Over two-thirds of American adults are obese (defined as a Body Mass Index of 30+), and more than 1 in 20 of these individuals are classified as extremely obese (BMI of 40+). However, the healthcare industry is failing to adequately provide care for this significant segment of the population. These problems include those relating to equipment, provider attitudes, and industry practices.
Many hospitals do not have the equipment to accommodate large people, including scales that can’t provide high readings, blood pressure cuffs that are too narrow, and scanners that are too small. CT or MRI imaging is necessary for diagnosing a variety of conditions ranging from trauma to blood clots, yet a significant proportion of the population is excluded from these essential procedures in the vast majority of hospitals. In a national survey of hospitals with emergency departments, just 10 percent of all hospitals had large weight capacity CT machines and 8 percent had large weight capacity MRI machines. Even more alarmingly, only 21 percent of hospitals designated as bariatric surgery centers of excellence have large weight capacity CT scanners.
In addition to equipment issues, physician attitudes are contributing to the problem. The stigma against obese people, both explicit and implicit, has reduced the quality of care for the obese. This perception on the part of some healthcare professionals is that obese people are weak-willed, lazy, and non-compliant. This often results in patients avoiding going to the doctor. An analysis of audio recordings of outpatient encounters by the Obesity Society found that physicians were significantly less likely to build emotional rapport with overweight and obese patients. When examining obese patients, doctors often automatically attribute their symptoms to weight without examining other possible causes. An International Journal of Obesity study found that doctors spend an average of 28 percent less time on obese patients. Physicians reported that the heavier their patients were, the more they felt that seeing patients was a waste of their time, that they liked their jobs less, that the patient was more annoying, and that they felt less patience. The stigma against obese people leads to less thorough treatment and to patients avoiding going to the doctor.
Dosing problems are also more common for obese people, as there are no requirements for drug makers to determine appropriate doses for this population. Dosing guidelines are often based on standard sizing developed decades ago when the average person was thinner. Since there are not many medical studies performed on larger people, it is difficult to predict how dosage rates designed for thinner people will affect them. Using total body weight, which is often used as a dosing metric for thinner people, can leads to overdosing for obese people. Lean body weight, the weight of the body minus its fat, is a more appropriate measure for obese people for many medications.
Additionally, the rating system for hospitals works against the obese. Hospitals can face penalties and reductions in Medicare reimbursements if too many surgeries have complications. Since obesity enhances the risk of complications, many hospitals impose BMI cutoffs for surgeries. This system creates disincentives for hospitals to treat the patients that often need care the most.
Finally, obese people can be more susceptible to certain diseases. According to the National Institutes of Health, “These conditions greatly raise your risk for other health problems,” including heart disease, stroke, type 2 diabetes, and others. These health problems can be magnified, when obese individuals are not getting the proper caliber of care for the reasons listed above.
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