Risk of obesity and surgical indications

Morbid obesity, defined arbitrarily as greater than 100 percent excess weight, is only rarely the immediate or sole cause of illness or death. In addition to the Pickwickian syndrome, localized adiposity can cause obstruction and/or organ compression resulting in clinical disorders. Most of the obesity-associated risk factors interact to (a) diminish quality of life, (b) impair health, and (c) shorten survival. Severe obesity in childhood and adolescence impairs scholastic achievement and final educational levels are lower than in the nonobese. For the adult, opportunities and promotions are fewer, the quality of jobs and pay are lower. Unemployment is more common. The obese are more apt to remain single or to lose their marriage partners. Sexual adjustment and reproductive capabilities may be impaired. Regarding morbidity, the obese are "high-cost patients'. The specific and common complications or morbid obesity have been extensively examined and are the major factors causing more severe, more prolonged and more frequently recurring illness. Some obscure risk factors are related to "sudden death', to serious hazards of various medical treatment regimens, and to complication arising out of rapid or repeated regain. Excess mortality has been documented in the morbidly obese to be greatest in the younger age categories while morbidity increases with age in the surviving obese population. The dismal results of non-surgical treatment require an alternative approach. Indications for surgery in a particular patient have to be individualized. Rigid criteria are not practical, but in general, surgery is indicated and justified if the benefits expected from surgical treatment can prevent or reverse the hazards arising from unrelieved obesity. Therefore, the resulting weight losses have to be sufficient to reduce the patients to within 30 or 40 percent of desirable weight. The potential surgical complications must not equal or surpass the hazards of chronic obesity.