It's impossible for anybody involved in hospitals and health care to avoid the "o" word these days.  America's obesity epidemic is impacting hospitals in everything from clinical training to staffing, from building design to the supply chain. Providers have been spending a whole lot of money to retrofit facilities and processes to accommodate really big patients, and to hire employees whose primary job is lifting and moving patients too heavy for nurses to handle.

Even when I write about obesity with what I consider sensitivity, I get emails complaining that I'm picking on a group of people who already have self-image issues, are discriminated against in the workplace and are continually derided by the media, the entertainment industry, the general public and, in some cases, their own health care providers.

Last year, when I sat down to blog about a hospital in Texas that announced it would no longer hire obese workers, I started with the assumption that it was a perfectly reasonable policy. Don't people who choose to make health care a career owe it to their patients to project a healthy image? But the more I thought about it, the more ambivalent I became. If an employee is doing the job well, should his weight — or, for that matter, any of his personal choices — matter? On the other hand, will patients take advice from somebody who evidently doesn't make healthy decisions in her own life? I ended up asking for readers' thoughts, and over the next several months, I received hundreds of considered and often passionate responses on both sides of the issue, which only deepened my ambivalence.

Lately, I've been tracking related developments, like the American Medical Association's decision earlier this summer to classify obesity as a disease. And reports about physicians who never discuss weight even with their heaviest patients. I've also written about hospitals across the country that have done what they can to encourage healthy habits. They've organized "Biggest Loser" style competitions in their communities; dispatched nurses and nutritionists into classrooms to encourage better eating, worked with schools to develop healthful cafeteria menus, and held wellness fairs, 5K runs and fitness programs. Some host farmers markets or set aside land on their own campuses for community gardens. And, along with government initiatives that require calorie counts on restaurant menus and ban unhealthy foods in school vending machines, some places are seeing an impact; in certain municipalities, the growth in obesity rates, especially among children, seems to be leveling off.

Still, the rates of extreme obesity — comprising people who are 80 or more pounds overweight — are surging. Some researchers found that the number of extremely obese American adults has climbed fourfold in the last several decades. It now stands in excess of 4 million and is expected to jump by 130 percent by 2030.

Two items recently crossed my desk that are a dismaying sign of the times. One was from Elgin, a small city here in northern Illinois. The fire department there wants to buy a $32,000 mechanized ambulance lift that can handle patients who weigh up to 700 pounds. The aim is to reduce the number of fire personnel needed to get severely obese patients to the hospital.

The battalion chief told the Chicago Tribune, "such calls used to be rare, but now come in several times a month, requiring as many as nine emergency responders, arriving in three vehicles, to lift the person into the ambulance."

Then earlier this month, I got a press release from the Brewer Co. about its new "power exam table" — the first, it claims, "to offer a 700-pound weight capacity to meet the demands of an increasingly heavy patient population."

Patients who weigh 700 pounds! Coming to the hospital several times a month! Clearly, we have a problem in this country. Our efforts to reverse the obesity epidemic are falling short. What more can we do?

Once again, I invite your comments and suggestions.