The rise in obesity buoys many trend lines. As a risk factor for a host of diseases, obesity contributes to upticks in hypertension, diabetes, heart failure and other conditions. Specialists and hospitals treating these patients face additional challenges that range from adapting interventional and imaging procedures to acquiring supersized equipment. Is there a way to turn the tide? Bariatric surgery offers one strategy.
Wave of the future
Body Mass Index* Classifications
*BMI=weight in kilograms divided by height in meters squared
Source: American Journal of Radiology 2007;188:433-440
Being obese or overweight ranks No. 5 on the World Health Organization’s list of leading risk factors for mortality, contributing to 8.4 percent of deaths in high-income countries. In 2010, one in three adults in the U.S. was obese, meaning they had a body mass index of 30 or greater, according the Centers for Disease Control and Prevention. Almost 17 percent of children and adolescents also met the criteria for obesity.
Among the trends pushing alarm bells is the prevalence of obesity in children between the ages of 6 and 11, which jumped from 4 percent to 11 percent in 30 years. On the other end of the age spectrum, obesity prevalence in Medicare beneficiaries rose 5.6 percent in a five-year span, prompting forecasts that by 2030 more than half the U.S. population will weigh in as obese (Circulation 2013;127:e6-e245). These people will not only pack on pounds but also mortality and morbidity risks.
A growing phenomenon that starts at an increasingly younger age, obesity portends generations of patients who may need treatment for cardiovascular risk factors such as hypertension, dyslipidemia and diabetes and also care for coronary heart disease, heart failure, stroke and other diseases predicted by obesity. “The increase in obesity has impacted us in a number of ways,” says Norma Keller, MD, chief of cardiology at Bellevue Hospital Center in New York City. “One is the (larger) number of patients with cardiovascular disease and the age at which we are seeing it. We see younger patients with more comorbidities like diabetes and high blood pressure.”
Complications extend beyond clinical challenges. To optimally treat certain obese patients, hospitals and their cardiovascular departments may need to invest in special equipment that can range from heavy-duty catheterization tables to scanners with larger aperture openings. And then there are issues related to basics such as toilets and beds.
A center of excellence for bariatric surgery, Bellevue purchased extra wide beds and bedding, motorized wheelchairs and stretchers to care for its morbidly obese patients. These specialty items carried hefty price tags, too. In 2012, a bariatric bed cost the hospital on average $22,500; a bariatric wheelchair $5,500 and an extra wide stretcher, $4,300. That may be as much as three times the cost of a standard hospital bed and twice the cost of a standard wheelchair, according to the New York City Health and Hospitals Corporation (HCC), an integrated healthcare delivery system that includes Bellevue.
HCC estimates that it spent millions of dollars in its hospitals on equipment, supplies and infrastructure to safely accommodate its obese patient population. That ranges from toilets that can support up to 500 pounds to operating tables with a capacity of 750 pounds.
If this is a tidal wave in the making, cardiology already has felt its first warning ripples. “In the medical world, the obesity epidemic has been obvious much longer than in the public because obese patients tend to be sicker,” says Udo Hoffmann, MD, a cardiac radiologist at Massachusetts General Hospital in Boston.
While bariatric centers have been designed with the obese in mind, some cardiac facilities may find they cannot accept some obese patients for safety reasons. “In the cath lab where (cardiologists) do diagnostic testing of the coronary arteries, weight can be an issue,” Keller says. Manufacturers for tables in catheterization laboratories, for instance, designate weight specifications and warn of potential dangers to patients and damage to equipment if the limit is exceeded.
In a survey to 94 institutions, Thomas E. Vanhecke, MD, of William Beaumont Hospital in Royal Oak, Mich., and colleagues asked cath lab nurse managers about their labs’ maximum weight limits, protocols when a patient exceeds that weight and an estimate of patients rejected as a consequence