Improving care: Treating obese patients with compassion and dignity

The Council of Australian Government (COAG) has found in its recent healthcare report that the number of Australians who are obese has reached “staggering” numbers. These findings are considered to have a direct impact on our healthcare system that will have to adapt to patients with different needs. We had the chance to speak to Janet Hope, Director of  Australian Bariatric Innovations Group (AusBIG) about the current state of bariatric care and how better education in nursing training can help delivering better care for obese patients.

IIR Healthcare: You have set up the AusBIG out of concern for poor care of the bariatric (overweight, obese and morbidly obese) patient. Can you tell us a bit more about what motivated you to start AusBIG?

Janet Hope: In 1999 I was working in a clinical nutrition and metabolism management role when the journey of an obese patient caused me considerable concern. The only information we had about the patient in the beginning was that he weighed over 200 kg. At the time, there were no ambulances available that could transport patients of that size. He had to be picked up from his home with two ambulances. One of the ambulance vehicles had to be completely emptied out for him to be put on the floor. The contents were put into the other ambulance. In preparation of his arrival, I had worked with our engineers to build him a chair on a pallet transporter because there was no suitable wheelchair available. On his arrival he had to access the building from the loading dock. I was emotionally moved by his predicament.  He was seen by our doctor in an area that wasn’t accessible to the public. We had to weigh him on a rail scale system with one foot on each rail. He weighed in at 270 kg with a BMI of 76.3 and was told he needed to be admitted for dietary weight loss management. When the hospital refused to admit him due to occupational health and safety concerns his family took the case to a current affair show. From there he underwent lap-band surgery at a time when the procedure was still relatively new, especially on a patient of that size. The surgery was performed interstate and he was released without having the appropriate follow up support. After an initial weight loss, he eventually regained the weight.

The story of this patient really made me think about our healthcare system. What is it worth if we can’t help everyone and help them with compassion and dignity? So I started out on my own, began to ask questions and conduct research about obesity. My name became known very quickly and people started to ask me for advice. That is when I first set up the association which started out as a Victoria based organisation (VicBIG). I initiated quarterly meetings to share information and network. When our member base grew over 400 I decided to change the name of the association to AusBIG and create a nationwide support system.

We now have over 800 members that meet regularly in most states. Normally interest groups in healthcare are set up within their disciplines, but I wanted to include a cross section from all healthcare sectors. Ultimately, this has proven to be the right decision and has enabled us to work with suppliers to source or build equipment that caters to the needs of obese patients.

IIR Healthcare: What issues do bariatric patients most commonly face in the current healthcare system?

Sadly, discrimination is at the top of the list. Not necessarily by the carer, but by the immediate surroundings. Often obese patients overhear conversations that can really inhibit their ability to open up and be receptive to treatment.

Another issue is the limited access to medical imaging and other tests due to the patient’s size and shape. An obese patient might not fit in the machine that is necessary to determine a certain illness or the fat tissue creates too much white noise which can distort results. This is often very hard to explain and can cause a lot of frustration.

One problem I regularly encounter is poor communication and a lack of compassion when it comes to caring for bariatric patients. Some people struggle to deal with situations when they are faced with something they don’t understand. This is often due to a lack of specialised knowledge in bariatric care.

IIR Healthcare: How can education for nurses help changing this situation?

Janet Hope: I really think that education is pivotal to achieve real change. I have asked a number of new nurse graduates about their knowledge in bariatric care. Most respondents confirmed my assumption that there was nothing in their training that prepared them for dealing with obese patients.

What we need to consider is that approximately 25% of the adult population are currently obese and about 40% are overweight. These figures show that we are experiencing a trend towards a heavier population that is also more likely to be hospitalised with obesity related illnesses. The younger generation is getting bigger earlier and the number of people in their 20’s diagnosed with Diabetes type 2 is rising. Our healthcare system is currently not prepared to deal with obesity on this scale.

At AusBIG we are trying to do our bit to change this. We are currently running a competition to come up with a national definition for bariatric patients*. This question has been asked for the past 10 years and it is time we developed a definitive answer for Australia. Currently, organisations write their own definitions and some organisations just use a weight limit to determine a bariatric patient. Without taking other factors into consideration, this can lead to inaccurate results. A clear and nationally recognised definition will make it easier for organisations to quickly identify bariatric patient and to take appropriate action immediately.

IIR Healthcare: If there would be one thing that you could change about the healthcare system what would it be and why?

Janet Hope: Waiting lists are a problem in healthcare in general. For bariatric patients this can lead to serious long-term problems. For example, if an obese person needs a knee replacement and has to wait two or three years to receive surgery, they often become confined to bed because their knee will not support their weight any more. The result is often more weight gain and greater difficulty when it comes to mobilising the patient after the operation.

Another problem I see for the obese is access to public rehabilitation. Only a few hospitals offer affordable rehabilitation services even though it is evident that the earlier people are mobilised, the better the results. I am hopeful though that because the American Medical Association (AMA) has now officially recognised obesity as a disease our healthcare system will also reconsider the attitude we have toward obese patients.

IIR Healthcare: You will be speaking at the 2^nd annual Reducing Avoidable Pressure Injuries conference. In how far do the risks and needs for bariatric patients differ from other patients?

Janet Hope: The weight, size, shape and mobility of a patient play an important role when it comes to assessing the risk for pressure injuries. Evaluating this appropriately is essential and an improved assessment tool needs to be considered to have appropriate staff patient ratios each shift and to assist choosing the right bariatric equipment.

IIR Healthcare: What discussion would you like to have with other healthcare professionals at the event?

You can definitely count on me asking a lot of questions to other participants. Have they established partnerships to better care for bariatric patients? How do they determine if a patient is considered bariatric? What kind of access do they have to bariatric equipment and how is this managed within their facility? Do they have a story to share that will help us develop a better understanding of how to improve care for bariatric patients?

*AusBIG is currently running a competition for a national definition of a bariatric patient/person. To participate in the competition, send in your definition to info@ausbig.com.au. Entries will be posted on the AusBIG website for voting. A prize (value $600) will be awarded to the winner.

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