As a man living with obesity, 50-year-old Marty Enokson has dealt with his share of public humiliation.
In 2009, complications from weight-loss surgery forced a return to hospital in Edmonton, where he shared a room with three other patients. At that point in his life, Enokson weighed 470 pounds.
When he told the attending nurse he needed to go to the toilet, he says she told him he couldn't.
"I was told that I could not use the bathroom because I was too fat for their toilet. I would break their toilet," Enokson says.
Instead, he says, the nurse had something else in mind.
"She said, 'Well we're going to set up four fabric walls, and we're going to bring a commode into the room, and you can go to the bathroom behind the fabric walls.'"
For Enokson, it was the most degrading experience of his life, and after continued complaining, he was moved to a private room.
"Historically, people with obesity have not been valued," says University of Alberta researcher Mary Forhan. "Their voices haven't been heard."
Forhan, an associate professor in the department of occupational therapy, is researching how Canadian hospitals care for patients with obesity, and whether they're unable or unwilling to provide proper treatment.
The study is looking into challenges for such patients in acute care, cancer, cardiology and rehabilitation.
Hospitals need to adapt
"Over the past decade, the issue has become more and more prevalent, with more and more people living with obesity and coming in for health-care services, but the system doesn't respond as quickly as we need to," Forhan tells CBC News.
"As a clinician it was really clear we were not trained properly or had the proper equipment available to us to be able to provide good quality care for patients coming in who were also living with obesity," she says.
Obesity is a chronic disease and is linked to other diseases such as diabetes, hypertension, heart disease and arthritis.
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Critical care specialist Dr. Michael Warner has experienced the challenges first-hand at Toronto's Michael Garron Hospital, where he's worked in the intensive care unit for the past decade.
"I can tell you that for the population I care for, critically ill patients, patients are generally larger, and their relative size is bigger than they were in the past," he says.
According to the Canadian Obesity Network more than 1 in 4 adults in Canada has obesity.
For Warner, it's a worrisome trend.
"When patients are of certain dimensions, it becomes harder for us to assess them effectively, to examine them, to even do tests on them that can help us establish the appropriate diagnosis, and then subsequent treatment," he says. "So everything slows down. Diagnosis.Treatment. And we're also not sure whether the treatments that we're using, specifically medications, are dosed appropriately for a patient when they are of a certain size."
That's because there is little obesity research to guide them when it comes to proper dosage. Warner says doctors are having to use "clinical intuition" instead.
Another obstacle is imaging machines, which are manufactured for standard-size patients, so most patients with obesity can't fit in them.
"We're almost working with one arm tied behind our back in the era of modern medicine," Warner says. "We're not able to use all of the tools in our armamentarium to provide patients with the most effective way to determine the diagnosis and any effective treatment."
The consequences can be fatal, he says.
Sturdier toilets and bigger beds
But slowly, hospitals like his are becoming more sensitive to the changing size and shape of patients.
Some of the patient rooms come equipped with sturdier stainless steel toilets rather than porcelain ones. Doorways to some rooms are wider. Beds are bigger and can hold a weight capacity of 1,000 pounds. Some wheelchairs have larger dimensions, and blood pressure cuffs accommodate patients with larger arms.
Each floor of Humber River Hospital in Toronto has rooms designed specifically for patients with obesity, including one room in the maternity unit. MRI and CT scanners are larger, too.
At the University of Alberta, where professor Forhan conducts her research, a state-of-the-art bariatric specialty suite is used to train health-care workers to care for patients living with obesity. It includes wider hospital beds, stronger ceiling lifts that can easily and safely move a patient strapped in a sling from hospital bed to shower to toilet.
Forhan sees this as an important part of her work, eliminating the stigma and so-called fat shaming of patients.
"It really provides education about obesity and gets obesity recognized as a chronic health condition. It deserves the same value and the respect that other chronic diseases do."
Her group is currently developing "best practice" guidelines that would improve hospital care for patients with obesity. The guidelines are expected to be available early next year.
For a time, Enokson was so fed up with the kind of medical care he got that he avoided hospitals and doctors.
Now, he's a passionate advocate for people living with obesity, volunteering his time at the University of Alberta as a real-life mannequin and helping train Canada's future doctors and other health-care workers.
"We don't want anything special," he says. "But we want to be treated and given the same treatments that other individuals that are normal sized have access to."