Treatment of overweight patients by the Otago District Health Board is primitive and there needs to be co-ordination between community and hospital services, professor of paediatrics and child health Barry Taylor says.
He was speaking to a report of a project looking at obesity management which found a variety of issues needed to be addressed in Dunedin Hospital, including inconsistent weighing of patients and recording of information, unsuitable scales and no knowledge of the weight limits of much of the equipment used.
About 33% of Otago's population is estimated to be overweight and 23% obese.
The weight limit of some equipment used "could well be challenged, and could possibly have been exceeded by some patients already", the team found.
Last week, the ODT reported two obese patients remained in hospital for weeks because there was no way to transport them home.
The patients had been transported to hospital by St John ambulance when they were in an acute condition, but the service had cited weight and physical dimension as the reason they could not safety undertake the transfers home.
Alternative transport was eventually arranged for them.
Prof Taylor told the board's community and public health advisory committee meeting there were some things which the board was unable to do because of the limitations of equipment.
Bone density scans, for instance, could not be carried out on those over 150kg but this was not generally appreciated.
The report noted that patients were not weighed in all services, and the computer software used did not have a single place where body measurements were routinely recorded and readily available for basic clinical activities, including prescribing the appropriate dose of medication.
Computer software changes were investigated at an information technology meeting, he said.
Prof Taylor would like to see a system which recorded the weight and height in a common place used across New Zealand in community and hospital settings.
The report also found much equipment had no traceable identification.
This meant some weighing equipment was not showing up as requiring regular calibration checks.
The report recommended that all equipment requiring such checks should be included on the asset register.
In some areas, domestic bathroom scales, which were known to be inaccurate and unreliable, were being used.
The report showed general practitioners were collecting body mass index data but noted that few healthcare staff were using this information to deal with issues of obesity.
The report sought oversight of issues related to obesity management, which involved all specialties and involvement of both hospital and community health care providers.
"This oversight is likely to be lost, and the current fragmentation of care [will] continue unless the board makes responding to the obesity epidemic a priority."
It asked that the board initiate a further project focusing on the case management of morbidly obese patients across both hospital and community care settings.
This would include providing client liaison, health promotion and health education as well as undertaking research and acting as a resource for health professionals.
Prof Taylor said if it was felt there needed to be a specialised clinic, then it would need to be resourced, but the team had been advised there would be no money for it.
A national report would be coming out soon which would recommend how childhood and adult obesity should be managed and the board would need to respond to that.
If there was a project group this would be able to lead implementation of the new guidelines and develop the ability of individual services to deal with obese patients entering their services.
He saw any future clinic as an integrated one between community and tertiary care, with the bulk of staffing likely to be at nursing level.
Following discussion, the committee agreed chairman Errol Millar should confer with the planning and funding team to come up with a resolution to the boards on how to proceed which covered both the preventive aspect of obesity and the management of overweight patients.
He had earlier acknowledged that there could be initiatives which would need specific funding.
The report suggested a five-step model of care related to BMI levels.
The bottom level would involve patients who were just beginning to have problems with their weight (BMI of 25 to 30, which is considered overweight) and would involve self-management and support from community programmes, while the top level would be for those with a BMI of 40 or more, who might be suitable patients for bariatric surgery.
Body mass index is calculated by dividing weight in kilograms by height in metres squared. A measurement over 30 is regarded as obese.
