The Obesity Crisis

  Obesity has increased dramatically in the US since 1990, when I opened the wound center at University of Texas in Houston. Today, the Centers for Disease Control and Prevention (CDC) claims more than one-third of adults are “obese.” In 2008, the estimated annual medical cost of obesity was $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight. Although I had not been tracking the national obesity trends all this time, I had been paying attention to the increasing challenges obesity is causing in the wound center. I am embarrassed to admit we did not begin routinely weighing all our clinic patients until 1999 and that we did not regularly calculate body mass index (BMI) until a few years later. Initially, I wondered if it was only my imagination that patients were getting heavier, so I decided to analyze data I had available electronically — 1,463 adult patient records (575 males and 889 females between 1999 and 2005). Since we did not have BMIs on everyone, we focused on patients weighing more than 250 lbs. An individual would have to be 7 feet tall to have a normal BMI at that weight. There was indeed an increase in patients weighing more than 250 lbs from 1999-2005.

  Furthermore, by 2005 nearly 1% of patients weighed more than 500 lbs, whereas there had been no patients at that weight 6 years prior. By 2010 it was not uncommon to see patients weighing more than 600 lbs, and we soon learned that waiting room chairs were not wide enough. We purchased wider, sturdier furniture as well as therapy tables that can manage up to 700 lbs, but unless they were bolted to the floor they had to be counterbalanced by 2-3 staff members for heavier patients to safely climb on to them. Special scales capable of weighing patients up to 800 lbs had to be obtained as well. Patients who did not have transport devices could not be safely accommodated in wheelchairs pushed manually, so we purchased an electronic, extra-wide wheelchair rated to 750 lbs that’s operated by a toggle switch and cost in excess of $10,000 (a topic of controversy in our budget at the time that has become one of the most important transportation devices in the hospital). Multiple staff members were often required to change dressings and bandages on obese patients because of their girth — although we were not able to increase our facility charges to reflect the increased cost of labor for these visits. The needs of obese patients could even be dangerous for staff members, some of who were injured assisting patients with transfers (at least one required back surgery).

  Meanwhile, lymphedema treatment was proving futile among patients who could not or would not move without electronic transportation and whose weight continued to increase. Since the hospital had been known for launching one of the first bariatric programs in Houston, I decided to require obese lymphedema patients to go to a free informational session on bariatric surgery and to participate in nutritional counseling as a requirement for treatment. Insurance coverage for bariatric surgery is another obstacle, but as more patients have done well with bariatric surgery, we’ve seen improvements in obesity-related lymphedema.

  Bariatric surgery is not the answer for all obese patients, but it is the answer for some. In this issue of Today’s Wound Clinic, we discuss bariatric surgery, getting patients mobilized, and helping them achieve better nutrition. The implications of obesity on the US healthcare system are more serious than the cost of new equipment and an over-burdened staff. A report released by the CDC earlier this year estimated 42% of Americans would be obese by 2030. This means there will be double the number of cases of diabetes and all its related consequences. We will not need to worry about having patients to care for in our wound centers. We will need to worry about whether the healthcare system will collapse under the financial weight of caring for them.