Minimum Standard of Care Sought for Obese Patients


State Sen. Andres Ayala was inspired by the premature death of former Bridgeport councilman Danny Martinez at the age of 26 to seek standards of medical care for the obese.
By Wayne Jebian
Moved by the death, at age 26, of former Bridgeport city councilman Daniel Martinez, state Sen. Andres Ayala (D-Bridgeport) has determined that hospitals need a legal standard to bring care for the obese in line with that offered to the general population. The proposed legislation, SB363, is entitled An Act Establishing an Obese Patients’ Bill of Rights.
Speaking about Martinez, Ayala said, “I had the opportunity after his death to think about what happened to him. I really began to ask myself, is there a standard of care for individuals who are obese? Even morbidly obese?”
Calling the overall issue a “crisis,” Ayala asserts that Martinez’ care suffered because of his size. This even though Martinez was a public figure and well established Latino leader in the state. Ayala said,  “He wasn’t able to get a CAT scan because the equipment was not available.” Martinez, who reached 400 pounds by age 21, was unable to fit into a standard-sized unit.
Rebecca Ruhl studies the problems faced by people dealing with obesity, as the Director of Research at Yale University’s Rudd Center for Food Policy & Obesity. She says that the lack of proper hospital accommodations is a factor that compounds a more general sense among overweight people that they are discriminated against.
“We know that the healthcare environment is a very common setting where patients who are overweight or obese feel very stigmatized,” she said. “This has a number of concerning consequences, one of which we know from research is that when patients who are obese feel that they have been stigmatized in the healthcare environment, they are more than likely to avoid future health care utilization.”
Given the health complications that obesity can cause, it makes sense that hospitals should be prepared for such patients, according to Ayala. “Larger and larger individuals will be going to our hospitals,” he said. “Our hospitals should be readying themselves so that they can handle these types of individuals that are coming in.”
According to a national survey of Americans, the nation’s obesity rate has held steady from 2010 to 2011 at 26 percent. Connecticut is ranked the third “thinnest” state with an obesity rate of 21.7 percent. Obesity is considered to be a body mass index, or BMI, above 30.
Hartford Hospital has been making such preparations for the past decade, according to Dr. Darren Tischler, chief of Metabolic and Bariatric Surgery. As he described the equipment and facilities in Hartford, he acknowledged that the cost of making certain accommodations might be out of the reach of many facilities.
“Chairs in the waiting room not only have to be wider; they have to be stronger. We have specialized examining tables that can handle patients up to 800 or even 1000 pounds,” he said, adding that the hospital has CAT scans that can accommodate people as large as 500 pounds, which represents the latest technology. “Equipment that can accommodate people of this size can be three to five times the [standard] price.”
In addition to equipment costs, establishing a standard of care for obese patients would be a matter of educating hospital staff and coordinating them appropriately. “It’s not just about having the correct equipment; it’s about knowing where it is in the hospital,” he said. “People need to know how to operate it properly and identify the weight capacity so that a patient is not put on a table that can’t handle the weight.”
The details of Ayala’s bill have yet to be worked out, so there is no way of knowing whether it will contain requirements that hospitals would find onerous. In the meantime, the Connecticut Hospital Association is taking a wait-and-see approach to the bill. “We look forward to seeing the language of the bill once it is developed,” wrote Michele Sharp, director of communications and public affairs, adding “Connecticut hospitals are committed to caring for all Connecticut residents and support ways to improve access to care for patients.”
Ayala’s initiative has drawn notice from those who work on behalf of the rights of overweight people. “It is our hope that Senator Ayala’s final bill will ensure those affected by obesity have access to safe and effective treatment options in a setting free of weight bias and stigma,” wrote James Zervios, director of communications for the Obesity Action Coalition.
Some academics feel that weight has become a civil rights issue and that even well-intentioned efforts to sound the alarm on the prevalence of obesity take on racist overtones. “Our dominant culture perpetuates an unhealthy thin ideal body type, which people are then compared to. This ideal is both race and class based, our body ideals are based on a white, middle-upper class norm,” wrote Abby L. Ferber, director, The Matrix Center for the Advancement of Social Equity and Inclusion. Ferber is a Professor of Sociology and Women’s & Ethnic Studies at University of Colorado Colorado Springs.
For his part, Ayala is not trying to address more generalized issues of social stigma. As much as he is fighting for fair treatment of larger individuals in medical settings, he is equally dedicated to combatting obesity and its health effects. “In the state of Connecticut, we tax our fitness centers,” he said. “We should be encouraging people to be going to the gym. Why not have a fast food tax that can go directly to dealing with this public health issue?”