February 26, 2019
By Anna Welcome, MD, FACOG
If the Oxford English Dictionary defines “morbid” as “an abnormal and unhealthy interest in disturbing and unpleasant subjects,” the diagnosis of morbid obesity might sound rather ghoulish and scary. What exactly does the doctor mean when they tell a patient that they have morbid obesity? Should they be offended?
The actual medical definition of morbid obesity is:
“A serious health condition that results from an abnormally high body mass that is diagnosed by having a body mass index (BMI) greater than 40 kg/m², a BMI of greater than 35 kg/m² with at least one serious obesity-related condition, or being more than 100 pounds over ideal body weight (IBW).”
Because medical providers and their patients understand the word “morbid” differently (no, medical providers don’t find their patient ghoulish), the preferred term is no longer “morbid obesity” but is using either “class 3 obesity” or “severe obesity.” This allows medical providers to communicate that this level of excess weight is a serious health problem without sounding judgmental.
The diseases of overweight and obesity are classified into increasing BMI levels that have increasingly higher levels of health consequences. The following are levels of obesity based on BMI:
- Overweight: BMI 25.0-29.9 kg/m²
- Class I Obesity: BMI 30.0-34.9 kg/m²
- Class II Obesity: BMI 35.0-39.9 kg/m²
- Class III Obesity: BMI ≥ 40.0 kg/m²*
Why Does the Definition and Degree of Obesity Matter?
Making a specific diagnosis allows medical providers to prioritize the level of health risk for their patient. The higher the level of excess weight, the higher the risk of serious health problems, disability and risk of early death for that patient. It also helps to identify eligibility for treatment options such as weight loss surgery or medications.
The list of potential weight related health problems for overweight and obesity, (especially morbid or class 3 obesity) is very long. Over time we have discovered that numerous health conditions are caused by or associated with excess weight. Reducing body weight and maintaining that loss can help to improve or reverse many of these problems.
Morbid or severe obesity is much more than a problem with physical appearance. Yes, there are definite problems with discrimination, social bias, depression, anxiety, and low self-esteem, but the problem is more extensive.
Some obesity-related problems come from the strain on the body while carrying extra weight such as: High blood pressure, congestive heart failure, sleep apnea, shortness of breath, nerve pain, arthritis, back pain, heartburn, leg swelling, varicose veins, and physical disability.
Does Having Severe or Morbid Obesity Classify as a Disability?
The short answer is no. Although several persons with Severe or Morbid Obesity can have disabling health conditions that result from the Obesity and could qualify for Disability benefits, the fact is that most people who have Severe or Morbid Obesity are quite able to perform their work functions. Having Severe of Morbid Obesity does not automatically qualify someone for benefits.
Other problems come from abnormal changes in how our body functions due to having excess body fat (adipose tissue). Examples of these are:
- Type 2 diabetes
- High cholesterol and heart disease
- Increased risk of many cancers
- High blood pressure
- Fatty liver disease
- Kidney disease
- Blood clots
- Infertility and polycystic ovary syndrome
- Erectile dysfunction
- Pregnancy complications
Unfortunately, this is only a partial list of issues related to morbid obesity... and the problems are getting worse around the world.
So how do we improve the problems with excess weight including severe, class 3, or morbid obesity? In other words, how do we lose weight?
First it helps to know what causes weight gain. Surely it is eating too much and not getting exercise, right? Not exactly, that is only a part of the entire picture.
Obesity is caused by the genes we got from our ancestors/family and these genes were influenced by our environment growing up and as an adult. Some of these influences include eating habits we learned growing up, our food culture and society, our medical history, food availability, hormonal changes (including pregnancies), stressful life events and how those affect our mood. Every person is unique in their assortment of causes.
It is also important to know that obesity is a complex and chronic problem that is not self-inflicted. Many people have tried to lose weight before. Some are successful but the majority struggle to lose or maintain weight loss. It can be very discouraging to lose weight only to regain it again. What can someone do if they find themselves with severe, class 3, or morbid obesity? They can get help.
If they are struggling with obesity, they can see an obesity medicine specialist. An obesity medicine specialist is a medical provider who has studied the causes, prevention, and treatment of overweight, obesity, and severe or morbid obesity. These specialists have the time, training and tools for comprehensive treatment. They help to provide education, support and a plan to help people overcome the disease of obesity.
Comprehensive morbid obesity treatment includes:
- Dietary modification: based on medical evidence
- Physical activity: adjusted to the person’s needs and abilities
- Behavioral modification: to help overcome unhealthy habits
- Medication: if appropriate, as a tool to help with the urge to eat
- Weight loss surgery: if appropriate, for those with severe or morbid obesity (Only a few obesity specialists perform surgery, but most can help people successfully prepare for weight loss surgery and help people to have the best results and lasting success afterwards)
- Prevention of weight regain: help with maintaining healthy habits
- Understanding, compassion, and respect
How can someone find an obesity medicine specialist? They can do a general internet search, take their chances and hope for the best… or they can look for someone with appropriate training.
The Obesity Medicine Association is a society of medical providers (physicians, nurse practitioners, physician assistants, and other healthcare providers) who treat obesity. Use the “Find a Clinician” search tool to find someone in your area who can help you manage your weight and regain your health. Many Obesity Medicine Association members are certified by the American Board of Obesity Medicine (ABOM), which ensures that those with this designation have the right tools to help tackle obesity.
There, that wasn’t scary at all.