Jeannine Cobb, MD, bariatric physician, executive medical director of Medi-Weightloss Clinic of Kansas, Andover, and clinical assistant professor, University of Kansas Medical School, Wichita.
Not that anyone has to search far and wide to find reasons why being overweight is bad for your health — but here’s one that you may not have heard before: Obesity interferes with your ability to get good medical care in ways that range from inconvenient to dangerous. In fact, obesity can even make it impossible to deliver lifesaving care — it’s much harder to quickly and accurately insert an intravenous line into an obese patient, and for patients in cardiac arrest, layers and layers of fat can deter the electrical shocks intended to bring a still heart to life.
Two-thirds of Americans are now considered either overweight or obese (100 pounds or more above their ideal weight), and obese people are far more likely than normal-weight people to need medical attention. What can patients and doctors do? I asked this question of several highly experienced physicians — Richard O’Brien, MD, an emergency medicine specialist in Scranton, Pennsylvania, and a contributing medical editor here at Daily Health News… Leo Galland, MD, internist and director of the Foundation for Integrated Medicine in New York City (www.mdheal.org), who is one of the experts we regularly turn to… and Jeannine Cobb, MD, a bariatric physician (bariatricians specialize in the care of obese patients) and executive medical director of Medi-Weightloss Clinic of Kansas in Andover, Kansas. They told me about some of the common problems that doctors face in conducting medical tests on heavy patients and gave suggestions on how to work around them.
According to Dr. Galland, procedures that require a needle can be a problem because the fat is difficult to penetrate and makes it far harder to find the target. Common issues include:
Drawing blood is difficult,since it becomes challenging to locate a vein to puncture.
Solution:Veins in the back of the hand can be the easiest ones to find in obese patients. Other potentially promising sites include the top of the foot, the ankle, the inside of the knee and where the thigh meets the pelvis.
Biopsies are difficultbecause it’s hard to find and reach the needed tissue samples.
Solution:In addition to using an extra-long needle (most hospitals stock them for surgery), doctors may sometimes need to use ultrasound equipment to help them find the target.
Standard medical equipment doesn’t always work well for obese patients. In addition to logistical problems, such as the need for extra-wide tables and sturdy chairs, doctors may need different technology to examine extra-large patients. For instance:
Blood pressure readings often are falsely highwhen a standard cuff doesn’t fit properly.
Solution:Larger cuffs must be used for seriously overweight patients. Patients who track their own blood pressure at home should purchase a device with a cuff of the right size (available at Amazon.com, Walmart, Walgreens and other such stores).
Weighing a patient accurately can be difficult— most scales reach only 300 or 400 pounds. This is especially problematic in a medical crisis, said Dr. O’Brien. Often, drug doses must be precisely calibrated to weight, but it can be “nearly impossible to weigh a critically ill patient who is difficult to lift and maneuver,” said Dr. O’Brien.
Solution: Obese people should track their weight at home (high-weight scales are available from www.Scale-It.com)… and then accurately report it to medical personnel whenever they ask. Make sure that your family and close friends know your weight, too, in case you become unable to report it in an emergency.
Interpreting medical test results is much trickier. An example:The serum creatinine blood test to evaluate kidney function, which takes account of a patient’s age, sex, height and weight in determining a “normal” result. “If the patient is obese, the weight calculation will be thrown off, and the heavier the person, the more the estimation will be affected,” says Dr. Galland, noting that this can lead to misdiagnosis or treatments that are ineffective. Dr. Galland said that this is just one of many such tests that are similarly affected.
Solution:According to Dr. Cobb, a “normal” reading for an obese patient would often be interpreted as “abnormal” for a patient who weighs less. Doctors may therefore need to repeat lab tests to confirm results, she said, noting that “bariatric medicine physicians tend to do a little more testing to determine if a particular result is due to obesity or because of disease.”
Drugs don’t get absorbed properly.For instance, anesthetics can be taken up by excess fat tissue so they don’t effectively reach the target area and therefore don’t end up working as well.
Solution:Dr. Cobb said that anesthesiologists must adjust accordingly, usually administering extra-high doses of drugs, which then take longer to work their way out of the patient’s tissues after surgery.
Another problem area — imaging tests. A study in Radiologyfound that the number of Americans too large to have proper imaging from X-rays, CT scans, MRIs or diagnostic ultrasounds has doubled in the past 15 years.
Images may be fuzzy or inaccuratebecause fat presents an obstacle. The problem is greatest with abdominal ultrasounds, followed by chest X-rays, abdominal CT scans, abdominal X-rays, chest CT scans and MRIs. In addition, says Dr. Galland, “An obese person may not be able to take a deep breath, and that can interfere with the resolution of a chest X-ray.”
Solution:According to Dr. Cobb, radiologists must use special formulas to determine the proper dose of radiation for X-rays and CT scans for obese patients, who require more radiation. She said that with MRIs, technicians may need to adjust the strength of the magnetic field for very large patients. And sonograms are harder yet, as there aren’t many ways technicians can adjust for obesity. Dr. Cobb said that in this case, doctors may need to figure out what other sort of test can provide the necessary information.
Scanning equipment may not be large or sturdy enough.This happens with both CT scans and MRIs. The tables may not be able to support the weight of a patient, and some patients are so large that they won’t fit through the opening of the machine.
Solution:Manufacturers of these machines have begun to increase their weight capacities (from 450 pounds for CT scans and 350 pounds for MRIs to 550 pounds for both). In the meantime, however, an obese patient may need to go to a different facility with specialized equipment to have imaging tests taken, possibly delaying care.
If you are obese and don’t already have resources for specialized care, now’s the time to find them — before an emergency arises. Dr. Cobb said that too many obese patients put off visiting the doctor because they are embarrassed about their weight or feel that the doctors aren’t interested in them. “Bariatric medicine physicians have lots of ways to help obese patients access appropriate care,” she said. “We can provide the support and empathy they need and also help people feel comfortable coming to the doctor, not judged or embarrassed by their weight. Bariatric physicians have solutions.”
In your search, make sure to find a bariatrician whose specialty is medical care of heavy patients — some specialize in weight loss instead. To find a bariatric medicine physician near you, contact the American Society of Bariatric Physicians (http://www.asbp.org). And for help conquering obesity, contact the Obesity Action Coalition (www.ObesityAction.org).