Morbid Obesity in Disasters: Bringing the “Conspicuously Invisible” into Focus

Abstract

It is a frightening reality for some people to be caught up in the midst of a disaster, alone and vulnerable due to their relative size, shape or weight. A literature search failed to find any empirical reports of data specific to body mass index (BMI) in disaster situations. A handful of largely anecdotal reports described situations in which people categorised as morbidly obese were negatively impacted in disasters because of their size and/or weight. While a small number of toolkits and training resources were found, there remains a paucity of research in relation to obesity and emergency planning or disaster risk reduction. This is somewhat surprising, considering the concern about increasing levels of obesity globally. Research is urgently needed to prioritise and address the specific considerations of people with morbid obesity and how communities plan, prepare, respond, and recover from disasters and public health emergencies.

Rising prevalence of BMI ≥40 kg/m2: A high‐demand epidemic needing better documentation

“…Increasingly, changes to care environments are being needed to accommodate larger body sizes, requiring adjustments such as widened doorways, reinforced floors, suitable seats, and larger rooms. Problems featured in the health literature demonstrate the scope of challenges, such as evacuation planning, diagnostic scanning, and positioning during surgery in theatre . Documented requirements include staff training, specialist equipment provision, and development of specialist clinical protocols covering essential areas, such as tissue viability guidance .…”

The care of older adults with extreme obesity in nursing homes: A collective case study

“…Similar issues with inadequate infrastructure have been identified in other countries who are having to consider the costs and issues of retrofitting healthcare facilities to accommodate the specific needs of the bariatric population (36). Renovating existing structures to make them 'bariatric friendly' appears to be the most pragmatic step for nursing home managers to take (36). This may involve remodelling and retrofitting existing buildings to provide extra space.…”

“We only have the one”: Mapping the prevalence of people with high body mass to aid regional emergency management planning in Aotearoa New Zealand

“…Obesity is typically defined by a Body Mass Index (BMI) of greater or equal to 30 kg/m 2 [ 4 ]. High body mass such as weighing ≥150 kg, or having a BMI ≥35 kg/m 2 , are associated with mobility limitations [ 5 , 6 ] and this can make moving and evacuation more difficult in emergency situations [ [7] , [8] , [9] ]. The two highest categories of body mass are the focus of this paper: class II (severe) and class III (extreme) obesity.…”

“…There is a significant gap in research relating to how people with high body mass are considered in disasters despite accounts that people have been left behind in direct relation to their size, shape, and weight [ 8 , [14] , [15] , [16] , [17] ]. While everyone is at risk of harm in a disaster, some people have been identified at higher risk in relation to their particular circumstances before, during, and following a disaster: this includes, but is not limited to, people from socioeconomically deprived areas, adults with severe mental illness, older people, people with chronic health conditions, gender minorities and people with disabilities [ [18] , [19] , [20] , [21] ].…”