Obesity Triggers Market Demand
Edition: December 2002 - Vol 10 Number 12
Author: Mark Thill
Forget the prejudices most of society has against those who are overweight or who suffer from obesity. Or the shame of those who suffer from obesity feel because of these prejudices. The fact is, obesity is a serious health risk.
“If you’re obese, your chances of also having several co-morbidities, including heart problems, respiratory problems, joint problems, high blood pressure or diabetes is much, much greater,” says David Spacht, director of bariatric services for Holy Cross Hospital, Fort Lauderdale, FL.
With obesity becoming what some describe an epidemic (an estimated 65 percent of Americans are overweight), it’s no surprise that the nation’s caregivers are seeing more and more obese patients today, both for the weight problem and for the related diseases that accompany it. Yet the problem continues to escalate.
And because of that, so too does the need for products and equipment specially suited to this patient population.
Bariatrics is the comprehensive treatment of obesity and overweight, encompassing medication, behavioral changes, dietary changes and medical procedures, says Beth Little, executive director of the American Society of Bariatric Physicians (ASBP) and the American Board of Bariatric Medicine.
It’s not a new specialty. ASBP is over 50 years old. Today, there are 212 board-certified bariatricians in the country, says Arthur Davidson, M.D., a physician in New York City and current president of the society.
But the specialty has been slow to catch on. For example, there are still no residency programs in bariatric medicine today. “The competition to get a curriculum included in medical schools is very high,” Little points out. The lack of formal programs in hospitals or residency programs has merely compounded the problem. “But it’s something we’re working toward,” she says.
One stumbling block has been reimbursement – or lack thereof. Insurance companies refuse to reimburse providers and patients for most bariatric services, says Little. One bright spot appeared this past April, however, when the Internal Revenue Service made many medical costs associated with overweight and obesity – except special food products – tax-deductible.
Nevertheless, obesity “is a national problem that needs attention,” says Little. “Obesity is now the second – and could become the first – most common preventable cause of death, with more than 300,000 deaths a year attributed to it,” she says, adding that the rates of childhood obesity have doubled over the last decade. As the incidence of overweight and obesity climbs, so too are the efforts to thwart the diseases and all their attendant health risks.
For example, when Holy Cross opened its bariatric services program several years ago, it was the only game in town, says Spacht. Today, there are programs everywhere, he says. And the demand keeps rising.
In 2000, Holy Cross performed approximately 400 gastric bypass procedures. In 2001, 850 were performed. This year, approximately 1,000 procedures will be performed, all by surgeons with a special interest in bariatrics.
The primary procedure they are performing is the Roux-en-Y gastric bypass, which many consider to be the gold standard in weight reduction. In this procedure, the lower part of the esophagus is separated from the stomach. Using the lower esophagus, a small pouch is created and this pouch becomes the new stomach, while the old stomach becomes an unused organ. The small intestine is attached to assist in the digestive process and the result is a new stomach about the size of a thumb. Proponents say it is one of the few treatments that result in dramatic, long-term weight loss.
A Market Develops
Wheelchair companies, bed manufacturers, office and hospital furniture makers, even manufacturers of surgical instruments are waking up to the bariatric market. And distributors are recognizing the selling opportunities.
For example, reps from Claflin Equipment Sales & Service, Warwick, RI, sold more than 30 physician suites this year designed for the examination of obese patients, says President Normand Chevrette. “We keep hearing that our population is getting bigger,” he says. “And over the last three or four years, hospitals have been changing what they buy. Now that’s moving down into the physician’s office. [The physician] wants that table to go down lower, so it’s easier for a heavy person to get onto it.”
In Bridgeville, PA, over the past three years, Kevin Trout, owner of Grandview Medical Resources, has built a specialty business out of supplying hospitals, rehab centers and nursing homes with bariatric equipment on a rental basis. “When you think about equipment [for the obese patient], you think about big beds. But that’s only part of what’s needed,” says Trout. “You need oversize wheelchairs, lift and transfer devices and commodes, so you can move these patients without calling in half a dozen people. You need the appropriate mechanical tools, so that it’s done safely and properly.”
Grandview rents these items to hospitals on an as-needed basis. His primary supplier is Prairie Village, KS-based SIZEWise Rentals, which carries wheelchairs, beds, lift and transfer devices, and other bariatric products. Trout likes the supplier not only because of its broad product line, but because of the education it provides caregivers on the proper care of obese patients. They offer a newsletter, workshops and research programs for hospitals that offer weight-loss surgery, says Trout. “It’s tremendous education for caregivers,” all of whom are focused on mobilizing the obese patient as quickly after surgery as possible, so they can begin the rehab process.
On any given day, Holy Cross Hospital’s bariatric services program treats 18 to 25 patients, says Spacht. All are surgical patients.
The hospital leases bariatric equipment from three companies. Most of the equipment is specially designed to meet the size of bariatric patients, whether it be their height, width or weight, says Spacht. For example, a standard bed can accommodate patients up to 350 pounds. Those patients who exceed 350 pounds, need special patient care equipment that can handle their weight and girth.
Not only must the sheer weight of the patient be accommodated, but the patient’s size as well. For example, when Repertoire spoke with Spacht, Holy Cross was treating a 750-pound woman whose hips measured 97 inches. When a patient like this lies or sits down, the weight expands and increases such a measurement even more.
“Beds for obese patients are extremely important,” continues Spacht. Obviously, they must be strong enough and wide enough to accommodate them. But obese patients face another danger – skin breakdown. “It’s just a fact that if a patient weighs 700 pounds, and lies on a foam mattress with a plastic overlay, there will be a considerable amount of sweat,” says Spacht. “Between heat, sweat and immobility, there is a tendency for the skin to break down.” That’s why facilities such as Holy Cross often use beds with mattresses filled with air. These specially constructed mattresses can inflate or deflate continually, to relieve pressure on the skin and simulate turning the patient.
Helping surgical patients become ambulatory soon after surgery is an important goal for the staff at Holy Cross. “Within the first day [after surgery], we like to see these patients up and moving,” says Spacht. “It helps the healing process.” Walkers are important, as they assist in mobility. And the beds for bariatric patients are often equipped with trapezes, to provide patients the stability they need to assist themselves into an upright position, he says.
Spacht recognizes the progress that medical products manufacturers have made in designing and manufacturing equipment specifically for the bariatric patient. But, like most providers, he bemoans the costs. To avoid large capital outlays, Holy Cross leases most of its bariatric equipment on a per-patient-per-day basis. Spacht is working with some vendors to negotiate a lease for an entire suite, complete with special bed, mattress, commode, walker and wheelchair.
His long-term goal is to adopt a “universal room” concept, so that bariatric patients could spend their entire hospital stay in one unit. Holy Cross attempts to be weight-sensitive in all waiting areas by equipping them with extra-large, sturdy chairs or benches for bariatric patients. Oversized wheelchairs are also available.
The challenge of accommodating bariatric patients anywhere in the hospital extends to clinical equipment, says Spacht. “Hospitals have a responsibility to make sure that the appropriate equipment is available to meet patient needs,” he says. “That’s evidenced by the fact that in addition to the equipment you would expect to find in our bariatric area, we have incorporated weight-appropriate equipment in other parts of the hospital regardless of where it is in the facility.”
One example is the hospital’s current CT scanners, which can handle patients up to 450 pounds. “Now we make sure that when we issue an RFP, we include weight-appropriateness. We’re not specifically targeting bariatric patients, but as they may be here for other reasons, we have to be sensitive to their needs. The bariatric program here has heightened the awareness of the needs of the morbidly obese throughout the hospital. We want to be accessible to and care for all people.”
Bariatricians have an almost evangelistic fervor about eradicating the disease. “It’s not just about the weight itself,” says Arthur Davidson. “It’s that the weight causes health issues. Being overweight is a sign that you have ill health.”
Davidson runs what he calls a nutritionally based practice in New York. “When patients come to me, they’ve made a commitment to themselves to change their lifestyle,” he says. “There are many programs that will take the weight off. But a good program gets the patient involved with exercise, proper nutrition and dealing with the anxieties in their lives that helped put the weight on.”
Caregivers play a crucial role in the process, says Davidson. “There was an old survey done, which asked overweight people how they are treated by the medical profession, that is, nurses, doctors, technicians and others. Most said ‘poorly to very poorly.’
“The overweight person has the same intelligence, sensitivity and perception as anyone else,” he continues. “They pick up on being slighted, just as you or I would. But often, the overweight person feels they deserve it.”
Doctors and hospitals that lack equipment designed for the bariatric patient can exacerbate the problem. For example, in facilities that lack the proper tools to move obese patients, the staff often approach the task with resentment (for being called away from their own duties) and even fear – some of it well-justified. According to the U.S. Department of Labor’s Bureau of Labor Statistics, healthcare-related services reported over 59,000 musculoskeletal injuries in 1992, the majority being strains and sprains to the back and shoulder caused by overexertion in lifting. Meanwhile, the patient can get resentful or embarrassed when six or seven staff members are summoned to his bedside to move him onto a commode or wheelchair.
“The entire industry can improve its sensitivity to the overweight,” says Davidson. “If you’re going to sell an overweight patient a product, the first thing to do is to become sensitive to yourself. Sensitize yourself to the needs of the overweight and your own preconceptions.”