When placing a morbidly obese patient on a stretcher, why should you avoid placing them supine or in full Fowler's position?

• A. Movement of the diaphragm is restricted.
• B. It is more difficult to lift them.
• C. It is more difficult to move them.
• D. The stomach occludes the inferior vena cava.

Answer: (A)

In morbid obesity, how you position the patient directly affects how well the lungs can expand. When the patient is placed supine, the heavy abdomen presses upward against the diaphragm. That limits how far the diaphragm can descend during inspiration, reduces tidal volume, lowers functional residual capacity, and increases the work of breathing. In full Fowler’s position, the chest wall is more upright, but the abdominal mass can still push against the diaphragm and chest, restricting diaphragmatic excursion and limiting ventilation during movement or transport. Because diaphragmatic movement is the key driver of effective ventilation in these patients, this restriction makes respiratory support more difficult, which is why those positions are avoided. While moving them and other concerns matter, the primary issue addressed by avoiding these positions is preserving diaphragmatic motion and adequate ventilation.