Obesity in the critically ill: a narrative review

Area of Science:

• Critical Care Medicine
• Metabolic Disorders
• Public Health

Background:

• Obesity, defined as excess fat accumulation, is a growing global health concern with a 20% prevalence in ICU patients.
• Visceral adipose tissue contributes to insulin resistance, chronic inflammation, and a procoagulant state, linking obesity to numerous chronic diseases.
• The
• obesity paradox
• suggests a J-shaped BMI-mortality curve in critically ill patients, where overweight and moderate obesity may be protective.

Purpose of the Study:

• To review the multifaceted impact of obesity in critical illness.
• To highlight the challenges in managing obese patients in intensive care settings.
• To discuss the implications of the obesity paradox in critical care.

Main Methods:

• Literature review of obesity's effects on health and critical illness.
• Analysis of the relationship between Body Mass Index (BMI) and mortality in hospitalized and ICU patients.
• Examination of obesity-related complications and management considerations.

Main Results:

• Obesity is linked to increased risks of acute kidney injury (AKI), infections, and respiratory/cardiovascular complications in critical illness.
• Despite potential mortality benefits (obesity paradox), obesity adversely affects morbidity and requires adapted management strategies.
• Obese patients face diagnostic, logistic, and drug dosing challenges, compounded by healthcare worker and patient stigma.

Conclusions:

• Obesity presents unique challenges in critical care, impacting patient outcomes and requiring tailored approaches.
• The obesity paradox warrants further investigation regarding its mechanisms and clinical implications in critical illness.
• Addressing the complexities of obesity management, including stigma, is crucial for improving care in intensive settings.