The big problem with equipment

Obese patients may miss out on medical treatment because of the lack of suitable equipment

OBESE PATIENTS in Ireland could be missing out on having a disease diagnosed, their elective procedures may be delayed and they may face difficulties living at home, thanks to a lack of healthcare equipment to accommodate them, according to experts.

Last month a group of Irish doctors, including Orla Buckley and William Torreggiani, addressed the European Congress of Radiology in Vienna about the growing numbers of morbidly obese patients whose dimensions exceed the limits of available scanning machinery.

"We find we are being referred people for an ultrasound, and they are unsuitable because their abdomens are so big and the intra-abdominal fat creates a lot of artefact," says Buckley, a specialist registrar in radiology at Tallaght Hospital.

"Somebody may be sent down for an ultrasound to query a lesion in their pancreas or something in their liver, and essentially the scan is non-diagnostic. That's awful, you could be missing things."

If the ultrasound can't give a reliable diagnosis, the patient may need to have a CT scan to investigate tumours or an MRI scan to examine blood vessels or organs. But these approaches are expensive and involve more exposure to radiation, notes Buckley.

And even at that, larger patients may still have a problem. Scanner tables have upper weight limits and girth is also an important factor, says Buckley: "It's not only that they may be too heavy for it but in fact their body is just actually too big to get through the space. They can't fit into the machine."

One solution is to buy more accommodating equipment, but this isn't always possible, so experts are now developing workarounds and protocols for using existing machinery to safely image obese patients. "To get the image with a CT scan the balance is that you need to increase the dose of X-rays going through them so you have enough to get an image at the other side, but you have to be careful then not to be totally irradiating someone," explains Buckley, who is teaming up with registrar Dr Victoria Chan at St Vincent's University Hospital to look at radiation exposure levels for obese patients.

With the obese population in Europe set to reach 150 million adults and 15 million children by 2010, health professionals will increasingly have to deal with equipment issues, and Buckley wants to see hospital staff become more aware of how to deal practically and sensitively with obese patients.

Better preparation is a good start, he says. "Everybody across the board needs to be aware and have protocols in place that can help, even if you have not got the brilliant technology, to optimise what you have.

"One option is to put a measuring tape or a hula-hoop of the known dimension around them in the outpatient department or on the wards before they come down to the scanner, not when they are on the table and they are being pushed in and told: Sorry, you can't fit. There needs to be a more positive, respectful attitude."

It's not good enough that obese patients could miss out on medical treatment because of a lack of suitable equipment, agrees Dr Naomi Campbell, a registrar with the weight management clinic at Loughlinstown Hospital in Dublin.

Her survey has shown that one in 10 patients at the Loughlinstown clinic is nearing the upper weight limit for radiology scanners, and one in 20 would be unsuitable for cross-sectional imaging or fluoroscopy.

She is currently looking at weight and girth limits for radiology scanners in hospitals throughout Ireland, but notes that the problem extends to other hospital equipment too, including wheelchairs, beds and operating tables. A lack of suitable facilities can delay elective procedures for obese people, she notes.

"There is a cohort of patients who are morbidly obese now who get the same if not more medical problems as everyone else, and they need to be dealt with in the hospitals," she says.

"It may seem slightly defeatist to be trying to make their environment suit their size, and obviously the ideal is that we want people to lose weight and become more healthy, but there is a problem at the moment."

And it's not just in hospitals. Obesity is also of growing concern in community care, where equipment for assisted living like stairlifts or bath chairs cannot accommodate people over a certain size.

"In housing it is becoming a recurring issue in terms of moving and handling for carers and family in the home, for general equipment for daily living and the adaptations for obese people who acquire disabilities or have illnesses," says Lisa Held, who chairs the Association of Occupational Therapists in Ireland's housing advisory group. "Once you get over the 24 or 25 stone mark you move into a new category, and there's a cost associated with that as well with the price of the equipment."

Stairlifts can generally hold an upper limit of about 20 stone, which precludes many obese people and can mean a more expensive, through-floor lift, or even the person being restricted to one floor, notes Held. Other modifications can include reinforced toilets, sinks and grab bars, wider doorways and a suitable bed and hoist, she adds.

"It's about accommodating for the situation you are in and then trying to deal with it," she explains. "It's a dual approach and we would be there to help people to function in their environment no matter what the issue is for them, and then in partnership with the obesity clinic they are trying to tackle the problem of losing weight."

And at the core there is the issue of dignity, she says. "If people are not being able to be cared for sensitively and appropriately then it's going to have an effect. You want to feel comfortable in your home."