Presenteeism and Obesity

A prominent and ever-growing cause of financial loss to businesses is obesity, as described in the previous post. That post included as a subheading “The big but…” which is indicative of the problem in general: Obesity is such an easy target for mockery.

One difficulty with this topic is the temptation to succumb to flippancy and make jokes about the ruinous cost to widen the doorways in workplaces, and replace collapsed chairs… which would be wrong. The humor temptation might be why obesity, as a contributing factor to presenteeism, does not cause as much concern as it should.

But for some very dedicated scholars and business experts, the problem is (to reference another corny old joke) “serious as a heart attack.” They and their colleagues have discovered that in the world of work, presenteeism (reporting for duty but performing less than optimally) is actually more expensive than absenteeism, or not showing up at all. Now, why, in the business realm, is obesity seen as exceptionally harmful to the bottom line?

A worker with a broken wrist will eventually have the cast removed and, after a period of readjustment, will probably return to their original state of productivity. A pregnant worker may need some extra leeway, but will eventually become, instead, the parent of a child who is elsewhere during working hours. That situation offers its own challenges to an employed woman, but most are able to return to their pre-motherhood level of usefulness on the job.

Another big but…

However, in most cases, obesity does not go away. Usually, it increases. Over time, whatever negative effect an employee’s obesity has on the situation will probably not change for the better, and will probably change for the worse.

But how, exactly, does obesity contribute to presenteeism, and how does it do that in an especially impactful and intractable way? Exactly how do our collective tons of excess body fat add to the price of doing business, and thus increase the amount that consumers pay for every product, service, and commodity?

Not surprisingly, it is possible to find a raft of academic papers exploring the relationship between excess weight and presenteeism. The connections may not be immediately obvious to the casual eye, but they certainly exist. There are many reasons why a person’s Body Mass Index might affect their ability to do top-notch work. Also, there is said to be a “threshold effect,” meaning that the workers with a BMI of 35 or higher are significantly less productive than their slimmer counterparts.

Moderately or extremely obese workers… experienced the greatest health-related work limitations, specifically regarding time needed to complete tasks and ability to perform physical job demands. These workers experienced a 4.2% health-related loss in productivity, 1.18% more than all other employees, which equates to an additional $506 annually in lost productivity per worker.

In 2010, journalist Alyssa Zamora described the work done by Eric Finkelstein and many others at Duke-National University of Singapore. Researchers took into consideration “three factors: employee medical expenditures, lost productivity on the job due to health problems (presenteeism), and absence from work (absenteeism).” Furthermore, health problems cost more than medical expenditures.

Zamora wrote,

Collectively, the per capita costs of obesity are as high as $16,900 for obese women with a body mass index (BMI) over 40 (roughly 100 pounds overweight) and $15,500 for obese men in the same BMI class. Presenteeism makes up the largest share of those costs.

Bottom line: “The cost of obesity among U.S. full-time employees is estimated to be $73.1 billion.”

Your responses and feedback are welcome!

Source: “Obesity and presenteeism: the impact of body mass index on workplace productivity,” NIH.gov, January 2008
Source: “Obese Workers Cost More Than Healthcare, Absenteeism,” Duke.edu, 2010
Image by louisehoffman83/Pixabay

Some Aspects of Presenteeism

As we have seen, the behavior known as presenteeism costs everyone a lot, in ways that are not always immediately obvious. According to a very scholarly work, of which more than seven full pages consist of references…

Studies abound that not only show how prevalent presenteeism is across a range of occupations and sectors… but also position it as more costly than absenteeism.

The first paragraph of “Presenteeism: An Introduction to a Prevailing Global Phenomenon” mentions the current need to “achieve more with less.” The factor that should always matter most is individual health and well-being, which is why we discuss it here. In cases of rampant presenteeism, everyone’s job performance is negatively affected, and productivity is not optimal. This, of course, implies negative financial impact and a bottom line that does not look good. The case is not always hopeless, and strategic management can make a difference.

In the real world, this may mean that, actually, different philosophies or even different value systems are needed. Of course, professional scholars are accustomed to looking beyond superficial meaning. How sick does a person need to be before the illness should be considered serious enough to keep them home? Who gets to decide if a worker is actually ill? And what does “attending work” really mean, anyway? Haven’t we learned from the pandemic that many jobs can be done very adequately from home?

Related inescapable facts

An employee with the flu can be reasonably expected to stay home until well, and past the point of spreading the contagion. Then they return, and even though some productivity has been lost, it’s back to “business as usual.”

Another case history: An employee with a broken arm in a cast has the doctor’s permission to return to work. But maybe that person isn’t really well enough. The fracture may still be painful, which affects the quality of work. So the person might take analgesics, and although the distraction caused by pain is lessened, the medication may cause problems that add up to “presenteeism” — namely, being slower, less effective, and maybe even dangerously mistake-prone.

Further, the cast itself causes awkwardness and discomfort in several ways. You want to keep it clean. It itches inside. Minor chores and actions that you used to do with one hand have to be ineptly performed with the other hand. You run out of patience sooner. Your general energy level is low, and the little extra kindnesses you might have done to make someone else’s day easier will not be attempted. Again, the conditions are there for presenteeism: the state of technically being on the job, but doing it so poorly that when all is said and done, the business actually takes a financial hit.

Still, even that counterproductive scenario will not last forever. Eventually, the fracture will heal, the cast will be removed, and after perhaps a period of adjustment, the worker will be back to normal. The episode of damaging, costly presenteeism will eventually come to a close.

The big but…

In most cases, obesity does not go away, and it usually increases. This implies that the presenteeism-related financial damage caused by obesity will not eventually subside, and the effect will only become more severe.

Your responses and feedback are welcome!

Source: “Presenteeism: An Introduction to a Prevailing Global Phenomenon,” Cambridge.org, 08/09/18
Image by Vika_Glitter/Pixabay

Presenteeism As a Concept With Consequences

Absenteeism describes the state of being absent, but the term “presenteeism” is loaded with much more significance than merely showing up. The term goes way back to the 1930s, where it appeared in the work of writer H. Withers.

Skipping ahead several decades, we find such citations as a chapter in Contemporary Occupational Health Psychology whose subtitles include “The Many Definitions of Presenteeism” and “Problems with Presenteeism Research.” Almost a century after the phenomenon was first named, here is a contemporary definition by Will Kenton, from Investopedia:

Presenteeism refers to the lost productivity that occurs when employees are not fully functioning in the workplace because of an illness, injury, or other condition.

People arrive at the job site, and even try hard to give an optimal performance, but they are not able to do their best, and are likely to make mistakes and in other ways contribute to an overall loss of effectiveness. Although they are trying, their physical, mental or emotional unwellness renders them unable to operate at the highest — or even an adequate — level.

The American Psychological Association dictionary offers this about presenteeism:

The resulting reduction in productivity is a growing financial and safety concern for employers, particularly since research suggests presenteeism is much more prevalent and damaging than absenteeism. Factors that drive presenteeism include a large workload, fear of missing deadlines, fear of disciplinary action or job loss, missed pay, the desire to conserve leave for future use, loyalty to coworkers, company loyalty, and job satisfaction.

A very recent Childhood Obesity News post quoted Duke University researchers who found that “obesity-related absenteeism and presenteeism cost U.S. employers $73 billion annually.” How do researchers arrive at a number like this, and its related conclusions?

Here is a surprising observation: Presenteeism might be an even larger problem than absenteeism. To use a sports analogy, “playing hurt” can cost the company more money than would be the case if people simply did not show up. On top of that, if a well-intentioned employee insists on working while unfit (or a boss insists on their doing so), it is easy to see how the illness or condition might be prolonged, which can rack up even more expenses down the road.

And obviously, where a communicable disease is involved, there is a real possibility that the illness will spread, leading to even more cases of both absenteeism and presenteeism.

Even enlightened employers who try to address the problem with wellness programs, varied types of leave, flexible scheduling, and other potentially helpful measures find themselves frustrated. Here is a significant quotation:

The costs of presenteeism have been estimated to be larger in real terms as employees suffering from longer-term conditions see persistent drops in productivity.

A perfect example of one of those “longer-term conditions” is… wait for it… obesity. And we will get back to that. Meanwhile, obviously, a company ought to do all it can to incentivize good habits and allow for a workplace culture that avoids presenteeism, whatever that may require. This includes the facilitation of easily transferable workflows, and even of working from home if at all possible.

No matter how inconvenient or apparently costly these measures may be in the moment, they are almost guaranteed to reduce overall expenses and rescue the bottom line from even worse consequences. And of course, a manager would do well to set a good example by not showing up in the workplace in obviously unfit condition, especially if their situation involves germs.

Your responses and feedback are welcome!

Source: “Presenteeism,” OED.com, undated
Source: “Presenteeism: A Short History and a Cautionary Tale,” Wiley.com, 03/29/12
Source: “Presenteeism: What It Is and How It Works,” Investopedia.com, 01/06/25
Source: “Presenteeism,” APA.org, undated
Image by re_almeida/Pixabay

Is Obesity Everyone’s Business?

Here is one final look at an archived piece of health journalism from Dr. Bruce Y. Lee, which featured seven myths about obesity under the punning title, “Obesity is Everyone’s Business.” The general topic of this sequence of posts is the overall cost to society of treating and/or preventing obesity, and especially the way in which it has increasingly affected the cost of doing business.

In a very pragmatic demonstration of cause and effect, the author enumerated some of the
“immediate and long term physical, psychological, and social ailments” caused by obesity, which in turn affect a person’s effectiveness on the job. It should be mentioned that upper-level executives are just as prone to debilitating illness as the most humble new hire in the shipping department. The difference is that the folks in the higher ranks are more advantageously positioned to hide the deficiencies in their work output.

The check makes a difference

Also, executives can much more easily afford health-producing commodities like high-quality food, vacation time to recover from stress, membership in fitness establishments, and so on. However, in recent years, there has been some improvement in the equality with which corporations try to affect the basic health of their people.

Many physical ailments may be detrimental to an employee’s productivity. Depending on what field of commerce they are in, the damage from workplace machines, noise, and substances in the air can be quite serious. Even psychological issues (depression, anxiety, etc.) are perfectly capable of minimizing the usefulness of a worker at any level. A conscientious manager never wants to see conditions deteriorate to where workers experience sickness, pain, lack of energy, and the consequent lowering of morale.

Hopefully, that consideration results at least partly from generous human considerations. It is possible, after all, to operate simultaneously on two different planes of consciousness. Management can care and, at the same time, remain conscious that any and all physical and mental dysfunction in the workplace leads directly to lowered productivity, increased healthcare expenses, and shrinking profits.

This quoted paragraph illustrates some of the trends that motivated the business world to take a hard look at the consequences of obesity in the workplace. As previously mentioned,

A study by researchers at Duke University tabulated that obesity-related absenteeism and presenteeism cost U.S. employers $73 billion annually. [W]hile normal-weight employees cost on average $3,838 per year in healthcare costs, overweight to morbidly obese employees cost between $4,252 and $8,067.

Once researchers have wrapped their heads around some numbers, they enjoy expressing the significance of those figures in various ways. In this case, the authors also calculated the dollar amount of Body Mass Index points above the normal range. Once the border of obesity territory has been broached, statically speaking, each BMI point was said to represent an additional amount of around $200 per year that the company would pay out in healthcare costs for that employee.

The broad overview matters

Getting back to Dr. Lee, he formatted his Forbes.com article as a series of propositions which turn out not to be true; or myths. As Myth #5, he specified: “Obesity has little to do with overall business strategy, management, operations and finance.”

On the contrary, this author emphasized the big picture and maintained that “Employee weight and health can be a bellwether or ‘canary in a coal mine’ of how the overall business is functioning overall.” Why? Because a person’s normal weight can say a lot about their dedication, discipline, and work ethic, as well as function as an indicator of “the social, cultural, and financial situation and environment.”

In various industries, many members of the workforce have learned (the hard way) to keep the majority of their job-related opinions to themselves. Surveys and requests for feedback about company policy are often thinly-disguised traps designed to identify underlings who might be inclined to cause trouble. If “management” really cared about the average worker (the thinking goes), that collective noun would have caught on a long time ago, and realized that the whole outfit, from top to bottom, needed refurbishment.

Instead of initiating feedback requests that could be viewed with suspicion, the wise executive might be well advised to consult a psychologist familiar with the health manifestations of discontent — because obesity can definitely be interpreted as one of them.

Your responses and feedback are welcome!

Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Image by daha3131053/Pixabay

More About Offices, Desks, and Obesity

Note: This post will definitely make more sense if considered in context with its predecessor.

Journalist Rodney Wagner poses other pertinent questions and makes several points about desk dining. It can certainly get a person fed “without sacrificing productivity,” because the diner is still able to concentrate on the work being accomplished at the desk, while chewing and swallowing.

On the other hand, we might add, many authorities believe that a person’s full attention and conscious participation ought to be directed toward eating. Otherwise, they have not fully experienced the intake of nutrition, and are apt to overeat in compensation for that lack, and become obese.

At any rate, according to this authority, snacking at work can allegedly help to maintain mental energy and improve alertness (though it seems the same might be said of periodic exercise breaks, or inhaling a hit of oxygen). However, admittedly, there are also “numerous downsides to eating at your desk.”

The person’s attention may be distracted from the work at hand (especially, we presume, if eating involves consulting a menu and placing an order.) Worse yet, the average worker’s meal often tends to involve items purchased from snack vending machines, the contents of which are universally acknowledged to be unhealthful and fat-promoting.

At any rate, the availability of food and water to those who need them is a factor that a manager can affect. While many people do not care for the nanny-state implications, it is probably on the whole a good thing, when those in charge bear some degree of responsibility for the well-being of the workers.

Strength in motion

For the well-being of employees who like to burn calories by walking between the floors of a building, the security of stairwells should be assured. Overall, the important thing is to cultivate an awareness of how extensively employee health affects productivity, morale, and healthcare costs. Basic amenities like breathable air count for a lot. So really, the biggest error an executive can make is to assume that she or he might not be able to affect the situation positively.

Understandably, one of the myths that Dr. Lee identified is the fallacy of ineffectualness. An employer should never buy into the idea that little can be done to shrink obesity in the workplace. There is a cliche that fits the case very neatly: “If you’re not part of the solution, you’re part of the problem.”

The boss can make a difference

Often, there is a belief that not even the most well-intentioned business can do much to prevent obesity, which by extension implies there is nothing they can do to stem the rising costs of obesity that adversely affect the company’s bottom line. Dr. Lee resists this defeatist notion because the reach of the job may in fact be extensive:

Your workplace can affect your commuting, sleep patterns, relationships with family and friends, available food at home, energy to exercise, overall stress levels and many other aspects of your life… No matter how you prioritize work-life balance, your workplace does have an impact on the rest of your life […] and in turn obesity.

Of course, obviously, the job affects the weight class of the worker’s entire family, because if the pay is not sufficient to feed them well, the consequences will show up. Which brings the topic back to the cost of a health plan, if indeed such an amenity exists at all. A company with common sense ought to recognize that it is cheaper to pay for obesity prevention than for bariatric surgery.

At the same time, corporate leadership must have the sensitivity to prevent its caring approach from coming across as criticism or worse yet, as a threat. In some times and places, rules are in effect to shield workers from various types of discrimination — even from what might appear as fat-shaming.

Dr. Lee’s last word to the bosses is,

In the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril. To make a real difference, you need to have real substantial change in the culture and operations of a workplace.

Your responses and feedback are welcome!

Source: “Source: “Is It Good to Eat While Working? Uncovering the Truth,” MeatChefTools.com, 02/03/25
Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Image by Pexels/Pixabay

Offices, Desks, and Obesity

We are in the midst of examining a very detailed, decade-old Forbes.com article. Authored by Bruce Y. Lee, M.D., it explored some myths about the extent to which companies are able to influence the amount of obesity experienced within the ranks of their employees. At the time, contemporary Duke University research showed that obesity-related issues cost American businesses, overall, just short of $75 billion each year.

More specificity was found in this quotation:

Another study measured that while normal-weight employees cost on average $3,838 per year in healthcare costs, overweight to morbidly obese employees cost between $4,252 and $8,067. Each additional body mass index (BMI) point above normal weight costs $194-$222 per year per employee.

Significantly, bosses at every level were reminded that weight-related issues tend to sneak up and may not become obvious until after some real damage has already been done. Consequently, it is always wise to have a finger on the pulse of industry-wide trends and interventions.

High employee turnover is never a good sign, and obesity-related issues can influence employee behavior to a very great extent, so the smart executive keeps an eye on that area. Advice in this area can be just as true today as when businesses began to track such matters. Overall, the author urges bosses to remember that substantial change might be needed, and that…

[…] in the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril.

But once the people in charge become aware of the potential undesirable impacts of obesity, relative to the big picture, they should not be discouraged by all the possible negative outcomes. As always, “fore-warned is fore-armed,” and it would be a mistake, according to Dr. Lee, for employers to think there was not much they could do.

In some work environments, for instance, it might help to offer the alternative of a standing desk. A slogan that was heard in this context was, “Sitting is the new smoking” — in other words, a harmful yet totally avoidable habit. Of course, many job descriptions preclude sitting and require constant standing. But in circumstances where sitting has always been considered the normal state for workers, to forbid it might be construed as gratuitous cruelty, and the basis for a legal challenge. Still, in many situations and workplaces, leeway could be built in.

While some things are simply not done — like a bank teller eating while taking care of customers at the window — in many situations company policy allows leeway for habits and preferences. Choosing a couple of articles at random brings to light some of the current thinking in this area. A website for professional chefs asks, “Is it good to eat while working?“:

A survey found that over 60% of employees regularly eat at their desks, indicating that this trend is not just common but almost normalized.

Amongst people who work seated at desks, perhaps. What about lifeguards? Firefighters? Heart surgeons? Okay, the author probably meant that, among the sub-population of office-bound, sedentary workers, more than half are accustomed to eating at their desks. (Leaving aside matters related to obesity, their habits might directly impact the company’s pest control budget.)

(To be continued…)

Your responses and feedback are welcome!

Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Source: “Is It Good to Eat While Working? Uncovering the Truth.,” MeatChefTools.com, 02/03/25
Image by StockSnap/Pixabay

Let’s Not Kid Ourselves

At this point, many of us are posing the rhetorical query, “How much does obesity cost the overall economy, anyway?” This sounds like a trick question, one posed not to extract a factual answer, but to take an indirect route toward confrontation with a really unpopular conclusion. It sounds this way because it is.

One reason the question is virtually unanswerable is, the price of each separate factor involved in bariatric medicine continues to rise. Another reason is that even with modern lightning-speed communication, it is still pretty difficult to guarantee that a pile of information about anything is the latest and greatest.

In many cases, multiple factors change too quickly to be meticulously tracked and compensated for. Sometimes, even experts review their work or the work of others and conclude that “Oops! Those numbers are on the wacky side.” We can take a snapshot that captures a moment in time and compare it to another snapshot in a later or earlier time frame, or in the same moment but in a different place.

A considerable fraction

Back in 2015, the management consulting firm McKinsey Global Institute announced that almost one-third of Earth’s population, or 2.1 billion people, were overweight or obese. In developed economies, “about 15 percent of health care costs […] are driven by [obesity].” Moneyweb.co.za noted that “healthcare costs are more than 40% higher for obese patients than normal-weight patients.”

The investment advice website added that the global impact of obesity was estimated to be “on a par with the impacts of smoking or armed violence, war and terrorism.” Expressed numerically, this figure amounted to around $2 trillion, or 2.8% of the global Gross Domestic Product. As the saying goes, “no matter how you slice it,” this was a real wake-up call. To put the icing on the cake, McKinsey issued the understatement of the century, namely, that “global disagreement on how to move forward is hurting progress.”

Some widespread misunderstandings

In the same year, a mere decade ago, Dr. Bruce Y. Lee compiled a list of seven myths that conspired to convince employers that they could safely ignore the encroaching threat of obesity — the first one being that obesity did not exist in their particular line of work. But in truth, few businesses were found to be exempt. While relatively few responsible authorities were paying attention, obesity had snuck into “nearly every country, income level, race, ethnicity and age group.”

Rising obesity rates were not random accidents, but established facts of life. Even if one particular corner of a commercial field had not yet been invaded, suppliers, subsidiaries, and other connected areas would be affected. And to simply hire skinny people was no solution, because the possibility that they could balloon up was always lurking.

The second prevalent myth was that obesity invariably sprang from each employee’s individual lifestyle choices. But the author pointed out how mistaken a boss would be to assume that anyone who put on pounds was simply lazy or lacking in self-control. To assume that everyone just needed to eat less and exercise more would be a serious error in judgment. People in positions of authority were urged to remember that behavior is governed by “a number of social, environmental, cultural, and financial factors,” which will be looked at in the next installment.

Your responses and feedback are welcome!

Source: “A fat investment opportunity, Moneyweb.co.za, 04/16/15
Source: “Obesity is Everyone’s Business,” Forbes.com, 09/01/15
Images by fabioeliasp1 and miosyn/Pixabay

The Devil Is in the Details

The most recent installment of this series focusing on the cost of obesity mentioned smart beds that can track patients’ vital signs, weight, and other factors.

It also mentioned a complex issue with which hospitals never cease to struggle: guaranteeing the correct amount of any medication to precisely fulfill the requirements of the patient’s body and condition. This obviously is of crucial importance not only to the clinically obese patient but to each and every patient. Meticulousness in this area is necessary for everyone from the pre-born infant to the geriatric patient who (where legal) opts for an assisted demise.

In the domain of medication, so much can go wrong. It must be the right medication, untainted, and within its use-by date. For numerous reasons, including public safety and legal liability, all the documentation has to be correct, and strictly accounted for. Substances need to be shipped and stored correctly. All communication regarding administration must be clear, accurate, timely, and easily accessible.

And of course, as already emphasized, the necessary factors include…

[…] a current, accurate weight instead of relying on a historical, stated, or estimated weight; and obtaining, documenting, and communicating patient weights in metric units only (i.e., grams or kilograms). Key patient information used to guide appropriate medication therapy includes age, weight, height, allergies, diagnoses, laboratory values, and vital signs…

The very explicit Pennsylvania Patient Safety Advisory is a good example of the thorough inclusion of multiple factors involved in risk reduction, like equipment cost, and its upkeep and repair cost, and the expense of training people to use it correctly. It comes as no surprise to see accurate weighing equipment at the top of the list, as always. As we have mentioned, such hardware includes “floor scales, stretchers and beds with built-in scales, and standing, chair, and wheelchair scales.”

The personnel who employ these devices are expected to be familiar with the manufacturers’ recommendations for keeping them accurately calibrated, lubricated, titrated, or whatever. And despite the USA’s stubborn refusal to join the world in using the metric system for general purposes, it must be employed in the realm of weights and measures having to do with humans and medications.

One important factor discussed by this document is that of organizational expectations. Specifically, the best practice is to specify and assume that…

[…] obtaining the patient’s actual weight is part of the mandatory nursing assessment and reweighing of the patient occurs as warranted, based on patient’s clinical condition. Consider requiring reassessment of a patient’s weight when initiating or changing the dose of weight-based medications, clinical situations in which weight fluctuations are expected, or situations in which a weight variation may impact the course of care.

In other words, stay on top of this factor. Even in situations where it may not seem very important, documentation creates reality. As more attention is paid to the phenomenon of weight fluctuation in patients, more factual information will accumulate and reveal its significance, for the good of future patients.

It is also recommended to pay meticulous attention to this factor, other than in the midst of an emergency, of course. And for goodness’ sake, be sure all pertinent weight stats are recorded clearly, and in a quickly findable location, in the patient records. The document contains even more suggestions about the administration and implementation of weight-related policies, and about sketching out contingency plans in advance.

Weight is one of the easiest variables to keep track of in a clinical setting, especially with the newest specially developed or adapted equipment. The weight factor’s ubiquity and banality place it in danger of being overlooked and undervalued, but excellent arguments can be made for paying meticulous attention to this issue.

Your responses and feedback are welcome!

Source: “Update on Medication Errors Associated with Incorrect Patient Weights,” PA.gov, June 2016
Image by geralt/Pixabay

Smart Beds — for Bariatric and Other Reasons

In the field of bariatrics, it seems obvious that heavy people face physical challenges and restrictions that can require some pretty elaborate equipment. It is also apparent that ever more complicated hardware must and will inexorably raise the total cost of healthcare. But obese people should not be assigned the whole blame. Increasingly, medical equipment related to weight is for everyone.

We spoke of the transfer safety factor, with an uncomfortable number of mishaps, resulting in what are somewhat euphemistically called “delays in care.” Moreover, for hospital inpatients of many sorts, continuous weight monitoring is increasingly seen as essential.

A company called SonderCare explains why:

A bed equipped with load sensors provides real-time information that derives from, and in turn affects, the patient. Treatment options can change minute-by-minute, rather [than] according to orders tied to an 8-hour shift.

Despite the best intentions of staff members, the big danger point connected with patient injuries is movement from place to place. If the patient can just stay right there in bed and be weighed, so much the better, because a potential cause of injury has been eliminated.

In this style of bed, load sensors convert the pressure they feel into electrical signals for crucial weight monitoring, while other technology includes keeping track of the patient’s vital signs. A sudden weight change, either up or down, may indicate a problem with the heart or kidneys, and can be quickly investigated.

In some conditions, fluid buildup may be detected before it causes serious damage. Overall, continuous weight monitoring, without the need for actual transfer of the body, greatly reduces injuries.

According to SonderCare,

Advances in bed technology include vital signs monitoring and alerts to prevent pressure ulcers, increasing safety and comfort for patients. Future innovations will incorporate smart fabrics and touch-sensitive sensors that offer real-time health updates directly into electronic medical records.

But wait, there is more…

Another entire area in which very large people can be particularly vulnerable is medication dosage. We are accustomed to the idea of child-size doses, to ensure that the young and vulnerable don’t get too much. But we think less often about the need for accurate measurement in the ratio of medication to body weight, in the case of an extremely large adult.

Both insufficient dosage and overdosage would be problematic. GoodRx.com says,

Some medication dosages are weight-based because your body weight or body composition could affect their absorption, distribution, metabolism, or elimination. These four factors predict how a medication will behave in your body. Drug toxicity can also play a role.

Changing any one of these factors can potentially make a medication more or less active in your body. In turn, this can lead to unwanted side effects or a less effective treatment.

Another paper points out that “the weight effect may be minimal or dosage can be affected only when weight is combined with other factors. Findings of sporadic studies in recent years indicated that fixed dosing was more advantageous than weight-based dosing in some cases…” It stresses that the medical facility needs to establish good processes for both weighing and documentation, and to ensure “sufficient and convenient availability of appropriate and properly functioning equipment for patient weighing and medication delivery.”

Insulin, antibiotics, and anesthetics are some of the drug types that need very careful consideration when prescribed. In the overall cost of obesity, this factor is not very large. Although considering it over and over again in each case certainly takes time, which adds up. But just one case that goes to court because a patient was under-treated or died from an overdose can become very expensive.

Any reader of this piece who treats lightly the matter of dosage calculation might take a look at this website, “How To Calculate Drug Dosage By Weight | Essential Guide.” This excerpt is just a tiny sample:

\[
\text{Required Volume} = \frac{\text{Total Dose}}{\text{Available Concentration}} = \frac{700 \text{ mg}}{250 \text{ mg/mL}} = 2.8 \text{ mL}
\]

Got that? This is why medical school is so expensive, and why physicians are so well-compensated. The matters discussed here are relevant not only to the status of obese children as they exist now. The whole area of concern involves viewing children not just as young people per se, but as precursors of the adults they will grow into.

We strive to avoid these very costly problems, both for the sake of each individual child and for the sake of the economy, as they will grow up to impact with their ever-increasing number of expensive obesity-related issues.

Your responses and feedback are welcome!

Source: “Do Hospital Beds Weigh You?,” SonderCare.com, 06/27/24
Source: “Weight-Based Dosing: What to Know About Medication Dosages and Body Weight,” GoodRx.com, 02/09/23
Source: “Weight-based dosing in medication use: what should we know?,” NIH.gov, April 2016
Source: “How To Calculate Drug Dosage By Weight | Essential Guide,” Wellwisp.com, undated
Image by [name not given]/Pixabay

Bariatric Hardware By the Numbers

In this series concerning the costs of obesity, today’s post is about equipment. We mention some specifics of why the issue is an ongoing and ever-growing problem for patients, family members, and/or caregivers, medical professionals, other hospital personnel, insurers, and basically the American public at large.

“Bariatric” is a term that refers not only to weight reduction surgery but to the entire field of obesity treatment. Let us confront the issue of equipment — first, by looking at some available devices. Several sources were consulted for bits and pieces of information; a typical website of this genre describes items designed for patients in their everyday lives at home and out in public.

Crutches can be found for people who weigh up to 650 pounds and maybe even heavier. There are canes guaranteed to support 500 pounds. Specialized companies make extra-wide, super-strong walkers. A combination walker and seat called a rollator will support up to 500 pounds and run you $800 or more.

An extra-wide wheelchair that supports up to 850 pounds can be had for just under $1,000, while a less sturdy model might go for half that price. And who would have guessed that a “transport chair” is a whole different category of item?

Other locales

For the home, a furniture company has designed a super-strong lounge chair that can be had for around $2,500, and a scooter available for approximately $3,750. A special bed for home use can serve a person of up to 450 pounds (or even heavier), but the basic horizontal structure itself is only the beginning. The side rails, for instance, may represent a separate, additional expense.

A home bed may cost around $3,000, but quite possibly might add up to more. In a hospital, a high-tech, specialized bariatric care bed could run for 10 times as much. A mattress particularly designed for very obese individuals is composed of different materials from the standard hospital mattress, and may cost as much as $4,000.

In either case, the patient will probably need a trapeze (around $1,000) to lift himself or herself off the bed’s surface and change the body position. For patients who need help when in physical therapy recapturing their ability to walk, there are ceiling lifts.

Similar devices are able to lift a very large person from the floor onto an exam table or bed. Although modern hospitals are designed from scratch with such contingencies in mind, the structure of a typical home might need some expensive refurbishment to handle a suspended load of this kind.

Different strokes for different folks

For more intimate needs in the individual’s bedroom and/or bathroom, there are transfer benches to help get a person on the toilet; bedside commodes (starting at around $200), shower chairs, raised toilet seats, toilet safety rails, and other beefed-up versions of standard items, and they all cost more if a lot of poundage is involved.

Equipment that will probably be found only inside a medical institution includes an extra-sturdy exam table that sells for around $2,000. For the use of the bariatric surgeon, special stapling equipment is available in the $4,000 – $5,000 range. But this begins to impinge on a whole different, related area.

Let’s take a moment to scope out an article about patient safety, with a long and explicatory title: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese.”

This assessment is five years old, but not much has changed since then:

Event reports […] indicate that some healthcare facilities do not have the necessary equipment to monitor and care for some individuals in this patient population, leading to embarrassment for patients, delays in care, and injuries to patients.

The most frequent problem situations involve imaging equipment, “especially MRI and CT scanners,” or at least events in the imaging department. Stretchers and wheelchairs are statistically implicated to a startling degree. Almost 75% of patient safety mishaps result in what is euphemistically called “a delay in care,” with most of the delays consisting not only of pausing to assess the damage, but in treating the resulting damage. Nobody wants this.

A huge field of knowledge is involved here, which mainly concerns adult patients rather than children. But this is the point we make again and again: The odds of an obese child growing into an obese adult are daunting. No parent wants to peer into the future and see this kind of picture. And looking at a bit of specialized bariatric equipment, and the associated prices, hopefully will cause some degree of a “scared straight” effect.

Your responses and feedback are welcome!

Source: “Bariatric durable medical equipment product guide,” Medline.com, undated
Source: “Bariatric and Heavy Duty Patient Lifts and Slings,” AdaptiveSpecialties.com, undated
Source: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese,” PatientSafety.pa.gov, March 2020
Image by dmchannelsng/Pixabay

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources