What is Morbid Obesity?

Morbid Obesity is a Serious Health Condition

Morbid obesity is a serious health condition that can interfere with basic physical functions
such as breathing or walking. Those who are morbidly obese are at greater risk for illnesses
including diabetes, high blood pressure, sleep apnea, gastroesophageal reflux disease
(GERD), gallstones, osteoarthritis, heart disease, and cancer.

Morbid obesity is diagnosed by determining Body Mass Index (BMI). BMI is defined by the
ratio of an individuals height to his or her weight. Normal BMI ranges from 20-25. An
individual is considered morbidly obese if he or she is 100 pounds over his/her ideal body
weight, has a BMI of 40 or more, or 35 or more and experiencing obesity-related health
conditions, such as high blood pressure or diabetes.

Common Obesity Related Conditions

Obesity-related health conditions reduce life expectancy. Here are some of the more
common conditions. If you would like more information, please speak with your physician.

Type 2 diabetes. People who are obese become resistant to insulin, which regulates blood
sugar levels. They end up with high blood sugar, which causes Type 2 diabetes. Learn
more about Type 2 diabetes.
High blood pressure/heart disease. The heart doesn't work right when the body is
carrying around excess weight. So, the obese person usually gets hypertension (high blood
pressure), which leads to strokes and damages the heart and kidneys.
Osteoarthritis of weight-bearing joints. Additional weight placed on jointsespecially
knees and hipscauses rapid wear and tear, along with pain and inflammation. Similarly,
the strain on bones and muscles in the back leads to disk problems, pain, and decreased
mobility. Learn more about osteoarthritis.
Sleep apnea/respiratory problems. Fat deposits in the tongue and neck can block air
passages, especially in patients who sleep on their backs. This causes them to lose sleep
and results in daytime drowsiness and headaches. Learn more about sleep apnea.
Gastroesophageal reflux disease (hiatal hernia and heartburn). Excess weight weakens
and overloads the valve at the top of the stomach, which then allows stomach acid to
escape into the esophagus. This is called gastroesophageal reflux, and "heartburn" and
acid indigestion are common symptoms. Approximately 10-15% of patients with even mild
heartburn develop Barrett's esophagus, which is a pre-malignant change in the lining
membrane and a cause of esophageal cancer.
Depression. People who are obese must deal with constant, depressing emotional
challenges: failed diets, disapproval from family and friends, remarks from strangers. Plus,
they often experience discrimination and cannot fit comfortably in public places. Learn more
about depression.
 Infertility. Obesity wreaks havoc with male and female hormones, disrupting normal cycles
and function, and leading to difficulty or inability to conceive. Learn more about infertility.
Urinary stress incontinence. A large, heavy abdomen relaxes pelvic muscles,
compounding the effects of childbirth. This weakens the valve on the urinary bladder,
allowing leakage when coughing, sneezing, or laughing. Learn more about urinary stress
incontinence.

Surgery Options
Working with your Surgeon, you will choose a surgery option that is right for you.

Learn more about:

The Roux-en-Y Gastric Bypass Procedure

The Duodenal Switch Procedure
Gastric Sleeve Surgery
Gastric Banding (LAP-BAND) Surgery
Defining Morbid Obesity

Obesity is a serious disease with symptoms that build slowly over an extended period of time. The
National Institutes of Health (NIH) define morbid obesity as:

Being 100 pounds or more above your ideal body weight

Or, having a Body Mass Index (BMI) of 40 or greater

Or, having a BMI of 35 or greater and one or more co-morbid condition

The disease of morbid obesity interferes with basic physical functions such as breathing or walking.
Long-term implications of the disease include shorter life expectancy, serious health consequences in
the form of weight-related conditions such as type 2 diabetes and heart disease, and a lower quality of
life with fewer economic and social opportunities.

Resolution of Comorbodities after Bariatric Surgery

Obesity is a serious public health issue in the U.S.

24 million U.S. adults are living with morbid obesity and may qualify for bariatric surgery based on NIH
guidelines.
By 2010, its projected that there may be 31 million U.S. adults living with morbid obesity and may
qualify for bariatric surgery based on NIH guidelines.

Co-morbid Conditions

The presence of obesity increases the risk of a number of medical conditions, including cancer. A co-
morbid condition is a health condition related to a primary disease such as obesity.

There are many health conditions related to morbid obesity, but some of the most common are:

Type 2 diabetes, which can lead to heart disease, kidney failure, blindness, amputation of the feet or
legs, and nerve damage

Heart disease, such as hardening of the arteries, heart attack, and angina

High blood pressure, which can lead to heart disease, stroke, kidney failure, and vision loss

High cholesterol, which can lead to heart disease, stroke, and kidney failure

Obstructive sleep apnea has been associated with high blood pressure

Acid reflux/GERD, which can lead to esophagitis, Barretts esophagus, and esophageal cancer
(adenocarcinoma)

Cancer

Depression

Osteoarthritis and joint pain, which can lead to loss of mobility

Stress urinary incontinence

Female reproductive health disorder, which can lead to infertility and sexual dysfunction

An emerging body of literature demonstrating relationships between maternal obesity and structural
birth defects, including:

Increased risk of spina bifida and heart defects

Decreased risk of gastroschisis

These conditions occur more frequently in people with morbid obesity. Mortality rates from many of
these conditions are also higher among people with morbid obesity.
Learn more about obesity-related health conditions.

Results of Five-Year Follow-up

Treatment Weight Loss (% of Patients)

Diet and Exercise* 2% to 5%

Medication** 0%

Bariatric Surgery*** 50% to 70%<

* Success measured as a loss of 10 percent of initial body weight.

** Weight loss is not maintained once treatment ends.

*** Success measured as a loss of 50 percent of excess body weight (equivalent to loss of approximately
20 to 25 percent of initial body weight).

The above chart compares the long-term effectiveness of three different obesity treatments: diet and
exercise, weight loss medications, and bariatric surgery.

Bariatric surgery clearly has the best weight loss outcome compared to the other two treatments50 to
70 percent of people were able to lose at least 50 percent of the excess weight and keep it off for five
years.

After five years, only 2 to 5 percent of the people who dieted and exercised had maintained a weight
loss of at least 10 percent.

People who had taken weight loss medications were not able to maintain any weight loss.
Bariatric Surgery

There are several different bariatric surgery procedures, but the two general ways in which they work
are restriction and malabsorption:

Restriction limits the amount of food you can eat. Whether it is a gastric banding device around the
stomach or a surgically-created, smaller stomach pouch, restriction ensures that the patient feels
satisfied with less food.

Malabsorption limits the number of calories and nutrients your body can absorb. During malabsorptive
procedures, the surgeon reroutes the small intestine so that fewer calories and nutrients are absorbed.

Commonly performed bariatric procedures include:

Gastric bypass

Gastric banding

Sleeve gastrectomy

Biliopancreatic diversion with duodenal switch

Learn more about the different bariatric surgery procedures.

Only you and your surgeon can decide if surgery is right for you.

Diet

To lose weight, your body must burn more calories than you eat and/or drink. A diet plan should be
based on your health and lifestyle needs, and would include reducing the number of calories you take in.
If you are considering this option, speak with your primary care physician about nutritional guidelines,
and keep in mind that many bariatric programs also offer medically supervised weight loss programs.
Exercise

Frequent and regular physical activity is beneficial to most anyonewhether they are pre- or
postsurgery. Generally, an exercise program includes cardiovascular exercise such as walking, swimming,
or cycling, strength training using resistance bands, weights, or machines, and stretching. Speak with
your primary care physician before beginning any physical activity.

Prescription Weight Loss Medications

Prescription weight loss medications may be considered a supplement to diet and exercise. Only a
healthcare professional can prescribe these weight loss medications.

The term morbid obesity refers to patients who are 50 - 100% -- or 100 pounds above -- their ideal body
weight. Alternatively, a BMI (body mass index) value greater than 39 may be used to diagnose morbid
obesity.

Times Essentials

Recent findings and perspectives on medical research.

For the Overweight, Bad Advice by the Spoonful

REPORTER'S FILE

For the Overweight, Bad Advice by the Spoonful

By GINA KOLATA

Conventional wisdom about weight hasn't kept pace with new research.

EXPERT Q & A

The Limits of Willpower

QUESTIONS FOR YOUR DOCTOR

What to Ask About Obesity

CLINICAL TRIALS

Selected Studies: Weight Loss and Obesity

REFERENCE FROM A.D.A.M.

Back to TopConsiderations

Medical problems commonly resulting from untreated morbid obesity include the following:

Diabetes

Hypertension

Heart disease

Stroke

Certain cancers, including breast and colon

Depression

Osteoarthritis

Affected people may gradually develop hypoxemia (decreased blood oxygen saturation) and have
problems with sleep apnea (periodic cessation of breathing while asleep).

Decreased blood oxygen and problems associated with sleep apnea may result in feeling drowsy
through the day (somnolence), high blood pressure, and pulmonary hypertension. In extreme cases,
especially when medical treatment is not sought, this can lead to right-sided heart failure (cor
pulmonale), and ultimately death.

Back to TopCommon Causes

Excessive caloric intake

Thyroid disorders

Lack of physical activity

Back to TopHome Care

A combination of calorie restriction and exercise (when adhered to) appears to be more effective rather
than either one alone. Sticking to a weight reduction program is difficult and requires much support
from family members and friends.

Back to TopCall Your Health Care Provider if

Contact your health care provider if you or your child appear to be excessively obese or are gaining
weight at an extremely rapid rate. Remember that catching the problem early is much simpler than
trying to fix it after the person has gained an excessive amount of weight.

Back to TopWhat to Expect at Your Health Care Provider''s Office

The medical history will be obtained and a physical examination performed. A dietary and exercise
regimen may also be prescribed.

Medical history questions documenting morbid obesity in detail may include:

Family history

Were any other family members excessively heavy?

Was a disorder diagnosed as a cause of obesity in any other family member?

Dietary history (complete history of eating habits as well as types and amounts of food eaten)

Other symptoms

Is there difficulty breathing?

Does the person wake up often at night?

Does the person appear tired or sleepy during the daytime?

Physical examination:

A thorough physical examination will be done to determine if there is any medical cause for the obesity.
Height and weight will be plotted on a chart to help determine the degree of obesity.

Diagnostic tests:

Body fat content can be determined by special studies. Your health care provider may want to obtain
tests for thyroid disorders.

After seeing your health care provider:

You should try your best to adhere to the diet and exercise regimen provided.

What Is Morbid Obesity?

Morbid obesity is a condition in which you have a body mass index (BMI) higher than 35. BMI is used to
estimate body fat and can help determine if you are at a healthy body weight for your size. BMI is not a
perfect measurement but it does help give a general idea of ideal weight ranges for height.

CAUSES

What Causes Morbid Obesity?

When you eat, your body uses the calories you consume to run your body. Even at rest, the body needs
calories to pump your heart or digest food. If those calories are not used, the body stores them as fat.
Your body will build up fat stores if you continue to eat more calories than your body can use during
daily activities and exercise. Obesity and morbid obesity are the result of too much fat being stored in
your body.
Certain medications, such as antidepressants, can cause weight gain. Medical conditions such as
hypothyroidism can also lead to weight gain, but can usually be managed so that they do not lead to
obesity.

RISK FACTORS

Who Is at Risk for Morbid Obesity?

Anyone can gain weight and become obese if they eat more calories than their bodies can use.

Some studies have shown that genetic factors can play a role in how your body stores energy. More
research is being done to further explore the relationship between genes and weight.

Many behavioral factors play a role in obesity as well, including your eating habits and daily activity
level. Many people develop their eating habits as children and have trouble refining them to maintain
proper body weight as they age. As an adult, you may be inactive at your job and have less time for
exercise, meal planning, and physical activity.

Other factors, such as stress, anxiety, and lack of sleep, can lead to weight gain. People who quit
smoking often experience temporary weight gain. Women may also have trouble losing the weight they
gain during pregnancy, or may gain additional weight during menopause. These factors do not
necessarily lead to morbid obesity but can certainly contribute to its onset.

DIAGNOSIS

Diagnosing Morbid Obesity

Your doctor will perform a physical exam and ask you about the history of your weight and your weight-
loss efforts. They will ask you about your eating and exercise habits, and your medical history.

Calculating BMI

BMI is calculated when your weight in kilograms is divided by your height in meters squared. You can
calculate your BMI by using a calculator provided by the Centers for Disease Control and Prevention.

Here are BMI ranges and their corresponding categories of obesity:

underweight: under 18.5 percent

normal: 18.5 to 24.9 percent

overweight: 25.0 to 29.9

obese (class 1): 30.0 and 34.9

morbid obesity (class 2): 35-39.9

Using BMI as a diagnosis tool for obesity has limitations. Your BMI is only an estimate of your body fat.
For example, athletes may have a high weight because of their higher muscle mass. They could fall into
the obese or morbidly obese BMI range, but actually have a small amount of body fat. Because of this,
your doctor might use other tests to get an exact reading of your body fat percentage.

Calculating Body Fat Percentage

A skinfold test may also be done to check your body fat percentage. In this test, a doctor measures the
thickness of a fold of skin from the arm, abdomen, or thigh with a caliper. Another way to test body fat
percentage includes bioelectrical impedance, which is often done using a special type of scale. Finally,
body fat can be more accurately measured using special equipment to calculate water or air
displacement.

Other Tests

Your doctor may order additional blood tests to look for hormonal or other medical problems that could
be causing your weight gain.

COMPLICATIONS

Complications of Morbid Obesity

Obesity is a health concern. Without proper treatment, obesity can lead to other serious health
problems, such as:

osteoarthritis

heart disease and blood lipid abnormalities

stroke

type 2 diabetes
sleep apnea (when you periodically stop breathing during sleep)

reproductive problems

gallstones

certain cancers

obesity hypoventilation syndrome

metabolic syndrome

TREATMENT

Treating Morbid Obesity

There are several different treatment options for morbid obesity.

Diet and Exercise

There is no data on the most effective way to induce long-term weight loss, but a healthy diet and
regular exercise are the keys to overall health.

It is also important to learn stress management tools that can be used in place of overeating or snacking
during stressful times.

You should work with your doctor and a dietitian to set realistic goals that will help you lose weight
slowly through diet and exercise. It may be helpful to find support from friends, family, or your
community in order to make lifestyle changes that will lead to long-term weight loss.

Weight Loss Drugs

In some cases weight loss drugs may be prescribed. These medications may cause weight loss, but most
people regain the weight once they stop taking the medication. There are many herbal and over-the-
counter supplements that claim to help you lose weight, but many of these claims have not been
verified.

Surgery
Surgery may also be an option to treat obesity if you have tried other methods for losing weight but
have not been successful in maintaining long-term weight loss. It can often help reduce the risk of other
diseases (e.g., diabetes, heart disease, and sleep apnea) that are associated with severe obesity.

Surgery may cause complications, and you should talk with your doctor to determine if this is an option
for you. There are two common types of weight-loss surgeries:

Gastric Banding Surgery

In this procedure, the surgeon will place a band around the upper part of your stomach. This limits the
amount of food you can eat at one time by making you feel full after eating small amounts of food.

Gastric Bypass Surgery

This surgery will change how the food you eat travels through your digestive tract by bypassing a portion
of your stomach and small bowel. It will make you feel full when youve eaten less food.

PREVENTION

Preventing Morbid Obesity

Obesity and morbid obesity are serious and potentially life-threatening conditions. A healthy lifestyle
that includes a healthy diet and regular exercise are important for preventing obesity.

Diet and Exercise

People who are morbidly obese should avoid fad diets and focus instead on changing eating
behaviors. Recommendations include:

adding more fruits and vegetables to your diet

eating smaller meals

count calories

eating mindfully
limiting saturated fats, trans fats, and refined sugars

Physical activity is good for overall health and is especially important if youre trying to lose weight. To
begin losing weight, you will need to do moderate to vigorous exercise for more than three hours per
week. Vigorous activity raises your heart rate significantly. Be sure to check with your doctor before you
begin any vigorous exercise programs. Examples of beneficial physical activity include:

running or jogging

swimming

jumping rope

brisk walking

biking

Moderate exercise can also include everyday activities like shoveling snow or yard work.

Article resources

FEEDBACK:

Medically Reviewed by Peggy Pletcher, MS, RD, LD, CDE on March 23, 2016 Written by Cindie
Slightham

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