Appetite and weight changes are commonly occurring symptoms of depressive illness. The occurrence of these symptoms may not only be related to depressive mood but may also be related to body weight.

To examine the relationship between symptoms of depression and body weight.

Symptoms of depression were assessed by the Montgomery-Asberg depression rating scale (MADRS) in 1694 patients seeking medical help and fulfilling DSM-IV criteria for a major depressive episode. The level of anxiety was evaluated by Covi’s anxiety scale. Body weight was expressed as body-mass index (BMI, kg/m2) and treated both categorically and continuously.

The total MADRS score was not statistically different across the four BMI categories (underweight: 32.3 ± 0.6, normal weight: 30.9 ± 0.2, grade 1: 30.6 ± 0.3, and 2 overweight: 30.6 ± 0.6, P = 0.053 (NS)). In women with BMI ≤ 18.5 kg/m2 MADRS was significantly higher than that in other BMI categories (underweight: 32.4 ± 0.6, normal weight: 30.6 ± 0.2, grade 1: 30.6 ± 0.4, and 2 overweight: 30.6 ± 0.6: P = 0.036). Increasing BMI was related to a linear decrease in symptoms “Reduced appetite” (P < 0.0001) and “Pessimistic thoughts” (P < 0.003). The presence of melancholic or atypical features was not associated with lower or higher BMI, respectively.

In patients with major depression higher body weight is likely to be associated with less reduction in appetite and less pessimistic thoughts.

Obesity is a growing epidemic in the United States with increasing burden to the health care system. Management and transport of the morbidly obese (MO) pose challenges for Emergency Medical Services (EMS) providers. Though equipment and resources are being directed to the transport of the obese, little research exists to guide these efforts. To address this, the author of this study sought to assess EMS providers’ perspectives on the challenges of caring for MO patients.

An anonymous, web-based survey was distributed to all active providers of prehospital transport of a large, urban, fire-based EMS system to evaluate the challenges of MO patients. The definition of MO was left up to the provider. This survey looked at various components of transport: lifting, transport time, airway management, establishing intravenous access, drug administration, as well as demographics, equipment, and education needs. The survey contained yes/no, rank-order, and Likert scale questions. Data were analyzed using descriptive statistics. The study was approved by the University of Miami (Miami, Florida USA) Institutional Review Board.

Of survey participants, 71.9% felt the average weight of their patients had increased, and 100% reported to have transported a MO patient. Of calls made to EMS, 25% were only for assistance in the house and another 25% were for non-emergent transport to a health care facility; shortness of breath was the most common emergent complaint. Of specific challenges to properly care for MO patients, 94.4 % ranked lifting and/or moving the patient highest, followed by airway management, intravenous access, and measuring vital signs. A total of 43.8% of respondents felt that MO patients require at least six to eight EMS personnel to transport patients while 31.8% felt more than eight providers were necessary. Greater than 81.3% felt it would be beneficial to receive more training and 90.4% felt more equipment was needed. Of participants, 68.8 % felt that MO patients did not receive the same standard of care.

Surveyed participants reported that patient’s weights are increasing with all having transported a MO patient. Despite the majority of transports being for non-emergent problems, providers felt more training would be beneficial, that equipment available does not meet needs, and that the MO pose challenges to appropriate patient care.

CienkiJJ. Emergency Medical Service Providers’ Perspectives towards Management of the Morbidly Obese. Prehosp Disaster Med. 2016;31(5):471–474.