The Ostomy Files: The Battle of the Bulge and Ostomy Care
A recent meeting in Florida1 included an exemplary presentation on diabetes mellitus. The speaker had a frightening set of chronological slides that illustrated the mounting overweight and obesity epidemic in the US over the past several years and its link to the increase in diabetes mellitus — even in children as young as 8 years old. This is not something new, yet we read more and more that this problem is taking an enormous toll — not only on our health, but also on the economy, our nation’s future, and the healthcare professionals who care for bariatric patients.
Although not a uniquely American phenomenon, Americans seem to be paving this downhill path. My career has given me the opportunity to travel all over the world; everywhere I go, even in third-world countries, I see American presence — in the form of fast food restaurants (some within view of historically significant locations like the Great Wall of China and Tiananmen Square). As an ex-patriot working in Canada, I see the American overweight trend creeping northward. Peoples with traditionally healthy Asian or Mediterranean diets are being enticed by high-fat, highly processed, high-sugar foods, increasing incidence of obesity, heart disease, vascular problems, and diabetes where these diseases previously had been nearly nonexistent.
The 25-year-long Canadian Health Survey (compiled 1997 to 2004)2 studied adults and children between the ages of 2 and 17 years. In 1979, 3% of Canadian children and 14% of Canadian adults were listed as obese. By 2004, nearly 30% of Canadian children and 60% of adults in Canada were considered either obese or overweight. It has been reported3 that the direct cost of obesity in Canada in 1997 (2 years before the Canadian Health Survey began) was more than $1.8 billion (CAD) or 2.9% of the total health expenditures for all diseases. The current nearly three-fold increase in people who are overweight and obese is anticipated to grow costs exponentially.
The US conducted a similar study between 1985 and 2004 — the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.4 The results mimic Canada’s data. In 1991, four states reported obesity prevalence between 15% and 19%; no state had a prevalence rate at or higher than 20%. In 2004, seven states reported obesity rates between 15% and 19%, 33 states reported rate between 20% and 24%, and nine states reported rates higher than 25% (one state sent no data). The trend continues.
What does all this have to do with ostomy care? Everything. A recent book by Susan Gallagher Camden5 clearly illustrates the multifaceted problems relating to caring for the obese patient, subsequently generating questions regarding the impact of obesity on ostomy, wound, and continence care. The book re-affirms the absolute imperative of preoperative stoma site marking to facilitate the ability of the overweight or obese patient to care for an ostomy after surgery and attain some level of normalcy and self-control. Ostomy care providers may have to revisit previous notions about when and how convex ostomy pouching systems should be used: Is a 7-day wear-time a realistic expectation for an overweight patient? Will setting that goal cause more disappointment or a feeling of “failure?” Will colostomy irrigation once again become more mainstream?
The obesity epidemic reminds us of the difficulty associated with healing in the overweight patient or the patient with diabetes. Clinicians should anticipate managing a greater number of open, complex, and/or dehisced wounds, especially in home care. Skin care and prevention, incontinence care and management all become part of the armamentarium required for today’s clinicians. More venous leg ulcers, more arterial ulcers, more diabetic foot ulcers — the numbers will increase, regardless of the clinical setting. For these reasons and others, clinicians must understand what differentiates bariatric care and take action to increase knowledge of appropriate products and services to better help patients deal with their myriad of problems.
The emergence of bariatric medicine is a testament to these facts. Ostomy care is one of many specialties that require extra attention, expertise, and understanding in order to provide quality healthcare to an increasing number of patients.
The Ostomy Files is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ.
1. The Florida Association of Enterostomal Therapists Conference. Port Canaveral, Fla. March 4, 2006.
2. CBC News Online, July 6, 2005. Losing ground in the battle of the bulge. Available at: www.cbc.ca/news/background/fats. Accessed: March 12, 2006.
3. Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH. The cost of obesity in Canada. CAMJ. 1999;160:483–488.
4. CDC Behavioral Risk Factor Surveillance System 1985-2004. Available at: cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm. Accessed: March 12, 2006.
5. Gallagher S. The Challenges of Caring for the Obese Patient. Edgemont, Pa: Matrix Medical Communications;2005.
