Breaking The Scale

"[Obese/malnourished patients heal slower, and] a diminished ability to heal may explain the substantial need for intensive care unit [ICU] support, re-operation and the high mortality observed in our study."
Research report, University of Alberta, Edmonton

"[The obese tend to be malnourished] and it takes much longer for the person to recuperate when he or she is in a malnourished state."
"Education is key to alert physicians and surgeons of the importance of how to manage people who are overweight and obese, who are quite different in terms of their physiology and metabolism, rather than simply treating them as 'normal' people with excess body fat."
Dr. David Lau, professor of medicine, University of Calgary

Fotolia    Obesity has been linked with an ever-growing litany of chronic diseases. But few studies have explored the impact of severe obesity on emergency surgery.

The global phenomenon of overweight and obese people is extremely concerning. Where once people ate regional and whole foods rather than processed foods pretending to be nutritious when they are not, people who once were physically industrious and ate sensibly are now sedentary and eat mindlessly. Too much of the wrong stuff; processed food products laden with salt, sugar and fat. Because it 'tastes good', and because it is convenient.

According to the article recently published in the Canadian Journal of Surgery, University of Alberta researchers write that world-wide, excess body weight is held to be responsible for an estimated 2.8 million deaths annually. Obesity is defined as having a body mass index of 30 or more. And it has been linked to a  group of chronic diseases which include diabetes, hypertension and heart disease. These can be said, by and large, to be representative of 'lifestyle' incapacities.

It is what we are carelessly doing to ourselves. Unthinkingly ingesting whole-food substitutes with little-to-no real nutritional value, where important minerals and vitamins are processed out of what started out as perfectly good food, to be processed into something approximating food, but not quite making the grade.

It has come to be understood that many obese people are malnourished people. The very diets that have caused them to gain an extraordinary and dangerous amount of weight, while high in calories, are deficient in the essential vitamins and minerals deemed to be critical in the normal process of recovering from illness, or post-surgery.

While lacking in protein and essential nutrients, the body cannot sustain itself under the pressure that surgery entails and as a result obese patients post-surgery become more susceptible to infections. Dr. Lau, who is also president of the Canadian Association of Bariatric Physicians and Surgeons, states that pre-surgery patients who are obese could be tested for protein deficiencies, and given the nutritional complement they require to enable them to recover post-surgery.

The researchers from University of Alberta involved 111 patients in their study who were treated at the University of Alberta Hospital, Edmonton, between 2009 and 2011. They discovered that the malnourished patients heal slower than normal-weight patients. Urgent operations like appendectomies, gallbladder surgery, abdominal surgery or hernia repair carried out on obese patients left half of their number requiring readmission to intensive care.

Of that cohort of study patients they all had a body mass index of 35 or higher and all of them had been admitted for urgent or emergency surgery through the emergency department intake of the hospital. These are patients, some of whom are so heavy that they cannot sit on a toilet attached to the wall without the toilet breaking off the wall. Patients so obese they cannot fit into imaging devices.

One third of their number required multiple surgeries. And 17 percent of these patients died while in hospital. Logically enough, given the above, it was found that the heaviest patients suffered the highest complication numbers. The fact that obese people have a tendency to suffer from underlying health problems such as high blood pressure increasing the risk of blood clots and other post-surgery complications simply exacerbates their situation.

Statistics show that in 2014, 19 percent of Canadians age 18 and older -- representing about 4.9 million people -- reported height and weights in a range classifying them as obese, records Statistics Canada. The study found that ICU care was needed for 40 percent of the patients in the study, while post-surgery complications affected 42 percent, and 31 percent required a second surgery.

And, compared with severely obese patient outcomes, those considered "morbidly" obese, with a body mass index of 40 or higher, suffered the highest rates of re-operation and increased hospital stays compared with their severe obese counterparts.

Caring for these patients taxes the health care system far in excess of  what it takes to care for normal-weight patients. Hospital beds, wheelchairs, surgical beds  that can accommodate normal-weight patients simply cannot take the weight of a 350 pound or 450 pound patient.

Hospitals are required to equip themselves with sturdier, larger equipment. And nurses who are able to singly care for a patient, require a nursing team to turn morbidly obese patients around in hospital beds to avoid bedsores and skin breakage. The toll on both patient outcome and the health care system to adequately prepare for their care is enormous.