Morbid obesity affects 4.5% of men and 5.3% of women according to the ENE-COVID study. According to data from the World Health Organization (WHO), 23.8% of adults in Spain live with obesity and the numbers do not stop growing. According to the ENE-COVID study, morbid obesity affects 4.5% of men and 5.3% of women. But it is also present in the child population, 2.1% according to the ENE-COVID study. María Jesús Garrido Ferrero, dietitian-nutritionist and member of the specialization group in Clinical Nutrition and Dietetics (GE-NuCyD) of the Spanish Academy of Nutrition and Dietetics, helps us understand this pathology.
What is morbid obesity?
It is type III or severe obesity. To understand it, you have to know that, using the WHO definition, “obesity is a chronic, multifactorial and complex disease, which is defined by an excessive accumulation of fat that can be harmful to health,” clarifies María Jesús Garrido.
To know if you are overweight or obese and to what degree, the body mass index (BMI) has normally been used, which is calculated by dividing weight by height squared (kg/m2). “Following this criterion, the Spanish Society for the Study of Obesity (SEEDO) indicates that there is morbid obesity when BMI values are between 40 and 49.9,” says the expert and clarifies that, for different reasons, BMI can be imprecise, so it is advisable to use other measurements such as waist circumference, waist-height index or bioelectrical impedance (BIA) which studies body composition quickly, safely and reliably.
At how many kilos is morbid obesity considered?
Morbid obesity is not defined by a specific weight in kilos, but by the Body Mass Index (BMI). However, to provide a handy reference for how morbid obesity is calculated and when it is morbidly obese, here are some examples based on height:
- Person of 1.60m: morbid obesity from ~102 kg (BMI 40)
- Person of 1.65m: morbid obesity from ~109 kg (BMI 40)
- Person of 1.70m: morbid obesity from ~116 kg (BMI 40)
- Person of 1.75m: morbid obesity from ~122 kg (BMI 40)
- Person of 1.80m: morbid obesity from ~130 kg (BMI 40)
It is important to remember that these values are approximate and that each case must be evaluated individually by a dietitian-nutritionist, also considering other factors such as body composition and fat distribution.
Main causes of morbid obesity
It is a multifactorial disease and among its causes there are «genetic factors, endocrinopathies, some psychiatric diseases or chronodisruption (changes in the sleep cycle and disorder in meal times)», lists Garrido, who also points out changes in eating and physical activity patterns, stress, alterations in the intestinal microbiota or the influence of socioeconomic level and exposure to obesogenic environments. “In epigenetics, a lot of research is being done on how the environment affects multifactorial pathologies such as obesity,” he points out.
Health consequences
Among the most important is the fact that it increases the possibility of developing other diseases. “Cardiovascular disease, type 2 diabetes, dyslipidemia, high blood pressure, liver disease due to non-alcoholic fatty deposits, respiratory diseases, sleep disorders, certain types of cancer, psychosocial problems or osteoarticular complications, among others,” explains María Jesús Garrido.
Photo from Unsplash
Medical approach and treatments available for morbid obesity.
The role of primary care is fundamental because it is the first point of contact with the patient and “it is also the ideal environment for preventive practice of this disease,” says María Jesús. «Referral to hospital centers or obesity units is made based on criteria agreed upon by both levels of care.» Adds the expert.
In any case, the approach to obesity must be multidisciplinary to address all the causes that cause it and address possible complications. The expert indicates that “teams should include endocrinologists, clinical psychologists, dieticians-nutritionists, nursing professionals, physical activity professionals, pulmonologists, etc.”
It is very important that the treatment be considered on an individual basis, taking into account physical, economic, cultural, or social factors that influence the person living with morbid obesity. The main objectives of the treatment are to reduce the metabolic risk, avoid psychological problems derived from stigmatization and discrimination, treat health complications and improve both the perception of body image and self-esteem, managing to increase the quality and life expectancy of the patient, indicates María Jesús Garrido.
Treatments available include:
- Dietary approach: Through an individualized eating plan that considers, among other things, the economic and cultural situation of the person with morbid obesity.
- Physical activity: It begins with a complete evaluation to install a program that allows you to progressively improve physical condition.
- Psychological treatment: Essential to identify possible emotional and behavioral factors involved in the appearance and development of obesity. There may also be eating disorders (binge eating, bulimia) that need to be treated.
- Pharmacological treatment: The development of medications that treat obesity in its different degrees has grown exponentially in recent years.
- Surgical treatment: Bariatric surgery is the last step taken if the above has not worked. Its objective is to achieve lasting weight loss and, therefore, reduce the incidence of comorbidities, thus improving quality and life expectancy. To access this surgery, patients must be evaluated by a multidisciplinary team and meet a series of requirements. «It is important to establish realistic objectives (the desired goal is not always achieved, since there is a possibility of weight regain). The patient must also be informed of the changes that, after the intervention, they will have in their diet, physical activity and eating behavior, as well as the possible appearance of adverse effects and the need for lifelong medical follow-up,» warns the expert.
Lifestyle curated on Unsplash
Food for people living with morbid obesity
An adequate diet is one of the bases of treatment in case of morbid obesity, regardless of whether other therapeutic options are used. “Proper eating habits are essential not only in terms of positive weight development, but also to guarantee an adequate state of health,” says María Jesús Garrido.
In this sense, the expert assures that we must follow an eating pattern that has proven its health benefits. “The Mediterranean diet includes abundant vegetables, fruits, legumes, whole grains, healthy fats such as olive oil or nuts, lean meats, fish, and water as the main drink,” recalls the expert.
Likewise, ultra-processed foods should be avoided, such as those rich in saturated fats (pastries, processed meats, fast food, snacks, etc.) or sugary drinks and other sources of sweet free sugars, chocolate, sugary dairy products, etc.
Before establishing an individualized eating plan, the expert recommends “evaluating the patient’s habits to adapt the dietary guidelines to their preferences, customs, culture and lifestyle, thus seeking long-term adherence to treatment.” Afterwards, the key is to calculate the patient’s energy needs and progressively reduce caloric intake until reaching a contribution that guarantees weight loss, but without ceasing to provide the nutrients necessary for good health.
Can morbid obesity be reversed?
María Jesús Garrido prefers to talk about “satisfactory results that are maintained over time.” And this can be achieved by following the therapeutic recommendations indicated above, and with the support of a multidisciplinary team. But, in addition, it is essential «to consider this modification of habits as a way of life and not as a diet, that is, not as something temporary, but permanent and rewarding,» adds the dietitian-nutritionist.
Physical activity in people living with morbid obesity
“Any activity, no matter how minimal it may seem, is displacing sedentary time and that is already an achievement,” María Jesús advances. But the expert recognizes that osteoarticular pathologies are common if it presents with morbid obesity and, in this case, pain conditions mobility. “There are studies that report the difficulty in correctly developing the gait pattern in people with high weight and fat percentage,” he adds. Added to this is a decrease in balance, increasing the risk of falls. “That is why it is so important to have specialists in physical activity and sports on the teams to evaluate the capabilities of each person and prescribe an exercise plan tailored to them,” concludes the expert.
The ALDI Council
Comments about other people’s bodies can do a lot of damage. Avoid judging others, as well as excluding them in your social relationships for having non-normative bodies.
María Jesús Garrido Ferrero. Dietitian-Nutritionist DN (mention in Nutrition and Public Health. Consumer education). Isabel I University. University diploma in nursing (DUE). Vigo University School of Nursing. University Master’s Degree in Advanced Nutrition and Public Health. UOC Expert in obesity and metabolic complications. University of Barcelona International Certification in Standardization of the Nutritional Care Process
