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Specialist reveals challenges of treating Australia's most obese patients

May 9, 2018

The challenges of treating patients who are some of the nation’s most obese have been revealed by a senior specialist at an Australian hospital which is at the frontline of the obesity epidemic.

Dr Jamie Beit, the Director of Anaesthesia at Toowoomba Hospital in the Darling Downs, west of Brisbane, said the hospital’s recent clinical snapshot of 250 elective surgery patients aged 18 and over revealed very high levels of obesity.

Ten per cent of the 141 female patients were in the healthy weight range. Sixty six per cent were classified as obese (BMI>30) and 23 per cent of all female patients were classified as Class 3 obese with a body mass index of 40 or more (BMI>40). Of the 109 male patients, 22 per cent were in the healthy weight range.

“We have over twice as many people who are class 3 obese than normal weight and from a service provision point of view that does create significant problems,” Dr Beit said.

Dr Beit told the annual scientific meeting of the Australian and New Zealand College of Anaesthetists (ANZCA) in Sydney on Wednesday May 9 that according to a National Heart Foundation analysis of Australian Bureau of Statistics data in 2015, the Darling Downs-Maranoa region has the highest incidence of obese adults in the nation.

Forty-four per cent of adults living in the Darling Downs, which has a population of 250,000, are obese compared to the national average of 27.9 per cent.

“In the anaesthetics department we see a recent measured weight for every patient we care for. We are seeing in real time what is happening on the ground. The reality is that patient BMIs appear to be continuing to increase. It is my opinion that the obesity crisis on the Darling Downs is continuing to worsen. ”

Dr Beit said some new doctors and staff found the number of obese patients at the hospital confronting.
“Visiting anaesthetists are often surprised by the sheer numbers of obese patients and how we still manage to provide excellent care” he stated.

Each year the regional hospital performs more than 10,000 elective and emergency operations and delivers 1800 babies.

Dr Beit said obese patients presented resourcing and clinical challenges for the hospital’s medical and nursing teams as they require larger than average beds, operating tables and other medical equipment. Anaesthetic and surgical procedures can take longer to complete and many obese patients also have type 2 diabetes, increasing the complexity of their care.

However Dr Beit suggested that one of the key strategies to managing both patient expectation and that of staff was to ensure that more time was allocated in advance to prepare for the needs of obese patients.

“We take longer to provide a safe service because it takes us longer to put in drips, it requires more time for surgery and can often take longer for the patient to wake up. Where you see frustration and problems occurring is when extra time is not allowed for this and staff become time pressured.”

Dr Beit said the hospital’s experience had shown that in many cases it was counter-productive to tell a morbidly obese patient that they needed to lose weight before an operation.

“In our experience conversations like this aren’t useful because the patient doesn’t lose weight and disengages from the process and that doesn’t help anyone.”

“A better approach is to have a pragmatic discussion about the risks and benefits of an operation. For example, if someone has a BMI > 40 and poorly controlled diabetes, their risk of post-operative complications are higher. A specific example being an increased risk of wound infection in joint replacement surgery. So much so that the risks may outweigh the benefits. There is no moral judgment of weight in that decision; it’s just a balancing of risks,” he said.

“In Toowoomba, we’ve had no choice but to confront this issue because it is the reality for us,” Dr Beit explained.

“Part of my job as director of anaesthesia is to deal with complaints from patients and staff and I am very aware of the sensitivities involved but the numbers are what they are.

“Patients with obesity are a significant component of our work and we want them to be treated well. The majority of morbidly obese patients are acutely aware that they have a weight problem. It is my impression that most of them have tried to lose weight. We need to be receptive and accepting of this, and do all that we can to provide them with the best care possible.”

More than 2500 local and international anaesthetists, pain specialists and other medical practitioners have gathered for the scientific meeting at the International Convention Centre in Sydney from May 7-11.
 
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