Medicine Is Failing Obese People

Watching a person die from cardiac arrest in an intensive care unit is devastating. It’s especially so when the person is a woman in her 40s who has been smothered to death by her own weight — and we doctors can do nothing to save her.

This 500-pound patient, who was at a county hospital in Georgia where I was working, had respiratory failure caused by obesity hypoventilation syndrome, a breathing disorder. It was just the tip of the iceberg of her medical problems. Her obesity had contributed to the development of heart failure, which led to kidney failure that necessitated dialysis. Her respiratory failure required mechanical ventilation, which placed her lungs at increased risk for infection. And so she developed pneumonia not too long after being placed on the ventilator.

While we "saved" her after the initial cardiac arrest, her weakened heart and body arrested again. Unable to overcome all of these odds, this patient died in the hospital’s ICU.

I cannot help but wonder what would have happened if we had managed to intervene long before her obesity sent her down this fatal path.

Obese patients often can’t even get standard medical procedures

We’ve long known that a body mass index over 25 can increase health risks like heart disease, stroke, diabetes, hypertension, and more. And as a huge meta-analysis out last week in the Lancet showed, incremental increases in BMI lead to rising mortality rates. The risk for premature death was highest in those with the highest BMIs.

Yet health care providers are generally ill-equipped to deal with obese patients and their complex health needs. Over the years of my medical training, I’ve seen more and more examples of obese patients unable to get the care they need.

Consider the challenges of something as simple as diagnostic testing. In medical school, we had a patient who was transferred to our academic tertiary care facility because she could not fit in the CT scanner at her local community hospital.

Occasionally, there are stories of patients having to be transported to the local zoo to have certain imaging tests done, where fitting in the machine is possible but the images are much poorer quality than what you’d get in a hospital. So after suffering from this incredibly humiliating experience, the patients are left with subpar diagnostic studies.