What is Severe Obesity?
Severe Obesity is a chronic, life threatening, multifactorial disease of excess fat storage that contributes to multiple health problems known as co-morbidities. Obesity becomes “severe” or “morbid” when it reaches the point of significantly increasing the risk of one or more obesity-related co-morbidities that result either in significant physical disability or even premature death. As you read about morbid obesity you may also see the term “clinically severe obesity” used. Both are descriptions of the same condition and can be used interchangeably. Severe obesity is typically defined as being 100 lbs. or more over ideal body weight or having a Body Mass Index of 40 or higher. A person can also be considered Severely Obese with a BMI of 35-40 with certain serious co-morbidities. According to the National Institutes of Health Consensus Report, morbid ovesity is a serious disease and must be treated as such. It is a chronic disease, meaning that its symptoms build slowly over an extended period of time. Being a chronic disease, it also means it takes Chronic Treatment!
Severely obese patients generally suffer with:
- Impaired satiety (unable to feel satisfied from the food they eat)
- Calories that are stored (as fat) not burned
- Inadequate basal metabolic rate (possibly due to years of yo-yo dieting)
Causes of Morbid Obesity
The reasons for obesity are multiple and complex. Despite conventional wisdom, it is not simply a result of overeating. Research has shown that in many cases a significant, underlying cause of morbid obesity is genetic. Studies have demonstrated that once the problem is established, efforts such as dieting and exercise programs have a limited ability to provide effective long-term relief.
Science continues to search for answers, but until the disease is better understood, the control of excess weight is something patients must work at for their entire lives. That is why it is very important to understand that all current medical interventions, including weight loss surgery, should not be considered medical cures. Rather, they are attempts to reduce the effects of excessive weight and alleviate the serious physical, emotional and social consequences of the disease.
The underlying causes of severe obesity are not known. There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also certain medical conditions that may result in obesity such as intake of steroids and hypothyroidism.
Health Threat of Morbid Obesity
Morbid obesity brings with it an increased risk for a shorter life expectancy. For individuals whose weight exceeds twice their ideal body weight (that’s about 2-6% of the U.S. population), the risk of an early death is doubled compared to non-obese individuals. An article in JAMA (Journal of the American Medical Association) in 2003 outlined the years of lost life for individuals that suffer from Morbid Obesity at various age ranges. Their studies show that some groups can have up to a 20% shorter life due to their over weight. The risk of death from diabetes or heart attack is five to seven times greater. Even beyond the issue of obesity-related health conditions, weight gain alone can lead to a condition known as “end-stage” obesity where, for the most part, no treatment options are available. Yet an early death is not the only potential consequence. Social, psychological and economic effects of morbid obesity, however unfair, are real and can be especially devastating.
Obesity-Related Health Conditions
Obesity-related health conditions are health conditions that, whether alone or in combination, can significantly reduce your life expectancy. These are termed “co-morbidities”. A list of some of the more common co-morbidities follows. These co-morbid conditions are what make morbid obesity a DISEASE in and of itself.
Type 2 Diabetes. Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, the resulting high blood sugar can cause serious damage to the body. Type 2 Diabetes represents over 85% of the diabetes (Type 1 representing about 15%) and most Type 2 Diabetics are obese to Morbidly Obese. Whereas this disease was unheard of in children 25 years ago, it is one of the biggest epidemics in adolescent medicine at the present time.
High blood pressure/Heart disease. Excess body weight strains the ability of the heart to function properly. The resulting hypertension (high blood pressure) can result in strokes, as well as inflict significant heart and kidney damage.
Osteoarthritis of weight-bearing joints. The additional weight placed on joints, particularly knees and hips, results in rapid wear and tear, along with pain caused by inflammation. Similarly, bones and muscles of the back are constantly strained, resulting in disk problems, pain and decreased mobility.
Sleep apnea/Respiratory problems. Fat deposits in the tongue and neck can cause intermittent obstruction of the air passage. Because the obstruction is increased when sleeping on your back, you may find yourself waking frequently to reposition yourself. The resulting loss of sleep often results in daytime drowsiness and headaches. A resent study shows significant life lost to traffic accidents due to sleep apnea and at a price tag of over one billion dollar.
Gastroesophageal reflux/Heartburn. Acid belongs in the stomach and seldom causes any problem when it stays there. When acid escapes into the esophagus through a weak or overloaded valve at the top of the stomach, the result is called gastroesophageal reflux, and “heartburn” and acid indigestion are common symptoms. Approximately 10-15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett’s esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer.
Depression. Though there is not a higher rate or incidence of “mental illness” in the morbidly obese population, the incidence of depression is high. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, cannot fit comfortably in theatre seats, or ride in a bus or plane.
Infertility. The inability or diminished ability to produce offspring. This is probably because of an estrogen-like compound produced by the fat that “confuses” the reproductive system. This “un-opposed estrogen” is probably the cause of several of the associated conditions.
Urinary stress incontinence. A large, heavy abdomen and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. Though this is not life threatening it does change people’s lives. Often our female patients who suffer most from this condition become reclusive and homebound. The discomfort, inconvenience and embarrassment is often overwhelming.
Menstrual irregularities. Morbidly obese individuals often experience disruptions of the menstrual cycle, including interruption of the menstrual cycle, abnormal menstrual flow and increased pain associated with the menstrual cycle.
Cholesterol and Triglyceride abnormalities. These are the fat levels in the serum of the blood that increase the risk of heart disease.
Some cancers. Morbid Obesity increases ones chances of suffering from some cancers like breast, and uterine cancers.
Am I Morbidly Obese?
Answering this question may give you the courage you need to take the first step. Below are tools you can use to determine if you are morbidly obese and potentially a candidate for weight loss surgery.
There are several medically accepted criteria for defining morbid obesity. You are likely morbidly obese if you are:
- More than 100 lbs. over your ideal body weight, or
- Have a Body Mass Index (BMI) of over 40, or
- Have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight
- Unable to achieve a healthy body weight for a sustained period of time, even through medically supervised dieting
If you would like to calculate your BMI, just go to our BMI Calculator Page.