Obesity is defined as having a BMI (Body Mass Index) greater than 30 – a number calculated based on the height and weight of an individual which can vary between males and females.1 This epidemic is not a new concern for healthcare and has increasing effects on the entire healthcare system:
#1: Patient health
Obesity has a variety of impacts on the body. The increased pressure from the accumulation of fatty tissue causes pressure on internal organs leading to conditions such as:2
- High blood pressure
- Type 2 diabetes
- Chronic Obstructive Pulmonary Disease
- Sleep Apnea
- Varicose veins
- Stress incontinence
- Venous insufficiency and poor circulation leaves patient more susceptible to infection, skin breakdown and dehiscence of surgical wounds
#2: Safety of hospital staff
Healthcare workers are put at risk physically due to the additional strain they incur helping the obese patient with mobility. In order to prevent skin breakdown in the immobile patient, most staff follow a schedule in which the patient’s position must be changed every two to four hours.3 This may require additional staff depending on the weight of the patient. If no additional staff are available, a staff member may willingly put their own physical well-being in jeopardy while re-positioning a patient.
#3: Financial impact on health system
- Increased spend on pharmaceuticals: Obesity affects the pharmacokinetics of the body, which can lead to the patient requiring more frequent administration or higher doses of medication,4 as well as more frequent care and vital sign monitoring by the nurse. This has the potential to increase the cost of pharmaceuticals that hospitals are currently spending.
- Non-reimbursable treatment: Due to the additional pressure the accumulation of fatty tissue creates, the obese patient is more at risk for infection and dehiscence of surgical wounds.5 In some cases, Centers for Medicare Services (CMS) standards call for hospitals and other healthcare systems not to be reimbursed for care related to conditions such as surgical site infections.6 Obesity also creates impaired mobility to the patient, leading to an increased risk for falling. CMS will not reimburse a hospital for patient fall complications and skin breakdown that is acquired while the patient is hospitalized.
- Cost of equipment: Hospitals may have to consider ordering new bariatric equipment including hospital beds, wheelchairs, bedside commodes, and walkers to accommodate obese patients. At a national convenience store, the standard size bedside commode costs under $80. The bariatric version of the same commode costs over $170. According to The American Institute of Architects (2016),7 hospitals that are seeing increased numbers of obese patients are turning to design experts to help create new doorways and hallways to accommodate the growing physical size of their patients.
Hospital staff may do everything in their power to treat obese patients, however complications may still be unavoidable due to the detrimental effects of obesity on the human anatomy. Obesity is not always addressed as most medical conditions are – directly to the patient – since there is often concern around being insensitive when addressing weight issues.
It is extremely important to keep top of mind the many strains that obesity causes to the health care system. As a society, we must work towards eliminating this epidemic through education and prevention, while also collaborating to deliver the highest quality, safe and effective care possible to the current obese patient population.
Footnotes & references:
1 Kushner, R. (2012) “Clinical Assessment and Management of Adult Obesity” Circulation, Vol 126 pages 2870-2877
2 Klein, S., Burke, L., Bray, G., Blair, S., Allison, D. (2004) “Clinical Implications of Obesity With Specific Focus on Cardiovascular Disease: A Statement for Professionals From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism” Circulation, Vol 110, pages 2952-2967
3 Camden, S. (2009), “Obesity: An Emerging Concern for Patients and Nurses”, OJIN: The Online Journal of Issues in Nursing Vol 14, No. 1
4 Kushner, R. (2012) “Clinical Assessment and Management of Adult Obesity” Circulation, Vol 126 pages 2870-2877
5 Camden, S. (2009), “Obesity: An Emerging Concern for Patients and Nurses”, OJIN: The Online Journal of Issues in Nursing Vol 14, No. 1
6 https://www.ncoa.org/wp-content/uploads/State-Policy-Toolkit-for-Advancing-Fall-Prevention-Select-Resources.pdf , Searched 3/13/2016
7 Collignon, J.D. “Strategies for Accommodating the Obese Patient in an Acute Care Setting”, http://www.aia.org/practicing/groups/kc/AIAS076325 , Searched 3/12/2016