|
Morbid Obesity |
| |
Morbid obesity, also referred to as clinically severe obesity or extreme obesity, is a chronic disease that afflicts approximately 9 million adult Americans. For comparison purposes, that is over twice the size of the total population with Alzheimer’s disease. If the entire morbidly obese population lived in one state, it would be the 12th state in population. The health effects associated with morbid obesity are numerous and can be disabling. Often, individuals with morbid obesity suffer with more than one health effect, creating a situation that can shorten life span and negatively impact quality of life.
Identification and Prevalence
Morbid obesity is defined as having a Body Mass Index (BMI) of 40 or more. This equates to approximately 100 pounds more than ideal weight.
Calculating BMI
The prevalence of morbid obesity is 4.7 percent, according to the last published figures from the Centers for Disease Control and Prevention (CDC); up from 2.9 percent observed in a national data set obtained from 1988 to 1994.
Gender and racial / ethnic differences in prevalence are shown in Tables 1 and 2. Black (non-Hispanic) females have a dramatically higher rate of morbid obesity compared to all other categories.
Increase in Morbid Obesity Prevalence (%)
Among U.S. Men
|
| Racial Ethnic Group |
1988 to 1994 (%) |
1999 to 2000 (%) |
| All |
1.7 |
3.1 |
| White (non-Hispanic) |
1.8 |
3.0 |
| Black (non-Hispanic) |
2.4 |
3.5 |
| Mexican American |
1.1 |
2.4 |
| Source: Flegal KM, et al. Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002;288:1723-1727.
|
Increase in Morbid Obesity Prevalence (%)
Among U.S. Women
|
| Racial Ethnic Group |
1988 to 1994 (%) |
1999 to 2000 (%) |
| All |
4.0 |
6.3 |
| White (non-Hispanic) |
3.4 |
4.9 |
| Black (non-Hispanic) |
7.9 |
15.1 |
| Mexican American |
4.8 |
5.5 |
| Source: Flegal KM, et al. Prevalence and Trends in Obesity Among US Adults, 1999-2000. JAMA 2002;288:1723-1727.
|
Prevalence differences by age are shown in Table 3 and by education in Table 4.
| Age |
1990 to 1991 (%) |
2000 (%) |
| 18 to 29 |
0.4 |
1.2 |
| 30 to 39 |
0.9 |
2.6 |
| 40 to 49 |
1.2 |
2.8 |
| 50 to 59 |
1.2 |
3.0 |
| 60 to 69 |
0.9 |
2.0 |
| 70 and older |
0.5 |
1.0 |
| Source: Freedman DS, et al. Trends and Correlates of Class 3 Obesity in the United States from 1990 through 2000. JAMA 2002;288:1758-1761.
|
| Education Level |
1990 to 1991 (%) |
2000 (%) |
| Less than High School |
1.5 |
3.4 |
| High School |
0.9 |
2.4 |
| Less than 4 Years of College |
0.8 |
2.2 |
| 4 Years of College or More |
0.4 |
1.2 |
| Source: Freedman DS, et al. Trends and Correlates of Class 3 Obesity in the United States from 1990 through 2000. JAMA 2002;288:1758-1761.
|
Causes
Although there are several factors involved in causing overweight, morbid obesity has a stronger genetic component than moderate levels of excess weight. In a study of adults who were candidates for bariatric surgery, approximately 85 percent had "elements in their history to suggest a genetic risk for morbid obesity."
Health Effects
The morbidity and mortality risk from being overweight is proportional to its degree. Individuals with morbid obesity, therefore, have the highest risk for developing numerous illnesses that often reduce mobility and quality of life due to their excess weight. In particular, type 2 diabetes, gallbladder disease and osteoarthritis have been found to increase concurrently with higher BMI. Premature death, a 20-year shorter life span, has also been found in individuals with morbid obesity.
All of the systems that make the body function are affected by morbid obesity. The list in Table 5 indicates some co-morbid conditions associated with obesity known to affect a specific system of the body.
Morbid obesity can also cause or worsen depression. Some individuals with morbid obesity have low self-esteem and other psychological difficulties attributed to feeling "shunned, insulted and ridiculed by outsiders."
| Co-morbid Conditions of Obesity
|
| Before Surgery |
Improved After Surgery |
| Cardiovascular System
|
- Chronic Venous Insufficiency
- Hypertension
- Hyperlipidemia
- Atherosclerosis
- Deep Vein Thrombosis
- Peripheral Vascular Disease
|
- Chronic Venous Insufficiency
- Hypertension
- Hyperlipidemia
|
| Digestive System
|
- Gastroesophageal Reflux Disease
- Gallbladder Disease
- Nonalcoholic Steatohepatitis
|
- Gastroesophageal Reflux Disease
|
| Endocrine System
|
- Diabetes (Type 2)
- Pancreatitis
|
|
| Musculoskeletal System
|
- Osteoarthritis
- Rheumatoid Arthritis
- Severšs Disease
- Vertebral Disk Herniation
|
- Degenerative Joint Disease Pains
- Hiatal Hernia
- Low Back Pain
|
| Nervous System
|
- Pseudotumor Cerebri
- Carpal Tunnel Syndrome
- Stroke
|
|
| Reproductive System
|
- Infertility
- Menstrual Abnormalities
- Pregnancy Abnormalities
- Hirsutism
- Impotence
- Polycystic Ovarian Disease
- Neural Tube Birth Defects
|
- Infertility
- Menstrual Abnormalities
- Pregnancy Abnormalities
|
| Respiratory System
|
- Asthma
- Obesity Hypoventilation Syndrome
- Sleep Apnea
- Pulmonary Hypertension
|
- Asthma
- Obesity Hypoventilation Syndrome
- Sleep Apnea
|
| Urinary System
|
- Urinary Stress Incontinence
- Gout
- Renal Disease
|
- Urinary Stress Incontinence
- Levels of Uric Acid
|
| Dermatology System (Skin)
|
- Cellulitis
- Fungal Skin Infections
- Panniculitis
|
|
| Immune System
|
- Cancers (Breast, Prostate and Colon)
- Poor Healing of Wounds and Infection
|
|
|
|
Treatment
The role of genetics in causing obesity is being explored for development of future drug treatments that could specifically target certain genes.
Surgery is currently the most effective treatment for morbid obesity resulting in significant weight loss and accompanying health improvements. The benefits of surgery are typically viewed to outweigh the risks. The overall mortality rate is about 1 percent. An appropriate nutrition and exercise plan is an important part of post-surgical weight loss and maintenance.
After surgery mortality rate is reduced and improvements seen to numerous health risks of obesity or symptoms of those risks. Overall, quality of life, self-image, mobility and stamina are reported to be better. The list in Table 4 indicates some of the health improvements found in various systems of the body.
Discrimination
Persons with obesity are victims of employment and other discrimination, and are penalized for their condition despite many federal and state laws and policies.
The most disturbing type of discrimination is within the medical community either from insurance providers or healthcare workers. Some health insurance providers realize the serious health effects of morbid obesity and cost benefits of its treatment. Some providers continue to deny insurance coverage, and some that once offered coverage of surgery for morbid obesity are now excluding it.
Discrimination from healthcare workers is reported to be likely due to a lack of understanding of the causes and consequences if left untreated. Teaching medical students about obesity management, including sensitivity training, is one direction that may lead toward improvement.
