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A Weighty Issue — Too Many Pounds Make Surgery a More Risky Proposition

Monroe Evening News, The (MI)

A Weighty Issue
Too many pounds make surgery a more risky proposition

By Michele Howe Special to The Evening News

Published: September 13, 2010

Imagine yourself lying on a bed in the hospital’s pre-op area waiting to go into the operating room. Those final few minutes generally are filled with minor chitchat and maybe hugs from loved ones before you’re ushered into the OR. You might be a little anxious, but overall, you’re simply ready to get fixed and on your way to feeling better, healthier. Then, instead of a nurse arriving to escort you into the operating room, the anesthesiologist comes in to tell you that your surgery has been canceled. You’re shocked and you wonder what the snag could be. Is there a problem with the surgeon? The attending staff? Equipment failure? An emergency that’s taken priority over your procedure?

Truth is, it’s none of the above. The unhappy expression found on the faces of your doctor, his surgical team and the surrounding hospital staff, aren’t due to anything within the realm of their control. Rather, yours. It’s your weight.

What was once an isolated event has grown into a burgeoning problem in hospitals and medical clinics across the country. A patient’s excessive weight is causing more surgeries to be canceled at the last minute because of the potential — and frequently life-threatening — risk.

It used to be that when a patient heard that he’d need to undergo a surgical procedure, he’d consider the who, what, where, when and how, Today it’s becoming more common to consider how much.

More Americans overweight

For a growing number of patients, the most problematic obstacle to getting better rests solely with their excess weight. Statistics show that two-thirds of Americans are either overweight, defined as a body-mass index (BMI) of 25 or higher, or obese, a 30-plus BMI.

However, many people think their excessive weight doesn’t hurt them. They think they can be overweight and healthy at the same time. Doctors say, though, that if sudden urgent medical care is required, the obese are not on a level playing field concerning surgical risks as their normal-weighted counterparts.

The fact is, none of us can anticipate when a medical emergency requiring immediate surgery will occur. Nobody plans on getting into an auto accident or injured on the job, but it happens every day.

And in comparatively similar fashion, a frightening number of patient casualties occur when medical professionals are forced to refuse treatment to people because the risk is simply too great pre-operatively, during surgery and post-operatively.

That’s why more doctors and patients are having conversations about weight before scheduling surgery of any kind. The patient should listen closely to what the surgeon is telling him as well as what he isn’t.

He’ll explain that because of excess weight, the patient is at an increased risk for anesthesia complications, blood clots and wound problems and the rehabilitation experience probably will be more difficult and longer in duration than normal-weight people. Those having joint replacements can almost count on the appliance wearing out prematurely, leading to another surgery down the road.

What the patient can’t hear, however, are the thoughts in the doctor’s mind. What he may not say out loud because it’s so discouraging to him as the medical professional whose job it is to heal is what he’s seen transpire in case after case in previous obese patients under his care.

As he’s speaking to a patient, he’s also running a mental dialogue though his mind of how the surgery (on an obese patient) will differ from a normal-weighted patient.

From a surgeon’s perspective, he has no choice but to accept the additional risks and challenges of operating on someone whose weight makes it exponentially harder to perform his job (fixing the patient) from a purely technical standpoint.

Doctors report that frequently morbidly obese people tell them that they (the patients,) are willing to accept the increased risk for complications without a thought for the difficulty that their surgeons will encounter during the procedure as well as what this increased risk for complications means to the physician as the responsible party. There appears to be a mistaken assumption that their weight is not a factor that might affect their surgeon’s ability to perform the intricacies required during any medical procedure.

Similarly, some other patients falsely believe that their surgery can be executed with the same ease as a patient of normal weight.

Weight can affect tests

Patients also must understand that weight-related health risks exist even before an individual enters the operating room. Extra fat can render some clinical tests ineffective at detecting potential and existing health problems.

Amy Parham, weight-loss participant on NBC’s “The Bigger Loser” in summer, 2008, remembers her wake-up call after viewing her bone density test results for the first time. She recognized at that moment how her extra pounds were punishing her organs and lungs hour by hour, day after day.

“It was eye opening to see that the fat was not something that was not only keeping me from buttoning my smaller pants, but it was also shoving my organs around and prohibiting them from working properly. Even my lungs were so compressed I couldn’t breathe well,” she said.

Mrs. Parham realized that as much as she hated how fat looks on the outside, “It is the fat that we don’t see, (on the inside) that is killing us.”

Beyond the risk complications already cited, a doctor knows that a surgical outcome may not be what the patient’s expecting because even with the most skilled surgeon working on his behalf, excess weight will continue to hinder mobility and range of motion post-operatively.

Both doctor and patient enter surgery at a disadvantage because both are fighting to overcome weighty odds of the most costly kind. Doctors warn that obesity is a life-and-death risk, a risk Mrs. Parham came to understand.

“I believe that many times vanity is the motivation for wanting to lose weight, but people need to wake up and realize that they are playing Russian roulette with their lives by the choices they make. I was slowly killing myself and didn’t even know it.”

Michele Howe is a LaSalle resident and author of “Burdens Do a Body Good.

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