accidentally breaking toilets off the walls.

Demand for bariatric equipment took off about a decade ago, manufacturers say. "It has come from nowhere to be the fastest-growing part of our rental business," says Marshall Dahneke, global vice president of marketing at Hill-Rom Co., a unit of Hillenbrand Industries Inc. in Batesville, Indiana. Other specialized-equipment companies are Kinetic Concepts Inc., San Antonio and Liko in Sweden.

Ergonomics experts are seeing an uptick in business too. A physical therapist in Atlanta has turned his knowledge of mechanical devices and therapeutic grips into a full-time consulting job. "I used to do two seminars a year until three years ago; now I average two a week" and travel around the country, says Michael Dionne; his one-day course costs $1500. Obesity is a particularly acute problem in the eastern South Central states and in the economically depressed Appalachia region. Eight years ago, the operating tables at Saint Mary's Hospital in Huntington, W. Va., accommodated people who weighed as much as 400 pounds. "Now we have two beds certified up to 1,000 pounds," says Sharon Ambrose, senior vice president and chief operating officer.

Saint Mary's also is mulling the purchase of a $2,195 scale that measures as much as 880 pounds. "We have no way to weigh people. We have been taking them to the laundry and putting them on scales down there," says Margaret Donnelly, director of patient care. "It's the most awful thing. But you have to have an accurate weight to treat someone with antibiotics."

Write to Rhonda L. Rundle at rhonda.rundle@wsj.com³

Updated May 1, 2002 11:39 a.m. EDT