Fairfield Ambulance Inspector Audie Yousif with the bariatric ambulance, used for obese patients. Credit:Anthony Johnson The hospital's bariatric rooms are fitted with a ceiling mounted hoist that can automatically lift a patient from their bed and transport them into the bathroom, where there is a reinforced toilet and extra-wide shower chair. The hoist can manage a patient weighing up to 500 kilograms although nurse unit manager Tracy Heath says they are yet to treat a person of that size. Bariatric commode chairs can take a weight of up to 300 kilograms and are 20 centimetres wider than standard chairs and bariatric wheeled walking frames can manage a capacity of 227 kilograms. The ward's bariatric scales go up to a weight of 450 kilograms. Staff at Campbelltown Hospital have formed a working party of physiotherapists, occupational therapists, nurses and other allied health professionals to navigate the best way to treat obese patients.

Erin Wagner, Rebecca Donnelly and Louise Bourrigan demonstrate the patient transfer hoist at Campbelltown Hospital. Credit:Brendon Thorne Like every public hospital around the country, Campbelltown is feeling the brunt of Australia's burgeoning weight crisis, with 63 per cent of the adult population overweight or obese, up from 56 per cent in 1995. "The new normal is to be overweight or obese," the Obesity Policy Coalition's executive manager, Jane Martin, said. She said health departments not only had to spend more on infrastructure and equipment to accommodate larger patients, but their treatment costs were often higher than patients of a healthy weight.

"Obese patients are more complex," she said. "They are more likely to spend more time in hospital, they require more staff resources, they are more expensive across the board. We know where the cost is going and it's going to continue to increase." The health system will eventually be crushed by this. Jane Martin, Obesity Policy Coalition According to data from NSW Health, almost 40,000 hospital admissions were due to high body mass in 2013/14. "The health system will eventually be crushed by this," Ms Martin said. "I think the federal and state governments will have to respond because it won't just play out in the health system, it will play out in the workforce in lost productivity." Research by KPMG Econtech for Medibank Health Solutions put the direct cost of obesity in Australia at $1.3 billion, with indirect costs of $6.4 billion.

Globally, obesity ranks third behind tobacco and armed violence, war and terrorism with a cost burden of $2 trillion, according to analysis by McKinsey. Professor of health policy at Curtin University Mike Daube warned of obesity-related budget blowouts as the public health system responds to the problem. "We are seeing significantly increased costs now," he said. "It means other areas will suffer. The health budget is finite. Unless the root cause of obesity is addressed, this will lead to immense headaches for health budgets and administrators in the future." He said obesity should be tackled with a similar strategy to tobacco control, with Australia on track to have smoking rates below 10 per cent in 2018.

"Tobacco shows the art of the possible," he said. "Obesity is where tobacco was 30 or 40 years ago. We know what needs to be done but at the moment we're treating all the symptoms rather than the cause." 'It's a vicious cycle' At 107 kilograms and 160 centimetres tall, J-Alice Hofler describes herself as "grotesquely obese". The Dee Why woman has struggled with her weight since childhood, managed to shed 35 kilograms on three occasions but always re-gaining the weight. Arthritis, two knee replacements and a 2013 hip replacement have prevented her from enjoying her preferred exercise – horse riding – although she still manages to climb the stairs to her apartment and walk each day. "I haven't been able to exercise much at all and I have gained back everything I have lost before," she said.

"I was quite an active person but without riding I can't lose weight. You need to lose weight in order to ride. It's been a vicious circle." As is the case with many people who are obese, Ms Hofler's weight problems started in childhood but she managed to keep it in check due to her love of physical activities such as competitive horse riding and skiing. The retired senior public servant blames a combination of lifestyle and psychological factors for the weight gain. "I was a Coke addict – but a legal one," she said. "And if you have a packet of Peanut Butter M & Ms, it makes up for an awful lot of things." She has tried dieting over the years, cutting out sweets, increasing her vegetable intake and trying to only eat when hungry but "the weight always crept back on".

At 75, she has developed a degree of acceptance about her weight although she acknowledges its impact on her health. "My obesity slows me down but it does not stop me," she said. "I'm still fairly mobile. There are 42 stairs from the street to my door and 52 from the garage. I say the day I can no longer climb the stairs is the day I jump." Specialised vehicles to transport obese parents In previous years the local State Emergency Service or NSW Fire and Rescue staff would have to be called in if a patient was too big to be moved safely by Ambulance Service of NSW workers.

The service now has a fleet of vehicles designed to transport larger patients and minimise the risk of injury to ambulance staff. There are 10 multi-purpose vehicles (MPVs) designed to carry a patient weighing up to 300 kilograms and two bariatric ambulances ,which can take a person weighing up to 500 kilograms. "They are highly specialised vehicles," Ambulance Service of NSW senior manager of fleet and equipment Rick Hamilton said. "Fortunately, there are not too many patients in that weight category and we usually know who those patients are and where they live." The vehicles come with technology adapted for heavier patients such as a powered stretcher which can load a person into the vehicle automatically. "The last thing we want is people getting back or shoulder injuries from moving patients," Mr Hamilton said.

"The vehicles have equipment that enables staff to move patients safely. It's very clever technology. Expensive, but clever." As well as the price of the $152,000 vehicles, there is also the cost of training staff how to use the specialised equipment. NSW Health statistics show demand for the vehicles has increased with 1261 patient transports in 2013/14, up 16 per cent from the previous year.