Robert Cima is holding up a thick metal paddle, a device bigger than a spatula. It's gray and shiny, and he's showing how he maneuvers it into place. "To get the leverage, you need a wider area," he says, tapping the bulbous end. "We need to keep more tissue away from the wound. The little one doesn't work."
Cima, a surgeon at the Mayo Clinic, is explaining how he needs bigger equipment these days to cope with an increasingly obese patient population. The old, smaller retractor clamp in his other hand isn't sturdy enough for patients who are 800, 900 or 1,000 pounds.
"It's not like their organs get bigger," he says. "It's the distance from their organs to where we are that is getting bigger. Instruments are becoming longer because you want to keep the focal distance to the patient the same."
The general public struggles to comprehend the scope of the obesity epidemic, but at hospitals like Mayo it's made real everyday. They see it in new OR equipment, in the larger beds, wheelchairs, and MRI machines, and in the new ceiling lifts. Whole hospitals are having to be redesigned and remodeled to meet the needs of larger people (in some cases, much larger people).
"You can't just redesign a wing. You have to redesign a whole hospital, because you never know when someone might come in," Cima says.
The costs of all this are enormous. Aside from new equipment and facilities, there are also longer recovery times, less-than-optimal surgical results, and injuries to staff from having to move heavier people. Working in a hospital now gives you a greater chance of injury than working in construction, according to the Bureau of Labor Statistics.
Cima doesn't see much hope in national obesity trends, which keep getting worse. Last year, 38% of Americans were classified as obese, with a BMI of more than 30, and about 10% of those had a BMI above 35. Many of these people will eventually need care, with the added burden this implies. Obese patients cost 42% more to the health system than normal weight patients.
"Obesity has a much more significant cost to health care than smoking," says Cima. "Smoking may kill at a high rate for specific diseases like lung cancer, but obesity impacts all levels of human health and every type of care."
Ultimately, our current model of paying for health care passes the costs of obesity on to everyone with health insurance. For example, Medicare pays a set fee for a particular kind surgery. But if the costs end up being higher—because, for instance, it requires specialized equipment—hospitals have to cover those extra costs, ultimately passing on their costs to privately insured patients.
Cima doesn't support charging obese patients more to reflect their higher costs. But he expects hospitals increasingly will want to see patients lose weight before admitting them for nonemergency procedures, and that more will pass patients on to facilities better equipped for dealing with the obese.
He says more should be done to reduce obesity among low-income groups. "Obesity is a social problem, not a health problem," he says. "We need to intervene in the food deserts in the inner cities, and educate and provide resources to populations at highest risk. That's where this is becoming a very sad cycle. Obesity is pervasive at the lowest socio-economic level, no matter what race we're talking about."