I recall that 20 years ago the limit on our scanner at Ohio State was 300 pounds. We rarely encountered someone too heavy for it. When we did, the patient took a quick trip to the veterinary school to be scanned on their large animal machine. (No, they didn’t return with hay sticking out of their ears.) Now we are happy when the patient weighs ONLY 300 pounds. We’ve come a long way.

This raises an ethical question. At what upper weight limit must a hospital’s advanced technology accommodate obese patients? Should table limits be 600? 800? 1,000? One might argue that, while it may not be intentional, hospitals discriminate against the superobese when these services are not available to them. The same could be said of movie theaters, restaurants, and airlines that fail to provide “big boy” seating.

The other side of the argument would be that the expenditure to accommodate a relatively few number of people is overly burdensome to hospitals. Try that argument on any business or municipality that has had to make changes to their sidewalks or entrances to accommodate those with physical disabilities. The Americans With Disabilities Act (ADA) of 1990 is far-reaching legislation that resulted in significant expenditures to benefit a relative few.

Agree with this type of legislation or not, the government has a long history of mandating action that is burdensome (see EMTALA).

In my mind, the question is not if, but when. I predict that the treatment of the superobese will be the next fertile ground for trial lawyers. There will be lawsuits based on discrimination and failure to provide proper equipment and testing facilities.

Some hospitals will make adjustments voluntarily. This could be done out of fear of litigation or the realization that there is money to be made.

Some hospitals might want to avoid the distinction of being the bariatric hospital for the region, which would require them to take transfers on every 401-pound patient who might need a CAT scan.

Eventually, this question will be tackled on a legislative level. It seems likely that someone will propose adding the superobese to the list of people covered by the ADA. The act does not currently apply generally to the obese as it does to someone who is blind or wheelchair bound. If the superobese gain this status, then hospitals would be mandated to make necessary changes.