Obese Patients Increase Need For Specialized Medical Care

The issue goes beyond girth to medical efficacy. Although an open MRI machine can accommodate an obese person, its penetration and focus often suffer. A higher energy level is required to bore through all that tissue and "produce a clear, clinical image with a diagnostic value," Boleyn said.

Obese people may face similar problems with ultrasound, mammography and electrocardiogram tests. They may avoid regular health care because of embarrassment, caustic physician comments or transportation difficulties. No matter the reason, the implications can be serious.

Even with comprehensive care, extreme weight heightens the risk of diseases and disabilities, including diabetes, hypertension, osteoarthritis and sleep apnea.

Two years ago, Duke University's medical school became one of the first in the country to start an "obesity management course" for its aspiring physicians. The professor who created the month-long rotation said the traditional medical curriculum offered little exposure to obesity or its treatment.

Much continues to lag, however. The Irish study released in late November may have determined that participants were getting inadequate drug doses because needles could not reach the buttocks muscles, but it did not look at whether the drug quantities being administered were adequate for people's weight.

Clinical trials are rarely conducted with severely heavy people, and extrapolating and adjusting dosages can be difficult, noted Morgan Downey, executive director of the American Obesity Association. "There's just a lot of uncertainty as to what to do," he said.

For most of his 66 years, Washington lawyer Michael Berman has confronted weight and medicine -- as a patient. He has been as much as 332 pounds fat, the word he always uses, though he's currently in the slimmer 230s. "I've never trucked with doctors who were the least bit put off with my size," said Berman, whose soon-to-be-published autobiography, "Living Large," likely will make that clear. Still, he has had to put up with health care along the way.

There was the knee surgery when he had to be bent over the edge of the operating table and "stretched" so the anesthesiologist could locate the right spot for an epidural needle. A kidney biopsy nearly didn't happen because of concerns that his adipose would keep a crucial line from its destination. To this day, any time a nurse takes out a regular blood-pressure cuff, Berman takes charge.

"The problems," he said, "are real."