What is morbid obesity and how do you treat it?

Morbid obesity is a complex, chronic disease that poses risks to someone’s physical and mental well-being. Morbid obesity is defined by an excessive amount of body fat. Also known as class 3 obesity, morbid obesity can lead to severe negative health effects, such as type 2 diabetes and heart disease. 

The term “morbid obesity” was created by healthcare providers in 1963 to justify insurance reimbursement for the cost of bypass surgery for weight loss in people with a body mass index (BMI) of 40 or higher.

In this article, we explore morbid obesity, its causes, and treatment options.

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What is morbid obesity?

Morbid obesity, more commonly called class 3 obesity, means a person has a body mass index (BMI) of 40 or higher. BMI is a widely used method where an individual’s weight in pounds or kilograms is divided by their height in feet and inches or meters squared. Morbid obesity can also be defined as having a BMI of 35 or higher combined with obesity-related health conditions, such as type 2 diabetes and heart disease.

What are the classifications of obesity?

Obesity is divided into 3 categories based on BMI. This helps to define the severity of obesity and the potential health risks involved. Classes of obesity are:

• Class 1 obesity: This classification includes people with a BMI from 30 to 34.9. People in this class have a lower risk of severe health complications compared to higher classes of obesity. But being in this class still puts someone at an increased risk for obesity-related health conditions such as type 2 diabetes, high cholesterol, hypertension, and heart disease.
• Class 2 obesity: This classification is defined by a BMI of 35 to 39.9 and carries a higher risk of developing obesity-related health issues. Individuals in this category may experience a reduced quality of life.
• Class 3 obesity: This class is characterized by a BMI of 40 or higher. Because this class includes the highest BMI range, people in this class have the greatest risk of serious health complications, including heart disease, heart attack, stroke, and certain types of cancer.

The term severe obesity is another name for morbid obesity, but most healthcare providers call it class 3 obesity. In the future, new names may emerge as providers create more personalized treatment plans that consider factors beyond BMI, such as waist circumference and overall health status.

How common is morbid obesity?

Worldwide adult obesity has more than doubled since 1990. And adolescent obesity has quadrupled. According to the U.S. Centers for Disease Control and Prevention (CDC), in 2023, at least 1 in 5 adults (20%) in the U.S. lived with obesity. And in 2023, 9.7% of people in the U.S. had severe obesity — that’s more than 32 million people.  

Experts predict that by 2035, 3.3 billion adults globally will have high BMI levels, compared to 2.2 billion in 2020.

What causes morbid obesity?

Morbid obesity is a complex condition caused by many factors. Studies suggest that genetics can account for 40 to 70% of a person’s predisposition to obesity, with certain genes influencing appetite and metabolism.

Lifestyle choices 

About 70% of morbid obesity cases are linked to lifestyle factors, such as poor diet and lack of physical activity.

Environmental influences

Environmental influences, including access to healthy foods and opportunities for physical activity, can contribute to obesity; for example, living in a “food desert” with limited access to fresh fruits and vegetables can increase the likelihood of obesity by up to 30%.

Mental wellness

Approximately 30% of individuals with morbid obesity also have mental health conditions like depression or anxiety, which can be both a contributing factor and a result of obesity. Also, certain medications for mental health conditions can have side effects that cause individuals to gain weight.

What are the risks of morbid obesity?

Morbid obesity is a serious health problem that affects individuals and communities. And it can lead to health and economic challenges. Addressing the risks requires a holistic approach, including lifestyle changes, medical interventions, and support for mental health.

Risks to physical health

There are serious health conditions associated with morbid obesity that include:

• Cardiovascular disease: Individuals with morbid obesity are 2 to 3 times more likely to develop cardiovascular diseases, such as heart disease, heart attack, and stroke, compared to those with a normal weight.
• Type 2 diabetes: Excessive body weight accounts for 80 to 85% of the risk of developing type 2 diabetes.
• Respiratory issues: Severe obesity is associated with a 40% higher risk of developing obstructive sleep apnea compared to individuals with a normal weight.
• Joint and musculoskeletal disorders: Individuals with morbid obesity are 4 to 6 times more likely to develop osteoarthritis and joint pain compared to people with a normal weight.

Mental health risks

Morbid obesity affects mental well-being as well. Mental health conditions associated with morbid obesity include: 

• Depression and anxiety: Research shows that individuals with morbid obesity are 2 to 3 times more likely to experience depression and anxiety compared to those with a normal weight.
• Self-esteem and body image issues: Around 70% of people with obesity report having a negative body image, which can lead to feelings of shame and low self-esteem.

What are the costs of morbid obesity?

Morbid obesity comes with high costs for both individuals and the broader community. In the U.S., the economic burden of obesity is estimated to be between $1,603.78 billion and $3,411.55 billion.

Individual costs

Adults with obesity in the U.S. incur annual medical care costs that are twice as much as individuals with a normal weight — averaging $5,010 compared to $2,504. These costs increase with the severity of obesity, with class 3 obesity leading to a 233.6% increase in medical expenses. This includes expenses for medications, hospitalizations, and specialized treatments for obesity-related conditions.

Societal costs

It’s estimated that the economic impact of obesity will surpass $4 trillion by 2035. This includes direct costs like medical care and indirect costs, such as lost productivity and disability.

Other impacts

Obesity-related absenteeism from work costs U.S. businesses approximately $4.3 billion each year. Obese employees are about 1.5 times more likely to miss work due to health-related issues and can have medical costs that are approximately 30% higher than those of normal-weight employees.

How is morbid obesity diagnosed?

Diagnosing morbid obesity involves an assessment that typically begins with calculating the individual’s BMI. A BMI of 40 or higher generally indicates morbid obesity. But, if someone’s  BMI is 35 or higher and they have one or more obesity-related health conditions, such as hypertension or type 2 diabetes, they can also qualify as morbidly obese.

In addition to BMI, healthcare providers often measure waist circumference to assess abdominal fat. A larger waist circumference is linked to higher health risks, even if someone’s BMI doesn’t fall in the morbid obesity range.

Providers may also do health screenings to identify related conditions that could influence the diagnosis or weight loss treatment plan. Screenings might include blood tests to check blood sugar or cholesterol levels, blood pressure, and breathing function to detect sleep apnea.

By combining BMI calculations, physical measurements, and comprehensive health screenings, healthcare providers can diagnose morbid obesity and guide patients toward treatment options.

How is morbid obesity treated?

Morbid obesity is best treated with a holistic approach that involves a combination of lifestyle modifications, medication, sometimes weight loss surgery, and possibly therapy.

Lifestyle changes to treat morbid obesity

Diet and exercise are key to treating morbid obesity. Adopting a balanced, calorie-controlled diet is central for weight loss and maintenance. This involves reducing the intake of high-calorie foods and increasing the consumption of fruits, vegetables, lean proteins, and whole grains. 

Regular physical activity is equally important, as it helps burn calories and improve cardiovascular health. Patients should work with their provider to create a personalized exercise plan, which may include activities like walking, swimming, or cycling.

Medical weight loss programs

Medical weight loss programs offer support that goes beyond lifestyle changes. These programs are designed to address the complex biological, psychological, and social factors that contribute to obesity and give patients the tools they need to achieve and maintain significant weight loss. They may be the only realistic option for people whose obesity doesn’t respond to lifestyle changes alone.

Medications

Commonly prescribed drugs for morbid obesity include appetite suppressants and fat absorption blockers. 

• GLP-1 receptor agonist medications, like Wegovy and Zepbound (generic name semaglutide), not only suppress appetite but also improve insulin sensitivity.
• Appetite suppressants, such as phentermine, work by influencing neurotransmitters in the brain to reduce hunger and increase feelings of fullness. 
• Fat absorption blockers, like orlistat (prescription Xenical and over-the-counter Alli), prevent the intestines from absorbing a portion of the fat consumed, reducing calorie intake. 

Behavioral therapy for morbid obesity

Behavioral therapy helps people identify triggers for overeating and develop strategies to change their behaviors. It can also address comorbid anxiety or depression. 

Cognitive behavioral therapy techniques teach patients how to set realistic weight loss goals, manage stress, and establish healthy eating patterns. Through regular counseling sessions, patients learn to replace unhealthy habits with positive ones and foster long-term weight maintenance and improved mental health.

Surgical treatment of morbid obesity

For individuals who don’t see results from medications and lifestyle changes, surgical treatment may be an option. Examples of bariatric surgery include:

• Gastric bypass that reduces the size of the stomach and reroutes the intestines
• Sleeve gastrectomy that removes a large portion of the stomach
• Gastric banding (Lap-Band) where an adjustable band is placed around the stomach to reduce the size of the stomach.

Surgical treatment results

With bariatric surgeries, patients typically lose 50 to 70% of their excess weight within the first 1 to 2 years after surgery. And these surgeries also improve obesity-related health issues including:

• Diabetes: Approximately 60 to 80% of patients with type 2 diabetes achieve remission after bariatric surgery.
• Hypertension: About 50 to 70% of patients experience significant reductions in blood pressure, with many being able to stop taking antihypertensive medications.
• Sleep apnea: Studies show that 80 to 90% of patients with obstructive sleep apnea see improvement in their symptoms after weight loss surgery.

When to see a provider about your weight

If you’re unsure whether it’s time to find professional medical help, consider if you have the following key indicators:

• BMI over 30: This is a significant risk factor for various health issues, including heart disease, type 2 diabetes, and certain cancers. You can estimate your BMI with the CDC’s adult BMI calculator.
• Difficulty losing weight: If you’re not seeing results after several months of lifestyle changes, a healthcare provider can help identify underlying factors, such as hormonal imbalances or metabolic issues, that might be preventing your progress.
• Health issues: Problems like high blood pressure, high cholesterol, type 2 diabetes, or sleep apnea, may be linked to excess weight. A healthcare provider can develop a plan to manage these medical problems while addressing weight loss.
• Emotional and psychological concerns: If you’re feeling depressed, anxious, or experiencing low self-esteem related to your weight, it’s important to address these feelings with a healthcare provider. They can provide or refer you to counseling and support services that focus on the psychological aspects of weight management.
• Family history: If obesity-related conditions run in your family, intervention can help you avoid or treat similar conditions. A healthcare provider can guide you in creating a preventive plan.

Remember, taking action leads to better health outcomes and improves your quality of life. If any of these factors apply to you, reach out to a healthcare provider here on Klarity Health or elsewhere to explore your options and take charge of your weight.

Key takeaways

• Morbid obesity is defined by a body mass index (BMI) of 40 or higher and poses significant health risks, including heart disease, type 2 diabetes, and certain cancers.
• Treatment options for morbid obesity include lifestyle changes, such as diet and exercise, medical weight loss programs involving medications, behavioral therapy, and surgical interventions like bariatric surgery.
• Medications can help with weight management by suppressing appetite and reducing fat absorption, while behavioral therapy helps modify eating habits and manage stress.
• Surgical options, such as gastric bypass and sleeve gastrectomy, may help people lose weight when other methods haven’t worked.
• Intervention is important, and healthcare providers are essential in developing personalized weight management plans to improve your health outcome and quality of life.

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If you’re struggling with obesity, a licensed healthcare provider can help. Find a provider on Klarity Health who can create a personalized treatment plan for you. Appointments are often available in 24 hours or less and select providers offer free initial consultations.*