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Severe obesity is associated with multiple comorbidities which reduce the life expectancy and markedly impair the quality of life. Obesity-related problems begin at the head and end at the toes, affecting almost EVERY ORGAN in between. Morbidly obese patients can suffer from central (android) obesity or peripheral (gynoid) obesity or a combination of the two. Gynoid obesity is associated with degenerative joint disease and venous stasis in the lower extremities. Android obesity is associated with the highest risk of mortality-related problems due to the “Metabolic Syndrome” or “Syndrome X,” as well as increased intra-abdominal pressure (IAP). The metabolic syndrome is associated with insulin resistance, hyperglycemia, and type 2 diabetes mellitus (DM) and this is associated with nonalcoholic liver disease (NALD) or nonalcoholic steatohepatitis (NASH), polycystic ovary syndrome, nephrotic syndrome of obesity, and systemic hypertension. Increased IAP is probably responsible in part or totally for obesity hypoventilation, venous stasis disease, pseudotumor cerebri, gastroesophageal reflux disease, stress urinary incontinence, and systemic hypertension. Central obesity is also associated with increased neck circumference and sleep apnea. Additional comorbidities include an increased risk of several cancers (uterine, breast, prostate, esophagus, colon, kidney), problems with pregnancy and delivery, and problems with infections (necrotizing panniculitis and pancreatitis) as well as difficulty in diagnosing peritonitis. The encouraging data are that almost all of these comorbidities resolve or improve significantly with surgically induced weight loss.


Severe obesity is associated with a large number of problems that have given rise to the term “morbid obesity” (Table 2–1). Although some consider this term to be pejorative, severe obesity is often associated with a number of problems that are truly morbid and incapacitating. The medical problems caused by obesity begin with the head and end with the toes and involve almost every organ in-between. Several of these problems contribute to the earlier mortality associated with obesity and include coronary artery disease, severe hypertension that may be refractory to medical management, impaired cardiac function, adult onset (type 2) diabetes mellitus, obesity hypoventilation, and sleep apnea syndromes (SASs), cirrhosis, venous stasis, and hypercoagulability leading to an increased risk of pulmonary embolism, and necrotizing panniculitis.1,2 Morbidly obese patients can also die as a result of difficulties in recognizing the signs and symptoms of peritonitis.3 There is an increased risk of prostate, uterine, breast, kidney, esophageal, liver, and colon cancer. Premature death is much more common in the severely obese individual; one study noted a 12-fold excess mortality in morbidly obese men in the 25–34 year age group.4 Increased morbidity and mortality have been noted in several other studies.5–8

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Table 2–1. Morbidity of Severe Obesity

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