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The Middle East's obesity woes are putting a strain on hospital equipment - and finances.

For hospitals, fat has become an economic issue. The obesity epidemic in full swing across the Middle East is forcing facilities to supersize their spending on equipment to take the weight of bariatric patients. For smaller hospitals, these purchases represent a significant cost. At the cheaper end of the scale, bariatric manual wheelchairs come with a price tag of US$3,000.

The standard version is nearer to $600. "That sort of equipment doesn't come cheap," says David Hadley, manager of City Hospital in Dubai, "and it's not a one-off thing for the odd-patient. We are providing it to some degree in the majority of our facilities."

Obesity has jumped threefold in the Middle East since 1980. The International Obesity Task Force (IOTF), a London think-tank, now finds 59.8% of women obese or overweight in the United Arab Emirates, 75.8% in Saudi Arabia, and 62.4% in Bahrain. These numbers will only increase, as will the percentage of obese patients presenting to hospitals.

Still, hospitals are lagging behind the curve. Maurice Faber, head of Siemens Healthcare, Near and Middle East, believes most facilities are unprepared to receive bariatric patients. "I'd say hospitals are only just starting to see it as an issue," he suggests. "Many don't have the equipment to accommodate these patients, because standard product lines aren't designed with that weight capability."

Weighing the cost

This is not just a manual handling issue. Only a handful of facilities have CT and MRI scanners large enough to fit obese patients, or transducers that penetrate deeply enough for a clear scan. As a result, images can be hard to read; like "shining a torch in fog" according to one radiologist. For patients already difficult to examine clinically, it's another diagnostic hurdle.

NMC Specialist Hospital, Dubai is the only unit in the UAE to have installed the Siemens Somatom Definition CT scanner. It can support up to 400lbs, and its dual-source scanner creates fast, clear images, even with bariatric patients. It's proved a solid investment for NMC. Rival hospitals have gone so far as to fly in morbidly obese patients to use the scanner, reveals Faber. "The referring hospital didn't have the technology to diagnose the patient themselves."

It's not that hospitals are unwilling to upgrade, more that the cost is prohibitive. In the UK alone, National Health Service units fork out almost $20m a year on bariatric equipment. America, which has been grappling the obesity issue for longer than most, still only has 5% of hospitals truly equipped for morbidly obese patients. Curtis Summers is the CEO of one of them; the Foundation Bariatric Hospital, Oklahoma.

It's a small surgical hospital, entirely devoted to bariatrics and - despite its location in one of the world's heaviest nations - something of a rarity. Community hospitals, argue Summers, would still rather sink their funds into treatment centres that tackle the comorbidities of obesity, rather than pay up to treat the disease itself.

"Three major hospitals in our area have shut down their bariatric programmes and cost has certainly been a factor," he admits. "They are not well-equipped - not just from a basic equipment side, but from radiology, operating tables, stretchers, the chairs in the waiting rooms."

A nearby university hospital has just spent $7m on a diabetes centre. "That's seven million dollars to medicate people who, if they could lose 100lbs, wouldn't need medication anymore," he says in disbelief. "The cost there is much higher than the value. If hospitals could accommodate these patients, it would be the less expensive option in the long run."

For new-build facilities, David Hadley believes the price tag is cheaper, but only just. "Newer hospitals are set up for obese patients. The way the rooms are designed, the beds you purchase at the outset. It's cheaper than having to upgrade the existing equipment in an older hospital."

Even so, City Hospital has invested in only a limited number of bariatric-capacity products, including a number of electric reclining beds that can hold up to 460lbs. "We won't buy these for every bed, because it is just too expensive," Hadley explains. "Probably three or four times as expensive as a standard bed."

Tipping point

Whatever the cost of bariatric products, it's outweighed by the potential cost of staff injury through inadequate equipment. Nursing ranks among the top 10 of at-risk occupations for back injury, and staff are feeling the strain of the obesity crisis.

Lori Larson works as a nurse supervisor on the Mayo Clinic Rochester's bariatric programme. Without specialist equipment, her job would be "nearly impossible", she says. "It's vital, not only for the patient's safety, but for the staff's safety. There is a high potential for injury."

Mayo's bariatric programme goes hand-in-hand with a workgroup dedicated to sourcing equipment for the unit. The ward itself is specially designed for heavier patients. It boasts wider doorways, expanded capacity rooms and beds with expandable partitions. The unit is in the process of having a ceiling lift installed in the rooms, creating an easy track between the bathroom and bed.

The halls sport a walking track so postoperative patients can be hoisted in a sling and moved. "When patients are larger with post-op pain, you never know when they might pull on you," Larson notes. "Overhead lifts are just a safer option."

Anecdotal evidence suggests these pieces of kit could become standard for hospitals in the next few years. Larson reports a surge in demand from other units for higher capacity equipment; so much so that the hospital plans to invest in a general pool for facility-wide use. "There is such an increase across the spectrum of care; whether it's cardiovascular or family medicine; they're all reporting an increased weight patient."

This buyer demand is fuelling a growth boom in the bariatric equipment market. From blood pressure cuffs to waiting room chairs, obesity is reshaping hospital care. Industry analysts Frost & Sullivan estimate market revenues for bariatric equipment in the US alone will hit $522.2m by 2012, with an annual growth rate of 17.3%.

These figures are partly why product companies are keen to keep bariatric equipment specialist, even as obese patients become the norm. "It's an added cost to build equipment to withhold 900lbs rather than 250lbs, and firms want to capitalise on that," insists Curtis Summers. "We're a long way from high-capacity equipment becoming the standard, so hospitals have to factor the added costs into their budgets."

Getting behind obesity

Score the average BMI of a Middle Eastern resident against the number of bariatric-ready hospitals and one thing is clear; patients are changing and hospitals aren't. A straw poll of UAE hospitals, for example, locates only one with a full-time bariatric programme. It's an interesting predicament for an industry that spins on supply and demand. Theoretically at least, obese patients need more care. Yet studies have shown they receive less; particularly when it comes to preventive services. Why?

For Summers, it boils down to one answer. "Obesity is the last form of acceptable discrimination," he shrugs. "Staff don't want to treat them, family physicians don't want to manage their drugs or problems; hospitals don't have the equipment or facility to take care of them."

Unsurprisingly then, obese patients are reluctant to seek treatment. The disproportionate number that present in the ER should be a wake-up call to physicians, Summers argues. "These hospitals will take care of these patients regardless. They will either help them to buy in and take control of their health, or they'll show up in the ER.

"You'll treat them anyway, but just in a crisis situation - and that's more expensive in the long-run."

There is, of course, a supreme irony, in an industry that profits from healthcare but refuses to capitalise on its most lucrative market. Hospitals, it would seem, can't see past the short-term outlay on equipment to the long-term revenue. If private hospitals are to survive, concedes David Hadley, they'll have to ditch their reluctance.

"Like anything in business, you have to provide the service the community is demanding. Yes, it is costing us to provide these services and equipment, but it is also providing an income.

"You don't want to sound like a money-making racket, but you recoup the money as an obese patient is generally sicker than a non-obese patient."

As Summers' fiscally-healthy facility shows, hospitals that court bariatric patients effectively are tapping into a growth industry. He ascribes its success to tactful staff and a well-planned hospital that allow patients to feel comfortable. All hospital employees undergo sensitivity training ("embarrassment is the first and biggest hurdle for patients"), and the building is tailored to help patients feel comfortable.

The hospital gowns fit. The blood pressure cuffs are the right size. As a result; "Patients are happy to attend and be treated," insists Summers. "It's not the community hospital, where they don't fit in the chair and the staff are rude. There are 10 other people here the same size in the same situation, and they can get the help they need."

On balance...

Obesity is fast becoming an irreversible trend. Bariatric patients are presenting new challenges to hospitals, and new market opportunities to equipment firms. As analyst firm Frost & Sullivan noted dryly in a report, the bariatric market is expanding almost as quickly as waistlines. The question now is whether regional hospitals have the inclination - and funds - to keep up.

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