Welcome to the Australian hospital where nine in 10 patients are overweight or obese. The operating tables can hold up to 400 kilograms, the wheelchairs are approved for 200 kilograms and extra-wide chairs are installed in consulting rooms.
“Normal isn’t normal for us,” said Dr Jamie Beit, the hospital’s director of anaesthesia.
Today, we are in Toowoomba Hospital, west of Brisbane. But this scenario could be coming to a hospital near you.
Since 1995, rates of obesity in Australia have increased by almost 50 per cent – to close to 28 per cent of the population.
It’s a growing burden on the health system that could see significant changes in the way hospitals plan for surgeries, if they are undertaken at all.
Already, some patients who are considered “severely" obese, with a body mass index above 40 are being told that it might be better not to have some elective surgeries due to the risks involved.
An example is a very obese person with diabetes who needs a knee replacement.
Dr Beit said the benefits of the operation may be outweighed by the high chances of the patient developing a wound infection.
“Wound infections in joint replacements are disasters. It causes patients endless pain, misery, repeated operations and they end up with a worse result than when they started,” he said.
"There is no moral judgment of weight in that decision. It’s just a balancing of risks.”
A snapshot of elective surgery patients at Toowoomba Hospital earlier this year found that only 10 per cent of 141 female patients were considered to be of healthy weight, while 60 per cent were classified as obese.
But Toowoomba is not alone as a community overwhelmed by unhealthy eating and lifestyles, with the problem acutely affecting many regional areas in particular.
The western area of Victoria, which includes towns such as Warrnambool and Ararat, had equally high rates of obesity, at about 70 per cent of the population. In western NSW, the rate is 71 per cent.
An orthopaedic surgeon who works in Wagga Wagga in NSW said she has a conversation with a patient about once every week about the risks of surgery as a result of complications from their weight.
Associate Professor Kerin Fielding said it was not about discriminating against larger patients.
“We are thinking about their outcomes and their care. [Joint replacement] surgery is great if it’s low risk,” she said.
“It’s not worth a major risk of death or infection.
“We have to stress that this is a really big surgery and the risk is really high if you have a major weight issue.”
Surgeons are also having conversations with patients about the possibility of losing weight before undergoing surgery – a task that can be very difficult given people have likely already tried to shed kilograms in the past and their weight can make it harder to exercise.
Specialists say that procedures involving severely obese people typically take much more time, and need more planning and special equipment.
“Even things like getting a cannula in can be much more difficult,” Dr Beit said.
“It can take much longer in a 160-kilogram patient than it does in an 80-kilogram patient, and it’s more likely to stop working halfway through the operation.”
Dr Rebecca Wood, a specialist anaesthetist with Sydney’s St Vincent’s Hospital, said obese patients also took longer to transfer and often spent more time in high-dependency units after surgery.
- Aisha Dow travelled to Sydney for the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists courtesy of the college.