What is morbid obesity?
Morbid obesity differs from obesity, it is when a person has excess amounts of body fat and a body mass index or BMI greater than or equal to 35.
Morbidly obese people are at greater risk of factors that can directly affect their quality of life; like it can interfere with basic physical functions such as breathing or walking. We can say an individual is morbidly obese if he or she is 100 pounds over his/her ideal body weight.
Any one of us can become morbidly obese. If we consume more calories than our body can burn and use. The body then stores this unnecessary calorie as fat.
As more and more calories one consumes, the fat stores in the body in larger amount, which leads to obesity or might be in later life- morbid obesity.
Our body needs some fats for energy, heat insulation, and other body functions. But if we consume more than recommended then, it could lead to serious health problems.
Obesity and Morbid obesity, both terms describe having more body fat than what is needed to be healthy. And Both works as an indicator for people who are at risk for health problems. However, the term “Morbid obesity” means an excessive amount of body fat in comparison to “obesity.” This body fat increases your risk for diabetes, kidney disease, heart disease, and other problems.
Also, people may be obese without being considered morbidly obese. Morbid obesity occurs when a person exceeds the level of obesity that increases the chances of developing the conditions given below;
- Heart disease
- High blood pressure
- Breathing problems
- Gallbladder disease
These conditions are termed as comorbidities and later in life they can be responsible for causing disabilities or death.
You should know where the excess weight is located!
If excess weight is accumulated around the abdomen (the apple shape), then there might be chances to develop health problems if compared to the weight around the hips (pear shape). If your waist size is greater, then your health risk of developing a problem is higher.
There are certain factors which can put a person more at risk than others.
- Genetic factors: If someone has a family history of obesity or morbid obesity is more at risk to become morbidly obese later in life.
- Dietary habits: The diet and lifestyle of a person affects the fact of whether or not they become overweight or obese.
- Mental factors: Stress and anxiety can be one of the factors to cause weight gain, as they lead to the production of the stress hormone “cortisol” in the body. Which causes fat storage and hence weight gain.
- Sleep habits: Another contributor to weight gain is the lack of sleep.
- Being a female: Post- pregnancy weight gain can create a negative impact on the mother and these females are prone to gaining weight during menopause.
- Certain medical problems: Some medical concerns also causes obesity.
- Some medications: taking antidepressants and beta-blockers can increase the chances of weight gain.
- Aging: Slowing down of metabolism due to age and sedentary but busy lifestyles might make people more likely to gain weight.
A morbidly obese person can be identified very clearly by physical appearance. But there are some main symptoms of morbid obesity like if a person is having a BMI of 35 or higher and obesity-related health problems- diabetes or hypertension.
However other symptoms include:
- Excess fat around the body mainly stomach region
- Being easily winded or heaviness in breathing
- Difficulty in walking
- Trouble in breathing
How can one calculate BMI?
- Anyone can calculate BMI from height and weight. To find out your BMI, use the formula: weight (kg)/ height (in meter square)
- A BMI between 25 – 29.9 is considered to be as overweight
- A BMI of 30 or more is considered to be as obese
- A BMI of more than 35 is considered morbidly obese
However, BMI estimates body fat but it does not directly measure body fat. Due to which, some people with muscular builds lie; athletes may have a BMI that identifies them as obese even though they do not have excess body fat.
At that point, people need to check the waist circumference.
For children and teens:
To find the BMI of child or teen, you should ask your healthcare provider, because children grow at different rates and teens get matured at different rates. So, they might be compared with growth standards, that take age and sex into account.
Individuals who are at lesser risk should be counseled earlier about healthy and effective lifestyle changes to prevent any further weight gain.
The main goal should be to reduce overall body weight and excess fat around the body parts and to maintain a lower body weight should be a long term goal. A weight loss of 10 percent over 6 months should be an initial target. There should be a reduction of 500g- 800g Each week. As greater rates of weight loss do not achieve long-term results. Once the 10% reduction has been achieved, the priority should be weight maintenance through combined changes in diet, physical activity, and behavior. And the further goal would be the prevention of weight gain later in life.
Diet therapy– In the majority of obese patients, adjustment on the diet will be necessary to reduce total calorie intake. Dietary therapy includes modification in diets to achieve a decrease in caloric intake. A key element of the recommendation is the use of a moderate reduction in calorie intake, which has been designed to achieve a slow, but progressive, weight loss. Ideally, calorie intake should be reduced in such a way that the energy level would be maintained throughout the day. If this level of calorie intake is achieved, then the excess weight will gradually decrease.
There are some recommendations that would help in achieving diet target:
|Calories||Approx. 500 to 1,000 kcal/day|
|Carbohydrate||55 percent of total calories|
|Protein||Approx. 15 percent of total calories|
· Saturated fatty acids
· Monounsaturated fatty acids
· Polyunsaturated fatty acids
|25 percent or less of total calories
· 8 to 10 percent of total calories
· Up to 15 percent of total calories
· Up to 10 percent of total calories
· <300 mg/day
|Calcium||1,000 to 1,500 mg/day|
|Fiber||20 to 30 g/day|
Physical Activity– Physical activity directly affects our health status. Regular physical activity is important in efforts to lose weight because it increases energy expenditure and plays a vital role in weight maintenance.
Not only for obese but for a healthy living physical activity is important as it reduces the risk of heart disease, may help reduce body fat and prevent the decrease in muscle mass which is mainly found during weight loss. But the intensity and rate differ for obese than normal people, for the obese people, activity should generally be increased slowly, with care taken to avoid injury. Like; household chores, including walking, dancing, gardening, and team or individual sports, can be done initially for at least 30 minutes or more of moderate-intensity physical activity on most, and that should be done all days of the week.
Some physical activities are shown below:
- Playing volleyball for 45–60 minutes
- Basketball for 30 minutes
- Bicycling 5 miles in 30 minutes
- Dancing fast for 30 minutes
- Walking 2 miles in 30 minutes (15 min/mile)
- Water aerobics for 30 minutes
- Swimming laps for 20 minutes
- Stair walking for 15 minutes
- Jumping rope for 15 minutes
- Running for 15 minutes (15 min/mile)
Behavior Therapy- Behavior therapy is a useful criterion to planned changes in food intake and physical activity. Some specific behavioral strategies are as follows: self-monitoring, stress management, stimulus control, problem-solving and social support. Behavioral therapies may be applied to promote adoption of diet and adjustments in daily life activity; this combination will be a useful approach to therapy.
Assess reasons for failure to lose weight-
What if a person fails to achieve the recommended body weight within the given time period. A critical question which has to be considered is whether the person’s level of motivation is high enough to continue the therapy.
If the person’s motivation is high, then revise goals (weight loss in 6 months) and strategies (diet, increased physical activity, and behavior therapy). If the person is feeling demotivated then the therapy should be discontinued, and the person should be encouraged to start on efforts to lose weight or to avoid further weight gain. Even if weight loss therapy is stopped, a person should take care of the risk factors management.
If one fails to achieve target weight loss then these points should be considered : –
(1) energy intake (i.e., dietary recall including alcohol intake)
(2) energy expenditure (physical activity),
(3) recent negative life events,
(4) family & societal pressure, and
(5) episodes of (e.g., depression, binge eating disorder).