In death, a hidden cost of obesity

People were obese in more than a quarter of cases analyzed by the county last year.
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As more Americans tip the scales, the impact of the nation's obesity problem is also felt at the end of life's journey. Funeral homes and the Snohomish County [Washington] Medical Examiner are seeing the trends in weight gain affect how they do their work. More often, bigger cots, larger cremation and embalming facilities, more staff and power hoists are needed to lift and prepare a growing number of deceased obese people.

"It's very important that you treat the deceased with dignity and respect," medical examiner spokeswoman Carolyn Sanden said.

The changes have increased costs for taxpayers and often, for families of the departed as well. "People are getting larger with time," Snohomish County Medical Examiner Dr. Norman Thiersch said. "Unfortunately we haven't had the ability to track it until last year."

Of the cases investigated last year, county officials provided the weight of 326. More than one-fourth - 84 adults - were considered obese based on their body mass index. Fifteen people each weighed more than 300 pounds. The heaviest of the county's cases in 2006 was a middle-aged man who weighed 499 pounds and was over 6 feet tall.

People are considered obese if they have a body mass index of more than 30, according to the World Health Organization. Body mass is a common way to gauge whether someone is overweight or obese using height and weight.

The trend in weight gain was a key factor in the county Medical Examiner's Office request to spend $75,000 for an on-call body transport service this year.

Worker injuries from removal and transport of heavier bodies is an ongoing and increasing problem in the Medical Examiner's Office, officials said.

The injuries have become expensive, staff reports to the County Council said, averaging $16,000 a year since 2003. One open claim is $93,300, officials said.

Officials plan to hire First Call Plus of Washington, called the state's largest body removal, cremation and embalming company. The Kent-based company is run by Jerry Webster, the retired chief investigator from the King County Medical Examiner's Office.

Once Webster's firm is hired, the county's seven medical investigators no longer will have to lift and transport bodies. Instead, they'll be able to focus on investigations, case work and going to the new calls. The county also has spent $18,000 in recent years on larger tables and electric hoists. "To accommodate the larger body, we needed the larger table," Thiersch said.

The county's older, smaller stainless steel tables could handle the weight of a 300- or 400-pound body. However, it was the size of the bodies that proved too large to be properly rolled over and examined, he said.

Crews now use electric winches to pull heavy bodies on stretchers into investigation trucks. Nylon straps and hoists now are used to transfer bodies within the medical examiner offices.

Devices also protect the bodies from unintended damage, which can offend families or obscure evidence of crimes or disease.

The Centers for Disease Control and Prevention estimate 22 percent of adults in Washington are obese and another 36 percent are overweight. Nationwide, an estimated 33 percent of adults between 20 and 74 years old are obese. The national obesity rate has more than doubled from the 15 percent estimated to be obese in a survey from the late 1970s.

Funeral home directors have noticed the trend. "It's not unusual to encounter 300-pound people now, which used to be the exception rather than the rule," said Jim Noel, who has worked 47 years in the funeral home profession and is executive director of the Washington State Funeral Directors Association.

Federal and state worker safety rules have led to more back-saving equipment at funeral homes, including lifting devices, Noel said. Cots are wider and sturdier for carrying obese people and have extra handholds.

The challenges don't end with transportation. About two-thirds of people in Washington state are cremated after they die, Noel said. And as people gain weight, uniquely designed crematory furnaces are increasingly necessary.

Some funeral homes are able to cremate most bodies, but sometimes must contract for larger cremations with Webster's facility in Kent, said Mark Hunstman, managing director at Solie Funeral Home and Crematory in Everett.

Webster's cremation services are often needed when bodies reach about 300 pounds. "We have the equipment to handle these morbidly obese folks, the decedent remains and the expertise in cremating them," he said. He has special cots that cost nearly $4,000 and are able to handle a 1,000-pound body. He also is called for services because he has embalming tables large enough for the morbidly obese.

Webster said he sees families who buy custom-sized caskets for large family members, and the family of one 784-pound woman had to buy three cemetery plots. Cremations for the obese can cost hundreds of dollars more depending on what funeral homes charge, Webster said.

"This whole issue of obesity can be a very sensitive issue to some of the survivors," he said. "One of the biggest concerns from families is, how is this person going to be treated? Is it going to be dignified and respectful? We show a lot of care.

"Our hope and goal through everything is that a large person is handled in a dignified and respectful manner regardless of their size."