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Supersizing Hospitals

Supersizing Hospitals

Hospitals are gearing up for overweight patients, with super-sized equipment, surgical tools, and furniture. The South and Midwest are especially hard-hit by obesity, but the trend holds true across the nation, according to Robert Cima, a colorectal surgeon with the Mayo Clinic in Rochester, Minnesota.

One of the fastest-growing industries in surgery is designing equipment for obese patients, such as laparoscopic instruments long enough to reach organs through layers of fat, he said. And architects who design new medical centers or hospital wings now do so with obese patients in mind.

Cima estimates that retrofitting or redesigning a hospital room for obese patients costs $50,000-$70,000. A 2014 report from Novation, a healthcare supply chain analytics and contracting company, found that making all renovations necessary to accommodate morbidly obese patients cost $100,000 at one hospital and $2.3 million at another. Virtually all of the 125 hospitals that responded to Novation’s survey reported using durable medical equipment designed for the morbidly obese, such as big beds, lifts, and stretchers.

Bigger patients mean bigger stuff

“The patient population that we’re treating – whether it’s in bariatric surgery, orthopedics, pediatrics – all of these specialties are having to cope with special needs because of obesity,” said Dr. Jeffrey Allen, medical director for bariatric Services at Norton Healthcare. “Even the chairs in the waiting room are bigger, not just for patients but for their families.”

Overweight and obese people are “the majority of the population,” said Dr. Robert Farrell, a surgeon with Kentucky One Health. “It’s become something we think about in everything we do.”

Giant beds, chairs, and instruments

Novation’s report provides a big-picture view. More than half of the hospitals in the Novation report saw an increase in workplace injuries in the previous year from caring for morbidly obese patients, and most of those offered safety training to healthcare workers.

Safety procedures involve using specially-designed equipment such as lifts and large wheelchairs with push-bars instead of regular handles so workers don’t have to bend down while pushing obese patients and risk hurting themselves.

Such equipment is also considered much safer for the patients themselves. Cima said wheelchairs used to be 17 inches across and could safely handle up to 300 pounds, while many new ones have a 22-inch-wide seat and can handle 450 pounds or more. Bariatric hospital beds, and some bedside commodes, can handle 1,000 pounds. Some MRI scanners are rated to 500 or 550 pounds, and Mayo has CT scanners able to accommodate up to 660 pounds.

Ceiling lifts for patients have become standard, Cima said, adding that one patient dubbed the device “the Shamu lift.”  Locally, Allen has watched the evolution of equipment in Louisville hospitals. Twenty years ago, when he worked at the University of Louisville Hospital, he said there were special lifts for patients weighing more than 300 pounds.  “Now, many of the patients are that heavy,” he said. “We routinely operate on 4-, 5-, 600-pound people.”

That means longer surgical tools. To reach a gall bladder in a 400-pound patient, for example, he said doctors may need a sharp instrument called a trocar that’s six to eight inches long, compared with the standard four-inch-long instrument. “The distance between you and that gall bladder is much bigger,” he said, “so you need longer equipment.”  Such instruments don’t work on smaller patients, so doctors need two sets.  But at least beds can do double duty, Allen said. “Put a small person in a big bed and it feels like a king-sized bed. I’m sure no one would complain.”

Beyond equipment and instruments, the very structure of hospitals has changed, with newer facilities in the region – such as Norton Brownsboro Hospital in Eastern Louisville and Kentucky One’s Flaget Memorial Hospital in Bardstown – built to handle people of all sizes.  “Flaget is not quite 10 years old. The whole hospital was designed with wider doorways,” Farrell said. “It’s being done at all hospitals across the population.”

Weighty troubles

Doctors call this the new normal, given the alarming rise in obesity.  Federal statistics show 66.7 percent of Kentuckians and 66.4 percent of Hoosiers are either overweight or obese, compared with a national median of 65 percent. Obesity rates have more than doubled in the past 35 years across America.

Kentucky has the nation’s third-highest rate of obese high school students – 18.5 percent, according to a 2013 federal survey that found Indiana’s rate was 13.6 percent.  Obese people are more likely than normal-weight people to get sick and wind up in the hospital. Excess weight raises the risk of diabetes, cardiovascular disease, and cancers. All of which strike Kentuckians and Hoosiers at some of the nation’s highest rates.

A Success Story

When Stanley Hall was morbidly obese. He couldn’t fit into most hospital beds. Once had to get a full-body CT scan on a machine used for horses and cows.  That was more than a decade ago. Since then, “I’ve seen a lot of changes,” he said. “The CT scanners, the beds — they got bigger.”   Hall, 67, of Crestwood, suffered from congestive heart failure back in 1999 when his weight got up nearly 700 pounds.

After working 25 years at a company that produces and distributes processed meats. The Marine veteran had to retire on disability. He could no longer drive or go fishing and spent much of his time in a specially designed, heavy-duty hospital bed set up in his home.  He recalled his doctor saying at the time: “How long do you want to live? At the rate you’re going, I’ll give you six months.”

His hopes fading, Hall decided to undergo gastric-bypass surgery, and by 2010 got down into the 300-pound range. But a few years later, he started gaining back some weight and attended a seminar with Dr. Allen. In the fall 2014, he got lap band surgery and continues to see Allen and the team at the Norton Weight Management Center.

Hall now weighs 260 pounds and is back to fishing, working in his garden, and driving a pickup truck he bought after his weight loss. He wears pants with a 44-inch waist instead of those with a 68-inch waist that he wore at his biggest. He carries a picture of himself from those days, as an inspiration to keep the weight off.  “I’m healthier now than I have ever been,” he said.

When Hall goes to the hospital or doctor’s office these days. He said, “I’m down to where I can fit anything” — but glad today’s hospitals can accommodate others struggling with obesity.   Today’s hospitals are geared up for this age of obesity, with super-sized equipment, surgical tools, and furniture. Many have wide doors, larger-than-average rooms, and floor-mounted toilets that won’t break under heavy weight.

Such accommodations will likely continue for the foreseeable future. While success stories like Hall’s are not unique, doctors said they don’t expect the nation as a whole to slim down anytime soon.  “As far as obesity goes,” Allen said, “the future is a little bit bleak.”


Dr. Kris Dinucci