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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