From funeral homes to hospital beds, the island’s obesity crisis exacts a growing toll beyond the impact of chronic disease.

According to the Bermuda Hospitals Board, a fully equipped bariatric hospital room costs $35,000 more than a standard, with six installed in the new acute care wing.

The Bermuda Government’s Health in Review report for 2017 showed Bermuda topping the Organisation for Economic Co-operation and Development countries — with four in ten adults overweight, and one in three classed as obese. While heart disease and diabetes dominate the impact on healthcare costs, procurement figures provided by the BHB show the high cost of obesity in hospital equipment:

• An extra large adult wheelchair costs $1,216 compared with a standard of $800

• A bariatric clinical chair for toilets and showers costs $3,753 versus $300 for a standard

• A wheeled bariatric roller is $381 versus a standard walker’s cost of $152

Other costs include bariatric lifts, used for obese patients, which are almost $4,000 — and more than $9,000 for a battery unit.

According to Debbie Jones, executive director of the Bermuda Diabetes Association, the island should also brace for other costs incurred at the end of life. She said: “Our graves are set to a standard size, and they are built of either Bermuda stone or concrete block, which is almost impossible to change.

“Many families have tombs where they will sit one coffin on top of the others.

“We have heard of bigger caskets being a very tight fit — if a casket won’t go in, what do you do? The cost of redoing graves would be horrendous.”

Doreen Williams James, the owner of the Alpha Memorial Chapel in St George’s, called it “a growing, increasing trend”.

She added: “Obviously it’s going to get worse if people don’t make a conscious effort to change their lifestyles.”

Ms Williams James said the island lagged behind the United States, which was often an indicator of coming trends.

She said: “Some stories I hear from colleagues in the US are unbelievable, where even a hearse cannot accommodate a body and tractor trailers have to be used for transport.

“We have not gotten there yet and hopefully won’t, it does happen occasionally where we have to import oversized caskets.

“Sometimes our graves are custom built and depending on the type of grave, we may have to widen to accommodate the casket.”

Ms Williams James added: “It needs to be talked about. No one considers what funeral directors have to deal with, and it’s growing.”

A standard Bermuda grave spans 28 inches, and can easily accommodate coffins, which are narrower and generally locally made.

She said: “The older generation prefers them. Caskets, which we import from Canada and the US, are bigger.”

According to the Reverend John Stow at Holy Trinity Anglican Church in Hamilton Parish, churchyards charge $25 per square foot to widen a grave.

Mr Stow said: “That’s not surface area — that’s the wall, which could cost as much as $1,000. That cost would be met by the family.”

He said that of about 30 interments at the churchyard over the last year, about five had required a widening of the grave.

Mr Stow added: “It would be hard to say that each year it gets worse. But over the decades it is becoming more of a difficulty.

“I have more questions than answers. It would be good to find out more on the research side.

“It is certainly money well spent if it is on health education rather than having to make the change after it becomes a problem.”