Isle health personnel
boost care for obese

Improvements are meant to
care for the increasing
population of overweight patients

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By Rosemarie Bernardo
rbernardo@starbulletin.com

Officials with Honolulu's ambulance service plan to order gurneys that can handle patients up to 500 pounds.

A surgeon noted a long waiting list for gastric bypasses.

Both are meant to meet challenges facing health care workers who deal with an increasingly obese population.

Nationwide, obesity among adults has doubled in the last 20 years. In Hawaii the rate jumped 2.1 percent from 1998 to 2000, according to a Hawaii Health Survey.

"Obesity is the most common nutritional disease in the state," said Dr. John Balfour of Straub Clinic and Hospital, who performs two gastric bypasses a week.

"It's an operation that is done more and more," Balfour said.

Honolulu Emergency Medical Services chief Robin McCulloch said, "All the normal challenges that paramedics face are amplified when you have an extremely large person."

He added that Fire Department personnel often assist paramedics.

About 47.4 percent of isle residents between ages 18 and 75-plus were reported overweight or obese in 2000, whereas 45.3 percent were reported overweight and obese in 1998.

The report also revealed the rate of overweight and obese among men jumped to 60.4 percent from 55.7 percent. However, the rate among women remained the same at about 35 percent.

At times an obese patient may have to lie on the floor of the ambulance because the gurney is not large enough to hold the person, said McCulloch.

"In a case like that, you have to sacrifice comfort in taking care of the emergency."

City ambulances are equipped with a patient's assisted litter -- a nylon-reinforced polyurethane-covered fabric that can hold up to 1,100 pounds. Paramedics are also equipped with standard gurneys that can hold a patient up to 350 pounds.

Within the last decade, there has been a demand for equipment to serve obese patients. Manufacturers have been creating tools with a higher weight tolerance, McCulloch said.

"It's not an insurmountable challenge," he added.

Though McCulloch said there may have been isolated cases where paramedics suffered from back strain, he noted "that's kind of the nature of the business anyhow."

Within the last year, a medical staffer at Kaiser Permanente suffered an injury while moving an obese patient, said spokeswoman Jan Kagehiro.

Wheelchairs and weight scales that can handle up to 600 pounds have been purchased to accommodate obese patients, Kagehiro said. Also, specialized beds are rented when the need arises, she added.

At St. Francis Medical Center-Liliha, a magnetic resonance imaging machine is available to scan a person weighing up to 550 pounds, said spokeswoman Moon-Yun Choi.

Specialized beds, operating tables and surgical equipment specifically designed for obese patients are available at Straub Clinic & Hospital, said Balfour.

Those who undergo gastric bypass surgery are about 100 pounds over their ideal weight, said Balfour. Under the procedure, the patient's stomach "is compartmentalized into a very small upper functional unit that handles up to an ounce of food and liquid initially," Balfour said.

"With a very small pouch, the patient gets an early sign of feeling full in a hurry," he added.

Obese men and women suffer from a myriad of weight-related conditions such as severe breathing problems, sleep apnea, pain in weight-bearing joints, diabetes and hypertension, Balfour said.