Postmortem examination in the morbidly obese

The incidence of obesity is rising, and morbid obesity is associated with increased mortality rates. Pathologists will therefore encounter increasing numbers of postmortems in the morbidly obese. It is essential that pathologists recognize morbid obesity and can identify its consequences at postmortem. The aims of this study were to assess how often obesity is included in the cause of death of morbidly obese individuals, and whether obesity-related causes of death are being missed.

The postmortem database of the John Radcliffe Hospital was searched to identify all medicolegal postmortems performed on morbidly obese individuals between January 2007 and September 2012. Of 4742 coronial postmortems performed, 3911 (82%) reports contained a record of height and weight, allowing body mass index calculation. Two hundred and two (5.2%) were performed on morbidly obese individuals. Death resulted from natural causes in 189 (93.6%), of which obesity was included in the medical certificate of cause of death in 41 (22%).

Postmortems in the morbidly obese represent a significant percentage of the total performed, but recognition of the contribution of obesity to death and of obesity-associated conditions is poor. Postmortems performed on the morbidly obese represent a distinct group with specific causes of death, and should be approached as such.