How obesity is reshaping our world

Room for a small one? Waiting rooms need space

Ambulances are the latest vehicles to face up to one inarguable fact - as a nation, we are getting bigger and that poses a huge design headache.

You can't move nowadays for warnings about rising obesity levels - as a result of which, ironically, the advice suggests we need to be moving more and eating less.

As experts continue to warn of increased health risks including heart disease, diabetes and some cancers, the world around us is having to change shape to accommodate our changing shapes.

It emerged this week that ambulance services across the country are having to revamp their fleets to cope with heavier patients.

"A few years ago, probably only 10 years ago, your average patient was 12 to 13 stone - now that's probably 17 to 18 stone. And we quite regularly see patients around 30 stone in weight and even bigger than that," says Nigel Wells of West Midlands Ambulance Service.

The specialist equipment being stocked includes heavy-duty wheelchairs and stretchers, inflatable cushions for lifting patients, while ambulance tail-lifts are being reinforced.

Many services are also buying specialist "bariatric" ambulances, at a cost of up to £90,000 each, equipped with double-width trolley stretchers and capable of carrying patients weighing up to 50 stone.

Many hospitals have had to take similar steps, investing in stronger beds and chairs, wider body scanners, and longer surgical instruments for use on obese patients. One NHS board in Scotland has spent more than £20,000 on three beds that can support people weighing up to 78 stone.

And there are other examples of the way our environment is adapting to handle a growing load.

Airlines

Just as the US has infamously led the way in the world in terms of obesity, its airlines have pioneered tough policies toward bulky passengers.

Big mistake: Southwest Airlines incurred the wrath of popular film-maker Kevin Smith

Several US airlines charge passengers for a second seat if they cannot fit into one.

This has been a longstanding policy at Southwest Airlines, which imposes the charge if a passenger cannot comfortably lower the armrests on their seat.

The airline generated headlines last year when it barred from a flight American film director Kevin Smith, who used his Twitter account to complain about being branded a "safety risk".

As well as the issue of their own and neighbouring passengers' comfort, there are concerns over overweight people's swift evacuation and possible hindrance of others in an emergency.

Gary Davis, Fellow of the Institute of Ergonomics & Human Factors, has been working on cabin design with airlines for about 15 years.

"He says that research into seating materials had allowed seat backs to be made thinner, increasing the space a passenger has up to the back of the seat in front."

"So you effectively increase cabin space without losing any seats, so you get the same number of seats in the aircraft but give the customer a better experience - it's a win-win situation if you can achieve that."

The more pressing problem - literally - of overweight passengers encroaching on neighbours' seats, was far harder to tackle, he says.

"In terms of the width of economy-class seats on commercial airliners, there's not much you can do without going to the extreme of taking out whole lines of seats - and I can't see airlines doing that very willingly."

In 2009, Irish budget carrier Ryanair announced it was considering a "fat tax" on its largest customers. The idea, widely seen as a publicity stunt, was never implemented.

Theatres

When London's Royal Festival Hall went through a £71m refit in 2004, more than 100 seats were removed to give audience members extra room.

This is typical of space problems now being experienced by a generation of theatres built about a century ago, when, according to the Theatres Trust, people were not just lighter on average but also about four inches shorter.

"Old theatres are probably one of the worst places where seat width and seat pitch are really tight," says Mr Davis.

Last year, a US report suggested that between 1900 and 1990 the average width of an American theatre seat expanded from 19 to 21 inches - then had increased another inch in the 20 years after.

Modern auditoriums held half the number of people as similar-sized spaces around 1900, the report added. And the bottom-line is all about those bums on seats for theatres.

On top of the costs of renovating venues for the 21st Century, they face the possibility of reduced revenue from fewer seats - while the public bears some of the burden with higher ticket prices.

Sports stadia

Facing similar pressures of cramming high numbers of people on closely-packed seating for prolonged periods are sports stadia.

The new Wembley stadium, which opened in 2007, offers seats that are 50cm wide and 80cm deep - 9cm wider and 16cm deeper than at the old Wembley.

"There is more leg room in every seat in the new Wembley stadium than there was in the royal box of the old stadium," the website declares.

Crematoria

Children can be set on the path to a lifetime of obesity before the age of two, a US study suggested last year, making this genuinely a cradle-to-grave problem.

And the challenge of larger and larger corpses is one that has had to be addressed by crematoria in recent years.

Some councils have spent thousands on wider furnaces, according to the Local Government Association. Grieving relatives have sometimes had to travel hundreds of miles to the few venues that can handle over-sized coffins.

The Institute of Cemetery and Crematorium Management has predicted that a large number of facilities will have to be upgraded because of this growing trend.