Emergencies and Obesity

There’s more to this than just cops and donuts, keep reading.

The US Surgeon General, himself a Trauma Surgeon and a police officer in Arizona (interesting guy), today asked cops to lay off the Donuts:

In remarks to the National Sheriff’s Association, Carmona said that “being overweight or obese directly impacts job performance when you’re trying to defend the public safety. Remember, when you are called upon, you [must] be ready to back up your partner or a citizen. To me, failing at this calling when challenged would be a fate worse than death.”

Now, this is one of those things that’s obvious but needs to be said, and not just to police officers. As an interesting bit of motivational psychology this will help: for a group to really buy into the delivered message it neeeds to come from someone who’s both credible and one of them, otherwise it’s just preaching, and the more insular the group the more important the messenger.

This reminds me to opine about a very real problem the massively obese are getting themselves into, and that is that it very much harder to care for and evaluate obese patients medically. According to my elders in this specialty, seeing a 400 pound patients used to be a once a year, and we all have stories about 600 plus pound patients, but now it’s at least a weekly event to see 400 pound patients, or more, in the ED. It isn’t surprising, as the population is fattening up and aging, both of which make you more medically fragile.

Obesity severely limits applying the standard of care to patients, because the machines cannot handle the size or the weight. Our CT scanner in rated to 350 pounds, and it’s terrific, but if you’re a patient and you would have a CT scan under 350, it’s a problem to get it done when you weigh more than the machine is rated for. It’s been pushed a couple of times, but that can backfire and leaves us with a broken scanner and a bunch of people who need scans and get delayed. This also goes for the Cardiac Cath table and a lot of nuclear medicine equipment.

Reportedly there is one CT scanner in town that goes to 500 pounds, but it’s at one of those free-standing radiology centers so it’s only open during the day, which limits its usefulness when it’s 0230 Sunday morning.

MRI isn’t any better, because the hole size is smaller than a CT, even if the total pounds are ok there’s only so much size that will fit. I thought I had this solved once with an open MRI, but there wasn’t enough room for the patient’s chest to fit under the magnet to get the head scanned.

So, add ‘limited technical ED evaluation’ to the list of reasons to avoid obesity.


  1. You can include “limited availability of nurses” on that list as well.
    The very obese requires at the very least 4 RN’s, and sometimes the big burly guys of Security to help move them around.
    Gathering 4 RN’s for a quick boost is usually do-able, but having to have them stick around and hold a large patient over for something takes a lot of coordination of resources. Whatever they need done may not happen for hours.

  2. GruntDoc says:

    That’s an excellent point, and worth mentioning. It’s very foreboding to watch about 5 great big firefighters help move a massively obese patient onto a gurney, then turn over the care to a single nurse.

  3. Dr. Kranky says:

    As a surgeon I can also tell you that it’s BITCH to operate on the morbidly obese. I wonder if Medicare and other insurers will allow me to add the “extra difficult” modifier to my CPT code when I charge for an operation.