Specialised beds that cater for patients weighing up to 500 kilograms are among Wollongong Hospital's defences against rising levels of obesity in the region.
Wider wheelchairs and bed-movers that can lift 800 kilograms of bed and patient are among the other items of bariatric equipment that have been purchased by the hospital to cater for super-sized patients.
Even the standard equipment is being upsized - an electronic hospital bed now has an increased weight capacity of 200 kilograms compared to the 150 kilograms an old manual bed could handle.
An Illawarra Shoalhaven Local Health District (ISLHD) spokeswoman said Wollongong Hospital had six bariatric beds and would purchase further beds, and other equipment, on demand.
She said obesity was one factor taken into account when developing new facilities and services and upgrading equipment.
"There are a number of lifestyle diseases, including obesity, which the [district] continues to support and consider when delivering quality services to the community," she said.
"... ISLHD also strives to ensure that all patients, regardless of their condition or circumstance, are cared for safely, in a timely fashion and with their dignity maintained."
However, the region's nurses and hospital staff - whose job it is to care for, clean, move and transport these larger patients - are feeling the strain, according to unions.
"It's a public health issue," NSW Nurses and Midwives Association regional organiser Mark Murphy said.
"While there are robust policies in place around the care of these patients, and specialised equipment is being purchased, issues still arise.
"Larger patients need to be moved regularly to ensure they don't develop deep vein thrombosis or pressure sores.
"The equipment is not on every ward, so it can be time-consuming to locate it and get it to the right location - it's also hard to get the number of human resources needed to safely use it."
Illawarra and Shoalhaven paramedics are sporting back and knee injuries from lifting XL patients, according to their union.
Emergency Medical Service Protection Association president Wayne Flint, who's based in Ulladulla, said specialised bariatric ambulances were scarce and paramedics often had to find their own lifting solutions.
"The concern for paramedics is there's limited equipment available," he said. "Bariatric ambulances are more for transport, they're not an emergency vehicle. So, for triple zero calls, paramedics have to deal with large patients the best way they can with the equipment they've got.
"That might mean utilising canvas sheeting to lift a patient out of a house, or leaving the stretcher out of the vehicle and placing the patient on the floor of the ambulance. You do whatever you can when it's an emergency."
With more than 57 per cent of the population in the Illawarra Shoalhaven Medicare Local (ISML) catchment area estimated to be obese or overweight, it's no surprise that services are feeling the strain.
The ISML Population Health Profile: 2013 found that, with 57.2 per cent of residents overweight or obese, the rate was higher than the state average of 52.6.
Meanwhile, recent NSW Ministry of Health figures revealed that nearly 2500 people in the region were admitted to hospital due to their high body mass in 2011-12.
"Obesity is globally accepted as a pandemic - not just because it is a problem in itself but because it is a precursor to chronic disease like hypertension and cardiac diseases," ISML population health and planning manager Abhijeet Ghosh said.
"It's a vicious cycle because being obese leads to more utilisation of hospital services, and higher healthcare costs."