The rate of obesity is continuing to grow in the United States. It affects the length of a hospital stay and medical cost. Differences in the duration of hospitalization may arise due to obese patients are medically more unstable.
Still, not all obese patients experience an adverse medical event. But, obesity does increase the risk of adverse medical outcomes throughout that individual’s life. As BMI increases, so do blood pressure, low-density lipoprotein (LDL, or “bad”) cholesterol, triglycerides, blood sugar, and inflammation. These changes can cause an increased risk of coronary heart disease, stroke, and cardiovascular death.
Obesity is one reason for extended hospital stays and higher costs for the Orthopedic patient. The obese patients make significant functional improvement during rehabilitation, but at a decreased extent and slower rate as their non-obese counterparts (“The Effect of Obesity on Direct Medical Costs in Total,” 2014). The number of total knee replacement (TKR) surgeries more than tripled between 1993 and 2009, while the number of total hip replacements (THR) doubled during the same period. A study appearing in the June Journal of Bone and Joint Surgery (JBJS) found that an increase in the prevalence of overweight and obesity in the U.S. accounted for 95 percent of the higher demand for knee replacements, with younger patients affected to a greater degree.
Prior studies have located an established link between a higher body mass index (BMI) and knee osteoarthritis. If the rate of overweight and obesity continues to increase, we could expect advancing numbers of knee replacements performed annually with an additional increase in hip replacements. The care of the obese patient necessitates the physician to utilize more time and medical resources. It may require the availability of specialized equipment; for example, large speculums and examination tables that can accommodate heavier individuals, and specially designed instruments for procedures in the operating room. Also, surgical procedures performed in a cost-effective outpatient surgical center may need relocation to a hospital because of the increased anesthesia risk to the obese patients, along with other medical concerns. These surgical procedures may be more complex, and they may be of longer duration. Extra time to educate patients on minimizing their risks is needed. Perceived or actual risks of complications arising from the care of obese patients may lead to the refusal of physicians to care for these particular based on fear of increasing professional liability or the additional time and resources that their care demands.
Strategies need to be initiated to ensure daily, quality physical activity and improved food options. One-step toward achieving this would be to enforce existing education including decreasing foods of minimal nutritional value during mealtimes, including snack foods. A change in the perception of obesity needs to be accepted so that health becomes a chief concern, not the personal appearance of an indiviudal. In some cases, physicians may not be medically capable of caring for a particular obese patient or providing a portion of their care. When a doctor is not able to provide safe and effective care to an obese patient, a consultation or referral is appropriate. One option for consultation and referral include a hypnotherapy consultation. It may be appropriate to refer the obese patient to another health care provider for an element of care that the given physician is unable to provide, while the referring physician continues to care for the patient overall. Whenever possible, maintain continuity of care. The referring physician may benefit from a close association with the hypnotherapist, learning about aspects of care with which he or she is less experienced. The hypnotherapist utilizes suggestibility and increases the patient’s self-concept. The hypnotherapist will assess the quality of family origin, age of obesity onset, education level, and socioeconomic status. This assists with appropriate care decisions.
Being unable to provide care to an obese patient should not prompt any medical practitioner to decline to provide other aspects of care that he or she is competent to deliver. Physicians can serve as advocates within their clinical settings for the necessary resources to provide the best possible care to the obese patient.
Referrals for other indications need completion quickly and compassionately. In such cases, a patient referral is required to the hypnosis clinician who has the skills and experience. In addition, the medical reason for the referral is conveyed to the patient. This is always completed with respect. Referrals demonstrate the ability of the physician to provide safe and efficient care.