Hospitals, Healthcare Costs, and Fat People

Reader May sent a question regarding wider social applications of The Underpants Rule, specifically as it relates to how much fat people “cost”. Here are my thoughts. (The block quote may be triggering although I don’t believe that was May’s intention. You can skip it and you’ll still understand the blog.  I choose to leave the actual question because I think that it makes it easier for some people to relate since they may be asking the same questions themselves.)

As much as I want to fight for the rights of the big beautiful folks (myself included), I do realize that there does come a point when some personal choices do cost others money. Did you know hospitals now have to have much wider beds and chairs (politely called “bariatric chairs”) for their very large patients? More hospitals also have electric lifts and slings to move a patient. And that ambulances have had to get specialized equipment to be able to move the obese? So my honest question is : who do you think should pay for these upgrades?

First, I think that those who take on the job of providing healthcare for the community should be looking for ways to remove barriers to healthcare, not trying to justify them.  The hospital needs equipment for all kinds of reason – to work with premature babies, to have an intensive care unit, to work with children, to work with people who use wheelchairs, and to work with people of size.  They signed up for this when they agreed to provide healthcare to the community.  The idea of “blaming fat people” for being fat as a way to justify not having the equipment that they need to give us healthcare is simply not-very-thinly-veiled bigotry.  Just like they should provide the equipment that people who use wheelchairs need – not ask them why they are in a wheelchair and then deny them help if was “their fault.”  Also, just for the record, they don’t need a “polite” name for a chair that fits my fat ass, they can just call it a chair – that’s what we call it at my house.

There is a sentiment here that body size is a choice and that it is changeable, and that people can choose whether or not to “accept” fat bodies, with which I disagree.  It is absolutely true that bodies come in many different sizes for many different reasons, there is evidence that weight is as heritable as height and research suggests that body weight is almost impossible to change long term.  In the end, it doesn’t actually matter why someone is fat – the hospital has taken on the job of providing healthcare to the community and they knew that the community included fat people when they took on that job, and so my question isn’t should they get the equipment they need to treat fat people.  My question is why wasn’t this factored into their business plans and cost of doing business in the first place?   I believe that they are responsible for having equipment to treat their patients of all sizes and needs.

I think that any time we try to identify a group of people based on how they look and then calculate their “cost” on society and/or figure out what we can blame them for,  we are going the wrong direction.  Our culture has taken to attempting to calculate the cost of individuals and figure out what we can blame people for as an excuse to deny healthcare or services in order to create the highest possible profits, even if that means that some people are completely unable to access healthcare. Next will they refuse to treat people whose issue can be considered their fault – they didn’t follow proper ladder safety, they were thin but sedentary,  they tried to do their own electric work etc.

I think our time and energy would be better spent working on access –  helping make sure that everyone has access to food options, safe movement options if they want them (that includes physical and emotional safety – if every person can’t go to the pool in a swimsuit with total certainty that they will not be shamed or bullied then we are failing to provide safe movement options,) and access to evidence-based healthcare that is affordable for each person.  At the end of the day, I think it’s important to remember that if equal rights and access seem to inconvenience others then it’s typically safe to assume that those other people have very likely been benefiting from the current situation, and that includes hospitals that have higher profit margins because they simply didn’t purchase what they need to serve patients of all sizes.

Healthcare should be about health not about finding ways not to provide healthcare.

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23 thoughts on “Hospitals, Healthcare Costs, and Fat People

  1. My work is now charging smokers $30 more per pay period for their insurance and this is making me furious. Don’t see them charging heavy drinkers more just smokers. Also know this is leading to charging people who’s BMI does not fit the scale more because they are so fixated that only fat people have illnesses. Too bad they did not know my mother who was 5’2″ and weighed right around 100 lbs. yet suffered from high blood pressure, cholesterol was off the scale and had osteoporosis. And her BMI was just fine!

    1. My job charges $20 more per pay period for smokers. We also have to take this stupid ass “health screening” every year. Mine said that I was a “high health risk,” probably mostly because of my BMI. I have mild hypertension which is controlled by medication. But I don’t smoke, drink, or do illicit drugs. Go figure.

  2. It’s not like thinner people can’t use those special beds, chairs, etc. I DO think that if a hospital only has a limited number of them then they should be reserved for the patients who actually need them (i.e. people like me who may not be able to fit in small furniture), but in an emergency or in a hospital where there are plenty of larger beds etc. to go around there is no reason why the enter hospital population can’t use them. Surely there are lots of people of all sizes who would be more comfortable in bigger, sturdier chairs and beds, and hospital staff out there who could benefit from mechanical help when moving any patient (all it takes is moving in just the wrong way to put your back out, even when moving a smaller/lighter patient). The thing is, nobody balks at oxygen tanks for people who need them, even people whose life choices may have contributed to their need for oxygen tanks now. Nobody balks at the need for specialty equipment in specialty fields that many people may never use (e.g. men, and women who don’t have biological children, will never need any of the specialized equipment in an OBGYN unit). Why is it so different when it comes to fat people? Because we’re a socially acceptable group to hate, scapegoat, and discriminate against. Blaming costs is just a smoke screen for the real issues.

  3. I’ve never had a baby, and at this point I’d say the likelihood is laughable that I will… but that doesn’t mean neonatal units aren’t necessary. They are, because babies get born early or under harrowing circumstances that may or may not have anything whatsoever to do with the behavior of the mothers.

    That means hospitals know going in that they will need baby sized equipment and facilities, as well as staff that are trained in their care. Should the cost for that be forced onto the shoulders of panicked and grieving parents?

    I’ve also never had a major head wound. But when my brother was hit in the head with a golf club (a putter, for those keeping track) in a childhood accident, I’m glad there were doctors on staff who knew how to treat him, and beds and assorted equipment that fit a ten year old. He needed it. It was there.

    I also have a husband who suffers from diabetes, heart failure, and severe hypertension… while I actually weigh slightly more than he does (and stand nearly a foot shorter) and have none of the above. I don’t care which one of us needs a hospital bed or a chair to sit in there, or the reason why, it should still be there because we are human beings who sometimes need medical care. Why? Because human beings come in a variety of sizes and shapes and it’s the hospital’s job to make sure there are appropriate resources for anyone who arrives needing medical attention.

    In fact, considering all the medical conditions associated with (and popularly blamed on) obesity, wouldn’t it make more sense for hospitals to have bed, chairs, gurneys, blood pressure cuffs, etc. readily available for us, while thinner people have to ask for a smaller cuff?

    I just thought I’d ask that.

    After all, we’re the ones ‘using up all the health care.’

  4. Twistie makes a super-valid point. It is difficult to see how we can be considered as “bringing up health costs” when there are supposedly more “overweight” and “obese” people than there are “average” or “thin” people. It seems to me that our needs should be considered the “norm” (I am not fond of any of these quantifiers), instead of deviant. Hospitals seriously need to rethink and revise not only their protocols for treating those “over” whatever weight is considered the norm, but their entire concept of “norm.” They need to know that there is a very different “there” there than the one they have been seeing. It simply cannot be seen as a burden to treat most of the population!

  5. Another commenter mentioned that the lifting equipment isn’t used only for fat people, and I wanted to “second” that point. (Which is not to say that equipment serving the specific needs of fat people shouldn’t be available and considered part of normal hospital operating costs.)

    Several years ago, I worked with an agency that promoted a “Zero Lift” program for hospitals. Their goal was to reduce the frequency of hospital staff doing manual lifts of ANY adult patients, since the risk of injury to staff members is so high. I helped them pull together the promotional literature for the program and also the packets soliciting hospital participation in a study to see how much they could reduce patient-handling injuries to hospital staff members. The hospitals that participated in their study showed a 43% drop in patient-handling injury claims and a 50% drop in time lost.

    One of the things I learned from working with that program is how much elderly patients benefit from the use of manual lift equipment. Elderly patients are at higher risk for serious injury if they are dropped during a lift–they are more likely to suffer broken bones and more likely to have difficulty recovering from them. Also, the use of lift equipment helps protect their skin integrity. Elderly patients have thinner skin, and moving, transferring, and repositioning them manually is more likely to cause breaks in their skin.

    1. Right! I don’t think there ‘is’ any hospital equipment that is used solely for fat people. Not even one item.

    2. Exactly! That was in fact one of my first thoughts when reading about lifting equipment, elderly patients are the ones who benefit a lot from that. I have friends and relatives who work in nursing homes and hospitals, and that equipment is so helpful. Patients, regardless of size can be difficult to live, especially when trying to be careful of any injuries and if the hospital is short-staffed so only one staff member is available for lifting the patient.
      Some of the reasons that healthcare costs are increasing are reasons we should be happy about instead of complaining. People are living longer, illnesses that once killed can now be treated or cured, women who wouldn’t have been able to have children in the past now can, and children who are born with certain illnesses or problems survive now instead of dying. While it isn’t pleasant to see costs increase, we should look around at our loved ones. I’m betting we all know at least one person (likely more) who wouldn’t be here if it weren’t for the medical care we currently have. And I think that’s worth the cost increases.

    3. The people that I hurt my back lifting/transferring in long term care over the years were actually not the fat people. They were generally very tall men. There was one fellow, a Parkinson’s patient, who was six foot seven. It took four of us to move him and change his position.
      Small, fragile people can sometimes take two people to move and transfer to in order to avoid damaging their brittle bones. No joke. A tiny person with contractures can be an absolute nightmare to transfer.
      I wish that they’d adapt the No Lift program for the place where I work. I think it would save a lot of backs!

      1. My husband was both tall & heavy. The first ICU he was in, they didn’t bother moving him. He got a horrible bed sore. The second one, he’d have to wait until enough staff were available because they’d have at least 4 of the strongest people lifting him. He’s 6’8″ & 300lbs.

        I wish they’d declare a height epidemic. We could NOT get a bed long enough to fit him, even in the better hospital that’s a major hospital for a huge number of people.

        And semi-OT, he proves, yet again, the “obesity paradox”. Due to being NPO an unjustifiable number of times, he wound up nearly staring to death. He was down to about 160lbs by the time I finally got him to start eating again. If he hadn’t been “fat” he most likely would have died. He looked nearly as bad as my father did in his coffin and my dad died from starvation due to stomach cancer. Oh, and to add insult to injury, the BMI says 180 is “normal” weight for someone my husband’s height. I was freaking out when he went below 200lbs, he looked skeletal.

  6. The nursing home where my mother died needed a sling to move her the last few weeks – and not primarily because of her size. (Actually, if she hadn’t lost 4″ in height to disc problems, she would not have been considered obese – yet another issue with BMI – though the same weight with her original height would have been even harder for the nurse to deal with.)

    They needed it because any motion caused her pain. A few weeks earlier she’d gotten herself out of bed without any assistance – her oncologist thinks the metastasis in the bone shattered her pelvis. The sling minimized the motion.

    A year earlier, she’d gone on a trip to Washington for the dedication of the Women in the Military monument – walked all over the Mall, stood in crowds, was on her feet all day – admitted that, in her 70s, she didn’t have the stamina she did as a young sprite of 65, when she walked to work every day (despite the back/disc problems, and a knee problem…) Her gradual need, over that last year, for mobility assistance, nursing assistance, and finally the sling was caused not by weight or inactivity, but by the cancer that killed her.

    Larger beds and chairs are also sometimes needed by people with casts or orthotics, or after some types of surgery. There is nothing new about that… And, as has been pointed out, when they are not actively needed for one person, they can still be used for another – it’s not as if they are taking up room, or a total waste of money.

  7. Dear fellow fatties, Go watch Tavis Smiley’s interview with Allyson Felix. She resists the bigoted “war on obesity” expression for her own, “fighting physical inactivity.” Very cool.

  8. “Also, just for the record, they don’t need a “polite” name for a chair that fits my fat ass, they can just call it a chair – that’s what we call it at my house.” Best line ever!

  9. I used to have the “big butt chair” at my house (until the fiance broke it trying to stand on it to change a lightbulb *sigh*), but it was called that because its butt (where you sat) was big and bowl shaped NOT because my butt is big. I miss that chair so much because I could curl up inside it with plenty of room left over. I haven’t been able to find a chair like it since!

  10. I agree that hospitals should have equipment available to be able to help everybody. But beyond that, I find it hard to believe that in the grand scheme of things, larger chairs, lifts, etc. actually cost that much.

  11. I hate the talk about how much fat people are “costing” the rest of the world for a couple of reasons. First, we can cite statistics and numbers all day long, but that completely removes any question of the morality of doing so. Morality is one thing that makes us human. We have the ability to do things not beneficial to ourselves because it is the “right” thing to do. Treating all humans as such is moral and right to me. Second, the people that really cost a lot to the healthcare system are old people, period. The bottom line is we will all get old (hopefully!), and we all want cared for, so you don’t hear this nasty talk about just throwing old people out in the street because they are too expensive. In reality all diseases are pretty much associated with age. Cancer incidence is higher as you get older, and if we lived long enough likely everyone would end up with cancer. High blood pressure, diabetes, heart disease, the list goes on and on are all age-associated diseases.

    It just makes me so sad to see us treating people as nothing more than a financial transaction.

    1. Exactly the point that I’ve been making for years–these are diseases of aging. We can see it. Yet these asshats with all the letters behind their names just don’t get it.

  12. I used to work in a hospital and we were not allowed to lift any patient, of any size, without using the equipment. Huge numbers of nurses have to take time off or leave the profession because they have damaged their backs, so the whole NHS says they have to use hoists and slings for all patients. It reduces the risk to the nurse/caregiver but also to the patient. So, at least in that, overweight people are not receiving any sort of special treatment here.
    I like your post, we should not be calculating how much a given person “costs” our countries, the idea is obscene.

  13. the whole “cost” thing really bothers me. The idea “I shouldn’t have to pay for life choices!” makes no sense at all. Everyone has to pay taxes for things that have nothing to do with them, but you do it because you have to.

    Things I (probably) will never need that taxes/hospitals pay for:

    Prostate exams
    holiday programs for kids
    Neo natal care
    lunch programs for poor kids
    streets and bin collection in neighbourhoods I don’t live in.
    dole payments
    drug rehabilitation

    And this is just the top of the list. Should I not pay for these things because they aren’t relevant to me? Of course not! That doesn’t make any damn sense.

    We’re a social society, a tribe, a family, and we need to look after each other. Even if their problems aren’t ours.

  14. Oh man. You start going down the slope of, “I don’t want to pay anyone’s medical costs if their health problems were the result of lifestyle choices,” you ain’t never gonna stop.

    Rural people would be able to veto health care for city dwellers — pollution and stress and crime, yanno?

    Tighty-righties would be able to wipe out the use of antiretrovirals for HIV or hepatitis C (you know how expensive that shit is, especially over 20 or 30 years?).

    Anyone who needed medical attention for a car wreck would have to prove that they had no hand in causing the wreck.

    And let’s not get into all the people who are against fatties but are two-fisted drinkers themselves.

    Lack of sleep is associated with all kinds of health problems; maybe the insomniacs and workaholics should get their health care revoked too?

    And heavens forfend you have boobs and a uterus and don’t have babies while you’re young and then get breast cancer. No healthcare for you, either!

    1. Yeah, I should probably be penalized for being one of those freakish night shift workers. I mean, what the hell is wrong with me, wanting to work THOSE hours? I’m an aberration of nature and should be penalized for it for sure.

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