Morbid Obesity As the New Normal
Many people in cities and suburbs don’t realize the extent of the morbid obesity problem because they hardly ever see the severely overweight. According to the CDC, 24 million Americans are morbidly obese, many of whom reside in more rural areas. In Appalachian Ohio, it’s definitely reached epidemic proportions to the point that inhabitants of the southeastern part of the state aren’t at all surprised to see people daily who tip the scales at 300–600 pounds.
A mere five years ago, an ultrasound scan on a 300 pound patient rendered the day unusual and challenging. If the person is 5'5" and 300 lb, it’s likely that there’s some overhanging abdominal flesh that the tech has to somehow prop up while imaging the legs. I’ve asked people in the past to hold up their abdomen while I scan the area, but many patients can’t reach that far to help get belly fat out of the way. There is also much more abdominal flesh to push through with the ultrasound transducer to see the aorta and kidneys, and often the images are suboptimal due to the massiveness of the patient. Pushing hard puts strain on techs’ shoulders and wrists and adds to the tally of ergonomic injuries in the profession. Nowadays, we scan 300 pound patients multiple times a day. Not until the patient is 400–500 pounds do we consider their weight noteworthy.
Recently, I scanned a man who is about 5'8" and weighs 418. I was stunned in the middle of the exam to hear him complain that he knew a lot of 400 to 500 pound people who had no trouble walking, and he didn’t understand why he had so much pain and weakness while doing the same. “Something must be wrong with my legs,” he concluded. “I sure hope the doctor can fix them.” More shocking than his inability to link his pain with his weight was that he considered 400 to 500 pounds to be a typical weight in his social circle. And more incredible still was that he didn’t consider dieting to be an option but was seeking a medical “fix” for his legs.
We listen to people in a state of denial all the time. At 380 pounds, a patient may complain that she’s short of breath and doesn’t understand why. While the heart is only a little larger than a fist and tries its best to accommodate a larger body, it’s never going to grow to the size of a gallon milk jug to match a body much heftier than it used to be. But we avoid asking the patient why she doesn’t link morbid obesity to her shortness of breath. We defer that to the doctor or nurse in charge of her care who can suggest weight loss options.
The Columbus Dispatch recently reported that Ohio spends just $13 per resident on public health per year. That amount puts Ohio near the bottom of the list among states. Clearly, more public health dollars should be spent promoting healthy diets and exercise in citizens starting at a very young age, and it won’t be an investment without returns. As morbid obesity exacts a huge price tag in the medical arena, public health guidance can help reduce the demand for so many medical services by this segment of the population.
