- The Washington Times - Monday, January 26, 2004

Inside the soothing blue walls of George Washington University’s Weight Management Program is a low, flat digital scale that can measure people who weigh as much as 1,000 pounds. The waiting room contains a so-called mega-chair, designed to fit large bodies comfortably. Some chairs are armless for the same reason. The doctor’s examining room has outsized blood pressure cuffs and gowns and a reinforced table 4 inches wider and 12 inches longer than regular-size tables.

Special furnishings and equipment are required to care for obese patients coming into this outpatient facility before, and sometimes after, they undergo gastric bypass surgery in the hospital’s bariatric surgery unit a block away.

Bariatrics is the branch of medicine specializing in the control and treatment of obesity and allied diseases. An obese person is someone who weighs least 100 pounds more than what is considered ideal for his or her age and height. The U.S. Centers for Disease Control and Prevention estimates that two of three American adults are overweight, many of them severely so. As such, they risk a host of auxiliary medical complications, including heart disease, sleep apnea and cancer.

“The numbers of overweight people are increasing,” says Dr. Arthur Frank, the trim, soft-spoken man who runs the GW Weight Management Program. “The subject has had more attention recently because the curve of increase has accelerated, particularly with reports directing attention to children that have been very startling.”

Dawn Vest, the program’s office manager, recalls when an especially large man fainted while having his blood drawn; he was too heavy for her to move off the floor.

“I had to just leave him there, but fortunately he had anticipated the fall and didn’t hurt himself. He came to quite soon,” she says.

The overweight patient can literally burden health care professionals.

“The old adage that nursing is backbreaking work really is true,” Inova Fairfax Hospital spokeswoman Janice Moore says only half jokingly.

Inova Fair Oaks, one of four hospitals in the Inova system, did 749 bariatric procedures last year, more than any hospital in the Washington metropolitan region. George Washington University Hospital has done 200 bariatric surgeries in the past six months and is expanding its bariatric unit from four to eight beds.

To care for obese patients, hospitals increasingly must buy supersize equipment, including stretchers, wheelchairs, beds, operating tables and surgical tools, such as special retractors and staplers. Before adult obesity became a national epidemic, an exceptionally overweight person might be sent to a commercial loading dock or a veterinary center to find a scale large enough to accommodate him or her.

Inova Fair Oaks is buying a new generator to provide more kilowatts for equipment that can image larger patients, says Ted Riche, assistant administrator for facilities services. Its new CT machine can scan a patient weighing up to 475 pounds. A scale that can measure up to 600 pounds is designed to hold a wheelchair-bound patient so the patient does not have to stand up to be weighed. In addition, Inova Fair Oaks has expanded its doorways by a half foot in some areas to accommodate a bariatric wheelchair and is considering buying a special lift device to use when transferring a patient from a stretcher to a bed.

“Equipment for hospitals is lagging because of the expense,” notes Dr. Joseph Afram, who has done 3,000 bariatric procedures in his career to date. Dr. Afram heads the private Center for Obesity Surgery at 2440 M St. NW, and he performs operations at George Washington University Hospital. “Buying a large version of a million-dollar CT scan or [magnetic resonance imaging] machine is too expensive for most hospitals, but it is coming,” he says. “Meanwhile, we make do with other means.”

Bariatric equipment can cost four to eight times more than regular-size equipment and furnishings. Auxiliary needs come into play, too.

“Often we find patients’ family members are on the large side, so we are purchasing larger guest furniture as well,” says Lisa Saisselin, director of marketing and business development at GWU Hospital.

Medical management advice is in great demand, notes Michelle McCleerey, manager for safety programs at Hill-Rom Co., an Indiana manufacturer of hospital equipment and devices that is sponsoring a series of conferences across the country titled Care of the Severely Obese Patient. She cites the problems encountered by hospitals where lift teams are used to transfer patients, mentioning a case where 10 people were called on for the lateral transfer of a 600-pound patient.

“A nurse ruptured a disc and had to go into surgery,” she reports.

Training in body mechanics and sensitivity issues, avoiding using the word “fat” or other supercharged words, for instance, is routine for medical staff working in bariatrics.

“It’s not [just] a matter of words, but the way you deal with patients,” says Pam CapoBianco, associate administrator and chief nurse executive for patient care services at Inova Fair Oaks. “It’s making them feel as important as any other patient and not different or guilty. We have nurses that are very excited to work with these patients because they see them as motivated and highly successful.”

Still, learning how to turn someone over in bed or help a patient to a standing position is critical to prevent staff injuries, notes Sue O’Connor, clinical director of oncology in the department of patient care services at George Washington University Hospital. “When in doubt, we always can call on the hospital’s physical therapists,” she says.

Inova Fair Oaks tries to focus on patients weighing 500 pounds or less primarily because equipment isn’t available for anyone larger. “It’s really for the safety of the patient,” Mrs. CapoBianco says.

The hospital recently hired a full-time nurse to serve as bariatric service line director, coordinating the treatment obese patients receive from the time of admission to discharge and beyond. The hospital — as does Dr. Afram’s obesity service center — offers extensive support as part of pre- and postoperative care. Inova Fair Oaks also has added a focus group for patients to express opinions about how they are treated.

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