[Obesity Discussion]

Obesity's heavier burdens
Special ambulances for biggest patients, longer needles are signs of fatter society
By Laura Ungar
The Courier-Journal



Our backsides have become too ample for old-fashioned shots in the rump, and fewer of us fit onto medical imaging tables.

And as an obesity conference brings more than 300 health professionals to Louisville this week, there's even more local evidence of our burgeoning fat crisis: The metro region now qualifies for its first "bariatric ambulance" to serve people heavier than 500 pounds.

Dr. Machiel Kennedy, a Florida physician who specializes in the care of obese people, finds one silver lining in Americans' increasing girth: "It's job security for physicians."

"But," he adds, "it's not job security we want."

Kennedy is participating in a conference sponsored by the American Society of Bariatric Physicians, those who specialize in obesity and its causes. He and other doctors cite the usual reasons for the epidemic: overworked adults super-sizing their meals and living sedentary lives, while children are entrenched in front of TV and computer screens. Doctors also point to psychological factors, like using food to deal with pain.

Kathy Yankey, a 47-year-old Shelby County resident, said counseling taught her that stress is one of the main reasons behind her obesity. She used to run her own mortgage company while also caring for aging parents. She would drink four to five sodas a day and indulge in fast food and late-night snacks. She swam, but the weight wouldn't budge.

Dr. George C. Stege III has heard similar stories through his practice, the Louisville Center for Weight Loss, and he said regional issues compound the national trends. Traditional Southern "country cooking" features fatty foods, for example, and Kentucky has the lowest rates of exercise in the nation. When Stege takes histories of obese patients, he said, few report ever exercising.

Brian Davis of Louisville, a 33-year-old computer programmer who used to weigh 319 pounds, fit this description. He belonged to a gym but went only a handful of times a month. He ate doughnuts and soda in the morning, fast food for lunch and counteracted a healthy dinner with a treat such as a Dairy Queen Blizzard or a candy bar.

It took mild chest pains, he said, for him to get to a doctor's office and to realize, "I'm going down a path that's not good."

Symptoms of a fat society
Expanding waistlines put people at risk for diabetes, heart disease and a host of other health problems.

Obesity also hits residents in the pocketbook. The federal government estimates that $75 billion a year nationally goes toward treating obesity-related health problems. In Kentucky, such costs are estimated at $1.1 billion, with $340 million paid for by Medicaid.

Meanwhile, the number of morbidly obese Americans -- those more than 100 pounds overweight -- has been steadily growing. It's now 9 million, twice the number of Americans with Alzheimer's disease, which is often said to touch every family.

Craig A. Keebler, a Seattle doctor at this week's meeting, said it's getting more difficult to diagnose heavy patients: Some don't fit into MRI or CAT scan machines, or even regular hospital beds. It's difficult to get accurate electrocardiograms of their hearts.

And it's getting tougher to get them vaccinated.

Buttocks have traditionally been considered a good place to give shots because they contain relatively few major blood vessels, nerves and bones that needles can damage. But research presented late last year at a meeting of the Radiological Society of North America in Chicago showed that 68 percent of vaccinations aren't reaching the muscles of the buttocks because the fat exceeded the length of the needles. Among women, the proportion was 92 percent.

Even before the study, led by Victoria O. Chan of Ireland, some doctors had already started using longer needles. But others simply are giving ineffective shots.

Lowdown on loads
In Louisville, meanwhile, Yellow Ambulance's bariatric unit has made 15 runs since late February. A four-person team of emergency medical technicians staffs the specialty ambulance, which is outfitted with a wide stretcher that can hold up to 1,600 pounds.

Previously, it would sometimes take more than an hour to get morbidly obese people out of their homes, Yellow Ambulance supervisor Michael Wallace said; now it can be done faster and more safely.

Personal trainer Tanika Owens has noticed yet another sign of the times in Louisville -- obese people using personal mobility vehicles instead of walking.

None of this surprises doctors at this week's meeting. They've got stories of their own.

Keebler talked about a 470-pound patient whose major goal was to fit in an airplane seat. Kennedy recalled a 5-foot-2-inch pastor's wife who, through binge eating, was up to 275 pounds.

(That story actually had a happy and rather humorous ending that shows all is not hopeless when it comes to obesity, Kennedy said. As his patient started dropping the pounds, she participated in a walk-athon, and because she was thinner, her skirt fell off.)

There are many ways to slim down, doctors said, including healthier diets, exercise, counseling, medications and in severe cases, bariatric surgery. The Mayor's Healthy Hometown Movement in Louisville aims to attack the problem by encouraging healthier habits.

Davis got help through the Healthy Solutions Weight Management Program at Baptist East/Milestone Wellness Center. He began exercising more and replaced his meals with food provided through the program -- including shakes, entrees and plenty of fruits and vegetables. Less than two years later, he's more than 100 pounds lighter.

Yankey said she lost 55 pounds in a year when she started seeing Louisville psychiatrist Dr. Michele Hines and making big changes in her life, such as closing her business and changing her diet.

Owens said such individual stories show that the nation's obesity problem can be beat -- even in the seventh-fattest state in the nation.

"Is it too late? I don't think so," she said. "I just know we've got a long way to go."