Most people who are grossly overweight have probably been told, at some time, that their obesity might be detrimental to their health and that it might lead to their death. Obesity is a major health concern facing the United States today. While it is a worldwide problem impacting people in countries around the globe, data regarding heights and weights indicate the prevalence of obesity has increased dramatically among Americans over the past 30 years. Two out of three adults are overweight, and one out of three is considered obese. The substantial prevalence of overweight and obese individuals is noted among all ages, genders and races; it is a problem that affects the entire United States.

Even more alarming is that the obesity trend is now beginning in childhood. The Center for Disease Control & Prevention reports that almost 17% of children and teens are obese, with the United States making little progress towards reversing the trend. This epidemic is putting our children on a path toward being the first generation to live shorter lives and be less healthy than their parents.

While obesity is partly a result of personal choices, there are also numerous trends that are adding to this growing issue:

  • At no time in history has our food supply been so dominated by processed foods that are so high in fat, sugar and salt.
  • Fresh, nutritious foods are often more expensive than high-calorie foods with less nutritional value.
  • We are less active than ever before – driving rather than walking, spending time in front of the television rather than outside and sitting in front of a computer screen rather than in an active job.
  • The diets that we use to try to lose weight aren’t always effective and result in weight regain.

But now there is another factor in obesity that increases your risk of dying.  For the 446-pound patient in New Mexico, having a heart attack wasn’t the worst thing that happened last April.  Even more harrowing was being turned down by the air ambulance that came to the rescue — because the victim was too big to get off the ground.

Increasingly, America’s growing girth is grounding patients who need emergency help by air.  An estimated 5,000 super-sized patients a year – or about 1 percent of more than 500,000 medical air flights annually in the U.S. – are denied transport because they exceed weight and size limits or because they can’t fit through the aircraft doors.  Experts say the nation’s plus-size proportions – at least two-thirds of adults are overweight or obese – are now forcing emergency medical providers to bolster their fleets, buying bigger helicopters and fixed-wing planes, or risk leaving critically ill and injured clients behind.

Just this spring alone, records show that at least three other patients were declined, including a 460-pound Texas victim who couldn’t breathe, a 444-pound Arizona patient with severe abscesses and cellulitis and a 225-pound Arizona patient who had an infection caused by flesh-eating bacteria and couldn’t be transported by a responding helicopter.

In such cases, the next option is to go by ground ambulance, which can take twice as long – often in situations where every second counts.  A 2011 study in the journal of Academic Emergency Medicine found that patients transported by medical helicopter were a third less likely to die than those who went by ground.

Turning away hefty patients isn’t a regular occurrence, but it happens often enough that flight crews keep measuring tools handy just in case. There have been times that the crew would go into the hospital and measure the patient then measure the tunnel (the entrance to the aircraft) and realize that the patient is just too large to transport by air.

Size limits for patients can vary widely depending on the medical transport operators, the types of aircraft, even the day’s weather. In Seattle, crews start to worry about any patient who is heavier than 250 pounds and wider than 26 inches across.

But other transport firms routinely handle patients who weigh 350 or 400 pounds, or more. At the Duke University Health System, officials with the Life Flight program recently bought two new EC-145 helicopters at a price of between $8 million and $10 million, partly so they could handle patients up to 650 pounds.  Before they got the new rigs, Duke Life Flight patients were limited to an abdominal girth of 44 inches.

Pilots, too, have to weigh the risks of plus-size patients, balancing the bulk of the victims with the forces needed to get the aircraft off the ground. The lift force that allows planes and helicopters to fly varies depending on air density. Denser air produces greater lift and thinner air decreases lift. Air becomes thinner as temperatures increase and the barometric pressure drops.  On a really hot, humid day, you can’t lift nearly as much as on a day when it’s cold and crisp.  So when a patient reported to weigh 250 pounds actually tips the scales at 350, emergency crews have a dilemma. Even if they fly around for 15 minutes and burn off fuel, they may not have enough lift to transport.

The solution, of course, requires a societal shift, including recognition that the health effects of obesity extend even beyond heart disease and diabetes to basic access to emergency care.  This is made particularly clear to Craig Yale, the 57-year-old Air Methods executive, who at 335 pounds could not fit inside his own firm’s aircraft.  He decided to undergoing gastric-sleeve weight loss surgery and eighteen months later, he now weighs 210 pounds.  Today, he’d have no trouble. But Yale said he worries about others who might not realize that so much extra weight could threaten their lives, not just with disease, but with delays in an emergency.

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