It would be nice if this problem could be settled without government intervention. It may be that hospitals will need to specialize in the treatment of the superobese just as they do for pediatrics and trauma. This could be done on a regional basis. I have no doubt that much will be learned and outcomes will improve if physicians, nurses, and administrators concentrate their efforts on this population.

Certainly, market forces would move this along if insurance companies, Medicare, and Medicaid would provide extra compensation to hospitals that are willing to take on the designation of being a bariatric hospital.

The superobese present significant challenges for us in the ED, and these patients can monopolize the resources of any department. I encourage every emergency physician to provide the same top-notch care to these patients as is done for everyone else.

Until the equipment and institutional approaches catch up to the problem, the patients may not have access to every service in the hospital.

A tactful explanation of the situation will go a long way to prevent misunderstandings and help the patient to understand that you are doing your best for them. n

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu.