As Obesity Rises, Health Care Indignities Multiply

hen Mark Rosenthal suffered a stroke, he was too heavy and wide for a stretcher, so he made the jarring, bouncing dash to the hospital lying on an ambulance floor. The ride injured his back, and he felt as if his own weight would suffocate him. At the hospital, doctors wanted to give him an M.R.I. scan, but he could not fit into the machine.

But in that ordeal last June, Mr. Rosenthal's gravest humiliation came from something as simple as having to go to the bathroom. He was in no shape to walk to the cramped bathroom — he might not have been able to fit, anyway — and the hospital's portable commodes and bedpans could not hold his 450 pounds. So, he recalled, hospital workers told him to go in his bed, on himself, saying they would clean it up afterward.

"I just cried," said Mr. Rosenthal, 51, the treasurer of District Council 37, the New York City employees' union. "I refused to eat anything for six or seven days, hoping I wouldn't have to go again."

Obesity is the fastest-growing major health problem in the United States. In 2000, 31 percent of American adults were obese, up from 23 percent in 1990 and 13 percent in 1960, according to the Centers for Disease Control and Prevention.

And those, like Mr. Rosenthal, who are classified as "morbidly obese" tripled in number in just a decade, to 2.2 percent of the population in 2000.

The perils of morbid obesity are not limited to life-threatening ailments like Type 2 diabetes and high blood pressure; merely getting the health care other people take for granted is beyond their reach.

Severely overweight people cannot fit into standard wheelchairs, waiting-room armchairs, blood pressure cuffs, hospital beds and gowns, or M.R.I. and CAT scan machines.

X-rays often cannot penetrate far enough into their bodies to produce useful images, and wall-mounted toilets snap off under their weight.

For the morbidly obese, trips to doctors or hospitals are more reminders that they literally do not fit, like paying for two seats on a plane, hunting for clothes, or enduring people's curiosity and derision. The indignities mean that obese people, who need medical treatment more than most, often refuse to seek it.

Teena Gamzon stayed away from doctors for so many years that by the time she finally sought treatment, her diabetes had raged out of control, sleep apnea had so ruined her nights that she spent her days in a haze, and a buildup of lymphatic fluid in her lower legs — a common side effect of severe obesity — had caused nerve damage and permanently hobbled her.

"I can barely stand up, but the chairs in the doctor's waiting room all have arms, so I can't sit down," said Mrs. Gamzon, 55, who lives in Bergen Beach, Brooklyn, and who declined to give her weight. "I didn't fit on the gynecologist's table, and the gown wouldn't cover me. Going to the doctor was just too hard, and it was humiliating."

Obesity is defined by the Centers for Disease Control and other health experts as a body mass index of 30 or more. Morbid obesity is a B.M.I. of 40 or more, and the term "super-obese" is sometimes used for 50 or more. (B.M.I. is one's weight in pounds multiplied by 703, then divided by the square of height in inches; or, in metric measures, weight in kilograms, divided by the square of height in meters.) A 5-foot-9-inch person would have a B.M.I. of 30 at 203 pounds, 40 at 271 pounds and 50 at 339 pounds.

This year, more than 100,000 morbidly obese Americans will undergo some form of bariatric surgery, or gastric bypass — four times as many as in 1998. But even as more hospitals treat weight problems, they have been slow to make physical changes to accommodate severely obese patients, according to patients and doctors.

For hospitals and doctors' offices, that transition is largely a question of money. "Some of the equipment needed is very specialized, very expensive," said Dr. Jeanine Albu, who heads the highly regarded obesity treatment program at St. Luke's Hospital in Manhattan.

Like many hospitals, St. Luke's leases, when needed, beds that can hold the largest patients. But the need became so common that the hospital recently bought one such bed that includes a scale and can tip the patient up to a standing position. The price, according to Bruce Lander, a hospital spokesman: $18,500, five times as much as a standard, motorized hospital bed. The hospital has spent as much as $2,446 for an oversize wheelchair, he said, eight times as much as an ordinary wheelchair, and $30,414 for an operating table for morbidly obese patients, almost double the usual cost.

Many weight-loss experts and patients say St. Luke's has done more than any other hospital in the city to meet the physical needs of the biggest patients. Yet even there, the equipment sometimes falls short.

"I wouldn't go anywhere but St. Luke's," Mrs. Gamzon said. "But sometimes they can't find a wide wheelchair for me when I go there, so I bring my own chair."

Handling extremely overweight patients — moving them, bathing them — can require several people, when one might do with a person of ordinary size.

One of the few nursing homes equipped to handle severely obese patients is Brookhaven Rehabilitation and Health Care Center, in Far Rockaway, Queens, which has a 60-bed obesity unit. Robert T. Kolman, the administrator, said Brookhaven spent as much as $8,000 for a custom-made wheelchair, $500 for an extra-wide, extra-sturdy commode, and hundreds of thousands of dollars on renovations like widening doorways to 54 inches from 36.

"I needed a residential weight-loss program," said Michael Hebranko, 50, who entered Brookhaven at 669 pounds several months ago and has lost more than 100. "We thought we'd found a place in the Bronx, but they said they couldn't take anyone over 500 pounds, because they just didn't have the equipment."

Many morbidly obese people, and some of their doctors, say that many doctors and nurses view them with the same disdain, even revulsion, as the general public.

"Size discrimination is the last bastion of bigotry in this country, and the medical profession isn't any more sensitive than anyone else," said Dr. Butch Rosser. "The people whose job it is to care for people, a lot of them have the attitude, `You deserve it.' Right now, people with substance abuse issues get more respect and better health care treatment. Morbidly obese people get substandard medicine."

Dr. Rosser, who performs bariatric surgery at Beth Israel Medical Center in Manhattan, underwent one form of it himself and lost more than 170 pounds. Dr. Rosser, an African-American, said being closer to a healthy weight was like a black person "passing" for white, in that, for the first time, he would hear other doctors' unguarded comments about morbidly obese people.

In a previous job at another hospital, he said, he had to operate on a patient who was lying in a hospital bed, because the patient did not fit on a standard operating table. "And it's little things, too," he said. "Like you try to put on a hospital gown and it's like putting a postage stamp on a rhino's butt."

Even something as basic as gauging a patient's weight is beyond the abilities of most doctors' offices and hospitals because their scales do not go past 300 pounds. For years, Dr. Rosser had no idea how much he weighed. A few years ago, he said, he needed to use a freight scale at a loading dock to learn his peak weight, 462 pounds.

Having been healthy his entire life, Dr. Rosser, 49, said he did not understand the medical hurdles faced by severely overweight people until a few years ago, when he was in a serious car accident and was rushed to an emergency room. Doctors there feared he might have a spinal fracture, but the X-rays were murky.

"They wanted to give me a CAT scan, but I exceeded the weight limit of the table, so they basically said, `Well, we'll just wait and hope for the best,' " Dr. Rosser said.

Traditional CAT scan and M.R.I. machines require sliding the patient into a narrow tube — out of the question for someone who is seriously obese. Newer "open" scanners can accommodate somewhat bigger patients, but even they have size limits.

Henry Ashley, who weighs 441 pounds, said that during one hospital stay, he fell while trying to use a commode that was too small, broke his tailbone and herniated a spinal disk. He said he spent 14 hours on the floor while hospital workers tried to figure out how to lift him back into his bed. The hospital had a motorized device called a Hoyer lift that uses a sling to raise patients — prices start around $4,000 — but, he said, no one there knew how to use it.

Mr. Ashley, who lives in the Catskills, said his worst moment came during another hospital stay, when he shared a room with another patient, a man who was not overweight. One day, as Mr. Ashley slept, his roommate went into cardiac arrest, setting off an alarm at a nurses' station.

"A bunch of people ran into the room and shocked me with the electric paddles," he said, lifting his shirt to show the faint scars they had left on his chest. "Stopped my heart. They had to shock me again two more times to get it started."

This is partly because they keep defining obesity downward. A squatty person that is not overweight (just bulky - think Samoans and some Mexicans) is now considered obese with their one-size-fits-all guidelines that don't even take gender into account.

The health care folks know they have a gold mine on their hands with the obesity "crisis" made worse by narrowing the CDC standards of what is considered a "healthy" weight.

Part of the problem is hard to deny (just stroll through a mall sometime) but don't buy their numbers at face value. They're as drummed up as Clinton's economy numbers.

Handling extremely overweight patients — moving them, bathing them — can require several people, when one might do with a person of ordinary size.

This is an understatement. Too bad the story doesn't discuss injuries incurred by health care workers while assisting these people with basic body functions. Finding rotted flesh and other assorted treasures under the massive skin folds is a painful task.

..."The people whose job it is to care for people, a lot of them have the attitude, `You deserve it.' Right now, people with substance abuse issues get more respect and better health care treatment..."

As a nurse, I can explain that one: we don't have to herniate our own discs lifting the huge, massively heavy buttocks of substance abusers. We may not feel that they are morally superior to the super-obese, but by gosh at least they're lighter! Try lifting some 500+ pound patient off the floor sometime, or cleaning them up, or transferring them to a bed from a stretcher... tell me you wouldn't complain!

Historically, obesity was a visible symbol of affluence - only the very rich could eat lots of "rich" (read fatty, sugary foods). They had a high caloric intake and were not subjected to the heavy manual labor of the average person.

It is a sign of the times that even the poorest American has enough to eat and so much leasure time that they eat more calories than they burn in productive work.

What isn't said in this article is that most of these huge bags of flesh DON'T work and are maintaining their bulk off of welfare and disability payments provided by the hardworking taxpayer. I'm sorry, but even if a person IS really disabled, I don't want my tax dollars to provide a 5000 - 7000 calorie-a-day diet.

When Mark Rosenthal suffered a stroke, he was too heavy and wide for a stretcher, so he made the jarring, bouncing dash to the hospital lying on an ambulance floor. The ride injured his back, and he felt as if his own weight would suffocate him.

Look. I'm a man of size. But the first sign you are too f***ing fat is when you lie down and you feel like your own weight will suffocate you.

ATKINS, Mr. Rosenthal.

ATKINS.

I've used a Hoyer lift on my mom, who is disabled. She's a little slip of a woman, though. I seriously doubt a Hoyer lift would be capable of handling a 441 pound man.

The whole sad story is one big joke.
We are supposed to feel sorry for these pigs?
It the hospital's fault that they don't have construction cranes in place to hoist and shuffle these hogs around?
That is the implication....wait for the lawsuits then hold on to your wallet as the hospitals have to pay for devices the handle these pigs.
This is just part of a well orchestrated scheme like the no smoking campaigns. This one started in 1996 or so with the revision of the ideal weight chart[downward] intantly creating a 20% rise in obesity.
Just watch how much concern is coming your weigh over your health, individually and as a taxpayer sucking more $$'s from your wallets.

There are things readily available that could be used to help these folks if the effort were made. Hoists for auto engines and tarps sewn for slings. You could place a chain fall in one of the hospital rooms for about $1,000. The problem is hospitals think they have to go to hospital supply houses for their needs, and say medical and the price goes up. Everything medicval has to be chromed or stainless steel, when a painted lift from the garage will do the same job.How much can it cost to build a wooden bench strong enough to hold the fattest person in the world? Hey it may not be a lounge chair but its better then standing.

anyone who travels abroad...perhaps very very few here... cannot but notice how obesity is a uniquely American ...Something about the "psyche" in the general populace?

I've recently returned from 2 1/2 months in Asia.

You're absolutely correct, there are few even moderate fatties and none of the huge people we commonly see here in the States. I think I saw only one local I would consider fat by American standards.

Being overweight myself (but not in the freight-scale category), I was embarrassed to hear the truly amazed comments by the locals about my weight and that of other Westerners (I speak one of the local languages). It shamed me into losing about 30 pounds, which I wanted to do anyway.

My theory is this, shoot it down if you like: America has become a very "closed door" society. We get in the car, go to work, get in the car, come home, close the door, and watch TV or videos or use the computer. Look in your own neighborhood - there are few opportunities to walk to a local cafe, which is certainly the rule in Europe and Asia. Eating your meals at one of dozens of cafes or street stands is an everyday occurance in most Asian countries. Since eating is somewhat of a social activity as well, sitting alone in your house and binging on snacks and huge meals would be considered positively weird there.

Isolation, loneliness, suburbia, the most demanding worklife of the industrialized nations, eating as private pleasure, etc. All of this combines to create a nation of fatties.

We are supposed to feel sorry for these pigs?

Actually, I don't feel nearly as sorry for "these pigs" as I do for those, such as yourself, who apparently only take glee in their misfortune. I suspect it is the very evil that drives us to kick a dog when it's down that causes many of the obese to look away from the world and towards the refrigerator.

The obese have no more problems than anyone else I've ever known, theirs are simply more visible.

I think that the UK must have many of the same problems we are experiencing

I think you're correct that the U.K. and Scotland have a good number of overweight folks, particularly among women.

When I was overseas in Asia, the chunky young women travelers invariably were American or Brit.

And most often Brit since Americans have traditionally been less apt to travel abroad (no time to do it), and particularly now with the media- and government-induced hysteria that the world is a hostile place for Americans (it isn't).

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