Table 1, Aggregate Medical Spending, in Billions of Dollars, Attributable to Overweight and Obesity, by Insurance Status and Data Source, 1996–1998
Overweight and Obesity Obesity
MEPS (1998) NHA (1998) MEPS (1998) NHA (1998)
Out-of-pocket $7.1 $12.8 $3.8 $6.9
Private $19.8 $28.1 $9.5 $16.1
Medicaid $3.7 $14.1 $2.7 $10.7
Medicare $20.9 $23.5 $10.8 $13.8
Total $51.5 $78.5 $26.8 $47.5
Michigan about 2.9 billion
Note : Calculations based on data from the 1998 Medical Expenditure Panel Survey merged with the 1996 and 1997 National Health Interview Surveys, and health care expenditures data from National Health Accounts (NHA). MEPS estimates do not include spending for institutionalized populations, including nursing home residents. Source : Finkelstein, Fiebelkorn, and Wang, 2003
No independent association of increased BMI with mortality for surgical trauma ICU patient with infection.
Impact of Obesity in the Critically Ill Trauma Patient: A Prospective Study Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM J Am Coll Surg . 2006;203:533-538
The authors collected prospective data on trauma patients (N = 1167) admitted to a shock trauma center, of whom 62 (5.3%) were obese -- defined as a body mass index (BMI) ≥ 30.
Most of the patients (71%) in the study had sustained blunt trauma.
Although the severity of injury was about the same in both groups, the obese patients had a significantly higher risk for complications. Furthermore, the risk for infection was increased ( P = .001) and the length of stay was 10 days longer ( P = .001); ventilator use was 8 days longer ( P = .001); and the overall risk for in-hospital mortality was 7-fold higher in the obese group ( P = .002).
The researchers looked at records on every person who came into the surgical intensive care unit at one L.A. trauma center in 2002. For each person, they calculated body mass index (BMI), which is a way to measure body weight while taking height into account. A BMI over 30 is considered obese. Most of the people were injured in car accidents or were pedestrians hit by cars.
Obese people were twice as likely to die, even though obese patients and nonobese patients had similar patterns of injuries. Nearly a third of obese patients died, compared to 16 percent of nonobese patients. The researchers don't know why this is—maybe the obese people who died had other problems like high blood pressure. Or maybe the body's normal inflammatory response to injuries has a worse effect on obese people. The researchers also mention that obese people are just harder to work on—radiology isn't as accurate, surgery is harder, and keeping airways clear is tougher, too.
In a prospective cohort study of all ICU patients in King County, Washington, with ALI in 1 year (1999 to 2000), 825 patients had a BMI recorded. Using multivariate analysis, patients in the abnormal BMI groups were compared to normal patients in the following areas: mortality, hospital length of stay (LOS), ICU LOS, duration of mechanical ventilation, and discharge disposition.
There was no mortality difference in any of the abnormal BMI groups compared to normal-weight patients.
Severely obese patients had longer hospital LOS than normal-weight patients (mean increase, 10.5 days; 95% confidence interval [CI], 4.8 to 16.2 days; p < 0.001);
ICU LOS and duration of mechanical ventilation were also longer in the severely obese group when analysis was restricted to survivors (mean increase, 5.6 days; 95% CI, 1.3 to 9.8 days; p = 0.01; and mean increase, 4.1 days; 95% CI, 0.4 to 7.7 days, respectively; p = 0.03). Severely obese patients were more likely to be discharged to a rehabilitation or skilled nursing facility than to home.
Effect of obesity on intensive care morbidity and mortality: A meta-analysis *. Critical Care Medicine. 36(1):151-158, January 2008. Akinnusi, Morohunfolu E. MD; Pineda, Lilibeth A. MD; El Solh, Ali A. MD, MPH
Design: Meta-analysis of studies comparing outcomes in obese (body mass index of >=30 kg/m2) and nonobese (body mass index of <30 kg/m2) critically ill patients in intensive care settings.
Data Source: MEDLINE, BIOSIS Previews, PubMed, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants.
Setting: Not applicable.
Patients: A total of 62,045 critically ill subjects
Fourteen studies met inclusion criteria, with 15,347 obese patients representing 25% of the pooled study population. Data analysis revealed that obesity was not associated with an increased risk of intensive care unit mortality (relative risk, 1.00; 95% confidence interval, 0.86-1.16; p = .97).
However, duration of mechanical ventilation and intensive care unit length of stay were significantly longer in the obese group by 1.48 days (95% confidence interval, 0.07-2.89; p = .04) and 1.08 days (95% confidence interval, 0.27-1.88; p = .009), respectively, compared with the nonobese group.
In a subgroup analysis, an improved survival was observed in obese patients with body mass index ranging between 30 and 39.9 kg/m2 compared with nonobese patients (relative risk, 0.86; 95% confidence interval, 0.81-0.91; p < .001).
May best be managed by noninvasive continuous blood pressure measurement technology that measures pressure from wrist sensor: Medwave Vasotrac and Tensys T-Line (T-Line only for patients under effect of anesthesia).
Special Treatment Needs: Calculating Dosages & Administering Medication
Options: Ideal, actual, adjusted body weight
Dose to effect: Begin with ideal and dose to effect
Obese patients have double the use and lines are in longer than non-obese pts because of difficulty in placing peripheral lines
One study suggests no difference in mechanical insertion complication rate
El-Solh A et al (2001)
Switch to PICC lines as soon
Special Treatment Needs: Determining Cardiac Dynamics
Using actual body weight is inaccurate
Lower total blood volume than non-obese (volume/weight)
O 2 and cardiac output are directly proportional to amount of weight over “ideal”
Cardiac output from exercise due to in heart rate, NOT from stroke volume or ejection fraction
in O 2 due to disease state not yet determined
Using ideal body weight is inaccurate
O 2 and cardiac output are higher than in non-obese
Using adjusted body weight is an effective compromise
[Ideal-(actual-ideal) X 0.4]
Special Treatment Needs: Diagnostic Tools For Spinal Cord Patients
Typical diagnostic aids may not be available to patients of size
No CT scans
No enclosed MRI
No venous dopplers
Chest x-rays difficult to interpret
Obesity interfered with 7 of every 1,000 abdominal ultrasounds in 1989. That rate more than doubled (19) by 2003.
Obesity interfered with 8 out of every 10,000 chest X-rays in 1989. By 2003, the rate had more than doubled to 19
“ Because radiologists can't get the images needed to diagnose potentially serious problems, these patients incur the cost of extra diagnostic tests -- and they may have to settle for substandard care- Spinal cord injured patients of size of particular challenge”
Uppot, R.N. Radiology , August 2006; vol 240: pp 435-439
Nurse’s Aides and Orderlies are the highest risk occupation category for work-related musculoskeletal injuries 1
Nurse injuries related to patient handling are increasing 2
750,000 lost workdays annually
$20 Billion annually
Back pain is second only to the common cold as the most frequent cause for nurse’s sick leave 3
1. United States Department of Labor, Bureau of Statistics 2. Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement, Pt. Safety Center of Inquiry, VHA and DOD, 2001 3. Frymoyer JW, Cats-Baril WL. An overview of the incidence and costs of low back pain. Orthop Clin North Am 1991;22:263–71.
Using Technology Can Help Address Patient & Care Giver Safety
Repositioning: Turning Surfaces
Transfer: Lateral Transfer Devices
Transport: Variable width beds; stretcher chairs
Mobility: Foot or side exit beds; mobility aids and accessories
Both normal-weight and overweight children describe obese silhouettes as "stupid," "dirty," "lazy," "sloppy," "mean," "ugly," and "sad," among other pejorative labels
Crocker, J., Cornwell, B., & Major, B. (1993). The stigma of overweight: Affective consequences of attributional ambiguity. JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY. 64(1), 60-70.
"Of all the conditions for which a person may be stigmatized in our culture, including racial or ethnic group membership, religious affiliation, physical handicaps, and sexual preference, the stigma of being overweight may be the most debilitating."
If the world needed any more proof that Americans are some fattie mcfatties, we present the French-Fry Holder. This $10 device fits in cup holders and holds a standard cardboard container of french fries. It even has a small holder for ketchup, for those fattersons that need to add a little more flavor (and sodium) to their deep-fried potato sticks. A no-slip grip secures the device in any cup-holder to prevent any wasted fries. Weren't French fries designed to be the perfect food while driving? Sure, we're all about driving safety, which this device addresses, but we wonder if the morbid-nature of this product outweighs its positives.
Insensitivity Toward Patients Of Size Is Common
“ He has poor protoplasm and is so large he can’t even care for himself: Its hopeless”
“ They have done it to themselves”
“ Don’t like to care for them because of the body odor”
“ He is sick because all he does is sit around”
Obesity is often described as the last 'acceptable' form of discrimination based on physical appearances. American Obesity Association
Crandall, C., & Biernat, M. (1990). The ideology of anti-fat attitudes. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY. 20(3), 227- 243.
"What turns these attitudes into prejudices is that they exist in the face of mounting evidence that one's weight is largely determined outside of volitional control"