'Working with one arm tied behind our back': Hospitals are ill-equipped to treat obese patients, experts say

As obesity rates in Canada continue to climb, more people living with obesity will go to hospital for a variety of health conditions. But hospitals and their staff are often ill-equipped to provide appropriate treatment in a timely fashion, experts say.

470-pound patient told not to use hospital bathroom because he 'would break their toilet'

Kas Roussy CBC News Posted: Sep 28, 2017 5:00 AM EDT | Last Updated: October 2, 2017

Obesity rates are increasing in Canada, but are hospitals ready to provide timely and safe care? (kwanchai.c/Shutterstock)

As a man living with obesity, 50-year-old MartyEnoksonhas dealt with his share of public humiliation.

In 2009, complications from weight-loss surgery forced a return to hospital in Edmonton, where he shared a room with threeother patients.At that point in his life, Enokson weighed 470 pounds.

When he told the attending nurse he needed to go to the toilet, he says she told him he couldn't.

"I was told that I could not use the bathroom because I was too fat for their toilet. I would break their toilet," Enoksonsays.

Marty Enokson used to weigh 505 pounds, but now weighs 370 pounds. He has become a passionate advocate for other people living with obesity. (Canadian Obesity Network)

Instead, he says, the nurse had something else in mind.

"She said, 'Well we're going to set up fourfabric walls, and we're going to bring a commode into the room, and you can go to the bathroom behind the fabric walls.'"

For Enokson, it was the most degrading experience of his life, and after continued complaining, he was moved to a private room.

"Historically, people with obesity have not been valued,"says University of Alberta researcher Mary Forhan. "Their voices haven't been heard."

University of Alberta researcher Mary Forhan displays a ceiling lift designed to safely move a heavier patient. (CBC)

Forhan, an associate professor in thedepartment of occupational therapy, isresearchinghow Canadianhospitalscare for patients with obesity, and whether they're unableor unwilling to provide proper treatment.

The study islooking intochallenges for such patients in acute care, cancer, cardiology and rehabilitation.

Hospitalsneedto adapt

"Over the past decade, the issue has become more and more prevalent, with more and more people living with obesityand coming infor health-care services, but the system doesn't respond as quickly as we need to," ForhantellsCBC News.

"As a clinician it was really clear we were not trained properly or had the proper equipment available to us to be able to provide good qualitycare for patients coming in who were also living with obesity,"she says.

Obesity is a chronic diseaseand is linked to other diseasessuch asdiabetes, hypertension, heart diseaseand arthritis.

Critical care specialist Dr. Michael Warner has experienced the challenges first-hand at Toronto's Michael GarronHospital, where he'sworked in theintensive care unit for the past decade.

"I can tell you that for the population I care for, critically ill patients, patients are generally larger, and their relative size is bigger than they were in the past,"he says.

According to the Canadian Obesity Networkmore than 1 in 4 adults in Canada has obesity.

ForWarner, it's a worrisometrend.

"When patients are of certain dimensions, it becomes harder for us to assess them effectively, to examine them, to even do tests on them that can help us establish the appropriate diagnosis, and then subsequent treatment," he says. "So everything slows down. Diagnosis.Treatment. And we're also not sure whether the treatments that we're using, specifically medications, are dosed appropriately for a patientwhen they are ofa certain size."

Dr. Michael Warner is a critical care specialist at Toronto's Michael Garron Hospital. The hospital has begun using wider wheelchairs to accommodate obese patients. (CBC)

That's because there is little obesity research to guide them when it comes to proper dosage.Warner says doctors are having to use "clinical intuition" instead.

Another obstacle isimaging machines, which aremanufactured for standard-sizepatients, so mostpatients with obesity can't fit inthem.

"We're almost working with one arm tied behind our back in the era of modern medicine," Warner says. "We're not able to use all of the tools in our armamentarium to provide patients with the most effective way to determine the diagnosisand any effective treatment."

The consequencescan be fatal, he says.

Sturdier toilets and bigger beds

But slowly, hospitals like his are becoming more sensitive to the changing size and shape of patients.

Some of the patientrooms come equipped with sturdier stainless steel toilets rather than porcelain ones. Doorways to some rooms are wider. Beds are biggerand can hold a weight capacity of 1,000 pounds. Some wheelchairs have larger dimensions, and blood pressure cuffs accommodate patients with largerarms.

Michael Garron Hospital in Toronto is redesigning some rooms with wider beds to accommodate obese patients. (Michael Garron Hospital)

Each floor of Humber River Hospital in Toronto has rooms designed specifically for patients with obesity, including one room in the maternity unit. MRI and CT scanners are larger, too.

At the University of Alberta, where professorForhanconducts her research, a state-of-the-art bariatric specialty suiteis used to train health-care workers to carefor patients living with obesity. It includes wider hospital beds, stronger ceiling lifts that can easily and safely move apatient strapped in aslingfrom hospital bedto showerto toilet.

Stainless steel toilets replace porcelain ones to accommodate larger patients at Toronto's Michael Garron Hospital. (Michael Garron Hospital)

Forhansees this as an important part of her work, eliminating the stigmaand so-called fat shaming of patients.

"It really provides education about obesity and gets obesity recognized as a chronic health condition. It deserves the same value and therespect that other chronic diseases do."

Her group is currently developing "best practice" guidelinesthat would improve hospital care for patients with obesity.Theguidelines are expected tobe available early next year.

Sydney conference aims to change how health-care workers treat obesity

For a time,Enoksonwasso fed up with the kind ofmedical care he gotthat he avoided hospitals and doctors.

Now, he's a passionate advocate for people living with obesity, volunteering his time at the University of Alberta as a real-life mannequin and helping trainCanada's future doctorsand other health-care workers.

"We don't want anything special,"he says. "But we want to be treated and given the same treatments that other individuals that are normal sized have access to."