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Morbid Obesity

The expression “morbid obesity” was coined by Payne and DeWind in 1963 (J. J. Payne, personal communication) in order to persuade health insurance administrators that reimbursement for the cost of intestinal bypass surgery in grossly obese patients could be justified on health grounds. The word “morbid” derives from the Latin “morbidus,” which means diseased but, ironically, it is also related to the Greek term “marainein” which means “to waste away” (1). Despite this discordant etymological note and the fact that the word “morbid” prejudges the case, use of this adjective is usually appropriate since very severe obesity qualifies as a disease per se and is conducive to many other maladies as well. Bray (2) has compiled data on 16 cases of extraordinary obesity whose maximum weight averaged 811 lb (369 kg) and whose average age at time of death was 35 years (range 22 to 59).

Obviously, obesity this extreme is associated with a greatly diminished life span, but there remain many valid questions about the relationship between degree of severity of obesity and health expectations. Such questions must be addressed if we are to attempt to balance the risks of inherently hazardous (but potentially successful) treatments of morbid obesity against the risk of permitting the obesity to continue unchaged.

What do severely obese people die from? Principally from heart disease, stroke, and diabetes meffitus. Some preliminary data (Fig. 2) about the relationship of excess weight to cause of death in men are available from the 1959-1973 study conducted by the American Cancer Society (4). Again, data for
the morbidly obese are lacking, but there is reason to believe that as excess mortality increases with increasing overweight, a similar distribution of causes of death would obtain.

The literature on the medical complications of severe obesity has become fairly sizable, but such articles are frequently case reports and the public health implications of DIGESTIVE such information are difficult to assess. The DISEASES kinds of health problems to which morbidly obese persons are believed to be especially susceptible include those shown in Table 1. Problems that are not unduly threatening to
physical health or quality of life, such as menstrual irregularities and dermatoses, are not included in this list. Unanimity does not exist concerning the hazard to life of gross obesity.



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