Monday, April 18, 2011

Obesity: New Products and Old Problems

You might be interested in the response of equipment manufacturers to the increase in the size of obese patients. Below you can see a photo of a wide-body wheelchair and a super wide-body bedside commode.

You will note that the bedside commode has a normal sized bucket but the seat is extra wide to accommodate the girth of morbidly obese patients.

Something probably not appreciated by most people is that a morbidly obese person’s body actually contains a normal sized individual surround by a large layer of adipose tissue.

Below is an abdominal CT scan which illustrates the point.

You can see that the organs are encased in body fat which extends to the limits (and beyond) of the CT scan table. The picture is grainy because the x-rays are partially absorbed by the thick fatty layer. This makes the interpretation of the images much more difficult.  So not only is the diagnosis of abdominal problems hindered by the fat, you can imagine how hard surgery must be. Or maybe you can’t. Take my word for it, it’s hard.

Recovery is also an issue due to impaired wound healing, increased incidence of infections, problems moving the patient, difficult intravenous access and many more.

Remember this when you order that second Big Mac with supersized fries.


Anonymous said...

You oughta try putting a labor epidural in a 350-pound parturient.

I think the failure rate is at least 50%, which is probably about the C-section rate for those patients in our facility.

I'd like to have obese patients sign a disclaimer that they understand that they'll be lucky to have anything go well for them during their admission.

Skeptical Scalpel said...

Agree. The other thing no one talks about is venous access. Obese people usually either have terrible veins or no veins at all. I spend significant time putting central lines in these people. The risk of complications is greater.

weight loss said...

Hello Sceptical Scapula, I enjoyed you post on obesity in children. He article from the group from Norways with 924 students showing that overweight children have different eating patterns those normal weighting children is very useful.

I have always believed that sugar is a major contributing factor to this epidemic.
I think that eating and drinking less sugar is a great start.

Here is what I use:
However as you stated exercise is an important component.

I will watch for further posts on this.

K_Chie said...

Well that's just the thing. You think it's logical to ask people to consider the difficulty in examining an obese patient with hands and stethoscope, of interpreting their imaging studies (or even getting them done in the first place), of pursuing interventions or of dosing medications. I can tell you from discussion with non-medically trained obese-and-happy-deal-with-it people that the response is "well, you need to learn better diagnostic and surgical skills and build better machines". The topic at hand was medical mistakes in obese patients and how their obesity is usually central to the medical error. "don't care, its 2011 (well it was) and doctors need to know how to take care of us better" was the response.

Skeptical Scalpel said...

K_Chie-Thanks for the comment. I really don't know how to respond to "doctors need to know how to take care of us better." There are physical limits to what we can do when people are very obese. It's not a knowledge issue. I can't make veins for IV access appear out of nowhere in a chubby arm. CT scanner tables are now able to handle the weight of a 400 pounder but the images still may be degraded by the fat. I could go on.

Anonymous said...

I love it when patients with a BMI of >40 comes in complaining of back pain due to their lumbar degenerative disc disease as if calling it a "disease" excuses them from any responsibility for their back problems.

Skeptical Scalpel said...

Anonymous, thanks for the comment. That goes for knee and hip replacements too.

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