Thanks to those who have weighed in with very thoughtful and insightful comments. Most of us don't have the specialized knowledge that some of you have shared, so I appreciate yours!
To me the over-riding message from all of this is that we're all best off doing our level best to get to (or stay) at a reasonable weight and fitness level. The physical costs of obesity are far beyond those experienced on a mundane basis and may show up at much more critical junctures, such as in the wake of an auto accident, during chemotherapy or pregnancy, etc.
If I were obese I think I'd take that article as a real wake up call and strengthen my resolve to do whatever it took to address the situation.
Knowledge is power and that is one reason I posted the link.
Fitness Minutes: (29,643)
1,823 9/21/13 1:36 P
Another scary thought is that a lot of medical equipment is not made for morbidly obese people. Breathing tubes are a standard size...about 8 inches. With the increase in bulk you may need 9, 10 or 12 inches to have the tube properly in place.
Chest tubes, used to re-inflate the lungs after surgery or injury have eyelets at the end to drain fluid and air. Do we need tubes with more eyelets?
IV catheters, standard size, are 2.25 inches long. If you need 1 to 1.5 inches to get through the skin and fat that leaves 1 inch to get into the vein.
A long time ago when I rode my T Rex to work, I was caring for a guy in our ICU. He weighed about 350#s. He went into cardiac arrest while lying on his side. The other nurse and I saw it happen, called the code and tried to turn him to do CPR. We couldn't get him on his back. We had to wait several minutes for enough help to arrive to roll him and then lift him onto the back board. CPR was exhausting. The effort required to compress his chest was tremendous. Most people can only do effective CPR on an average size person for 7 to 10 minutes. We were switching off every 3 to 5 minutes. And to be effective you need to minimize interruptions. The man did not survive. I don't know if he would have lived if he had been smaller, might not have made any difference. But it still bothers me after 30 yrs.
This article itself points out that it's an issue of knowledge, not inequality:
"[...] it's because doctors are afraid to follow a standard weight-based formula because the dose seems so huge and they're afraid of harming the heart and blood system, Lyman said.
"You're three times the size of the average person, but it doesn't mean your heart is," Griggs explained."
They're saying you probably do have to increase the dosage, but it's not as simple as multiplying by weight. They don't really have the testing data to know how much to increase the dose. Chemo is poison-- it's intended to kill cells, and it's really, really easy to kill too many and end up killing the patient. A huge number of the people who "die from cancer" actually die from chemo-- it's all a carefully calculated gamble, and *anything* that messes with the calculation raises the odds that you'll lose that gamble.
Fitness Minutes: (29,643)
1,823 9/21/13 3:56 A
The standard doses on OTC medicines are considered to be safe for the average person. But, there have been a lot of reported cases where people say they took the recommended doses and still ended up with complications. M.y advice is no matter what your size follow the label directions and your doctors advice
I wish it was as easy as saying the average dose for an average person is x so if someone is twice the size of an average person than the dose is 2X.
Unfortunately, the side effects of taking 2X can be lethal. Using your example of aspirin. Take too much and you can cause severe bleeding and renal failure. But how much is too much? Does it metabolize faster in a larger person? Slower? Is the bleeding risk the same? Will the same dose prevent clotting like it would in a smaller person? Will the average dose cause the same stomach irritation in an overweight person as it could in an average person?
Ibuprofen and acetaminophen are drugs that are given in weight based doses for kids. If you gave it in weight based doses for adults, the doses for morbidly obese people would be large enough that they would cause liver in an average size person. Would they cause liver failure in the obese? Probably, at least that's what the reports are demonstrating.
Antibiotics are sometimes given in weight based dose ranges and sometimes in standard doses. Going higher on lot of antibiotics can cause liver failure, hearing loss, c. difficle infections. Will the average dose work as well? Usually it seems to. Would a larger dise work better? Maybe. Would the larger dose cause more side effects? Probably. Does anyone want to risk it? not really.
As for office furniture, it doesn't surprise me that they don't have larger sizes in a lot of places. If you think about it, most doctors offices are furnished when they open the doors for business and are not updated very often. It's expensive to refurbish a lobby. When they add something new it's usually a TV or a computer screen that they can put messages on.
New offices usually have larger size furniture and are more likely to have larger sized equipment. But every piece of large sized equipment like exam tables, blood pressure cuffs etc costs a lot more.
There are a couple of OB/GYNs in Florida who made the news a couple of years ago by refusing to treat the morbidly obese. They said their office did not have exam tables and other equipment to treat them safely and that the risks involved in the pregnancies and surgeries wasn't worth the cost to update their offices as it cost them more to treat than they received in payments.
I also think it is a scary world out there medically, for people of all sizes, because dosages, diagnostic techniques and over the counter meds should (IMO) all have weight factored in and I have noticed that it really doesn't.
The Idea that dosage and treatment are affected is frightening. I am amazed at waiting rooms in many doctors offices where the chairs either have arms or can't hold a morbidly obese person...don't they know better.
but I have a question.....should the dosage on Over The Counter medication (like aspirin) be based on weight instead of age ...and should someone assume that the dosage is for a 150 pound adult.????
Fitness Minutes: (29,643)
1,823 9/21/13 12:56 A
This was also posted on an earlier thread.
What people have to remember is that many drugs were originally tested on healthy white males who were of normal weight. They were not tested on women, children, blacks etc. So dosages and effectiveness were based on those tests.
Testing on newer drugs is done on a more diverse range of volunteers. But, many people such as the very obese are disqualified from the testing due to their many health problems. How do you know if something is a side effect or just a normal flare of a disease process?
Pregnant women and children are also disqualified as who wants to assume that risk?
The "obesity epidemic" has outpaced medicines ability to keep up in many ways, not just drug dosages. Many facilities do not have beds that are large enough, or wheel chairs, or MRI's. Rescue helicopters can't carry the very obese nor can many of the older ambulances.
Hospitals, drug companies, fire departments and ambulance companies are playing catch up. Trying to order equipment (and pay for it), trying to figure out safe dosing, trying to fi gure out how to safely operate on a 500# person when the breathing tubes are too short. Trying to figure out how to roll a 350# person from their side to their back in order to do CPR. There are so many difficulties associated with caring for the very obese, many of which have been identified but not resolved.
It's a scary world out there.
Fitness Minutes: (215,800)
7,685 9/21/13 12:17 A
Fitness Minutes: (76,885)
2,953 9/20/13 5:56 P
Wow definitely not the same in Canada. I checked with my brother and he (doctor) said that they base dosage on weight where he works in the EAST Coast of Canada....
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