While most Americans are aware that obesity is a growing trend and concern within the country, understanding how it is identified and how exactly it affects the body is not necessarily common knowledge. More than a third of U.S. adults are obese, according to the CDC, with tens of billions of dollars being utilized annually to cover medical costs related to the condition.[1] Due to its seriousness and pervasiveness, we’ve decided to do a two-part series on obesity in the hopes that we can increase knowledge on obesity’s effects both on patients and those caring for them as well as potential red flags in PI and medical negligence litigation. In this first post, we will focus on how obesity is diagnosed and what health risks it poses:
BMI and obesity diagnosis
Body mass index, commonly known as BMI, is a measure of weight relative to height, resulting in a number that indicates excess weight on the body.[2] The chart below outlines BMI measurements and their relative reflection of weight status:
| BMI | Weight Status |
| Below 18.5 | Underweight |
| 18.5-24.9 | Normal |
| 25.0-29.9 | Overweight |
| 30.0 and above | Obese |
Since studies have shown that BMI is a generally good indicator of body fat, and therefore future health risks, it is the most commonly used method to determine obesity in adults. However, it is important to realize that BMI measures excess weight, not excess fat, and so factors such as age, sex, and muscle mass can influence how accurate BMI is at predicting health risks.[3] For example, women have greater amounts of total body fat than men with an equivalent BMI, and highly-trained athletes will likely have a high BMI due to increased muscle mass.[4] One study found that nearly half of their participants considered overweight by way of BMI were actually metabolically healthy after checking blood pressure, glucose, cholesterol, and triglyceride levels.[5] Therefore, it is extremely important to look at the various factors that can lead to obesity, and understand that simply losing weight doesn’t solve all of the problems associated with metabolic unhealthiness.
Associated Health Risks
Obesity affects nearly every body part, and can lead to a wide variety of health risks. Here are some of the most important ones to be aware of:
- Diabetes: increased fat cells can increase inflammation, which makes the body less responsive to insulin and affects how the body metabolizes fat and carbohydrates, resulting in higher blood sugar levels.[6]
- Cardiovascular disease: blood pressure, low-density lipoprotein cholesterol, cholesterol, triglycerides, blood sugar, and inflammation all increase with more body weight, increasing the risk for coronary heart disease and stroke.[7]
- Cancer: obesity’s tie to cancer is not quite as clear-cut as the two definitions above because it is not a single disease, but significant evidence has been amassed connecting the two.[8]
- Depression: the relationship between depression and obesity very well might be a two way street, with each being potentially responsible for causing the other. While a biological link between the two has not been definitively identified, inflammation, changes in hypothalamic-pituitary-adrenalin axis, insulin resistance, and socio-cultural factors have all been proposed as potential causes.[9]
- Reproduction: obesity can increase infertility, chance of miscarriage, gestational diabetes, preeclampsia, and complications during labor and delivery.[10]
- Lung function and respiratory disease: excess weight affects the mechanical and metabolic pathways within the respiratory system, and is known particularly for its link to asthma and obstructive sleep apnea.[11]
- Memory and cognitive function: Alzheimer’s disease and dementia have both been strongly linked to obesity.[12]
- Musculoskeletal disorders: the strain placed on bones, muscles, and joints from excess weight can lead to osteoarthritis and general limb and back pain.[13] While obesity has not been clearly determined to be direct cause of degenerative disc disease, it is widely identified contributing factor and associated with degenerated discs, greater severity of disc degeneration, including narrowing of disc space.[14]
- Surgery: obese individuals have a much higher risk of longer operative time, greater intraoperative blood loss and potential for short term postoperative complications. [15] What is of interest is that the underweight patient is at the most risk of major postoperative complications, including long-term mortality[16].
A thorough review of chart notes always reveals a patient’s preexisting conditions, including elevated BMI and obesity, but an untrained eye may miss connections between such conditions and other conditions a patient may be suffering from. If you’re trying to determine whether or where obesity ties to a personal injury or medical negligence case, consider using Integrity Legal Nurse Consulting. We have experience with chart review and analysis; helping you understand your case strength and weaknesses and what you might be up against in litigation.
[1] “Adult Obesity Facts,” CDC, Aug. 29, 2017, https://www.cdc.gov/obesity/data/adult.html,
[2] “Body Mass Index: Considerations for Practitioners,” CDC, n.d., https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf
[3] Ibid
[4] Ibid
[5] Baulkman, Jaleesa, “Normal Body Mass Index Doesn’t Mean You’re Healthy Study Says: Millions of Americans Mislabeled as Obese,” Medical Daily, Feb. 6, 2016, http://www.medicaldaily.com/body-mass-index-obesity-america-372526
[6] “Obesity Prevention Source: Health Risks,” Harvard T.H. Chan School of Public Health, n.d., https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/health-effects/
[7] Ibid
[8] Ibid
[9] Ibid
[10] Ibid
[11] Ibid
[12] Ibid
[13] Ibid
[14] https://northamericanspine.com/obesity-is-double-whammy-risk-for-degenerative-disc-disease/
https://www.ncbi.nlm.nih.gov/pubmed/15917859
https://www.wiley.com/WileyCDA/PressRelease/pressReleaseId-102236.html
[15] https://www.wiley.com/WileyCDA/PressRelease/pressReleaseId-102236.html
[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520073/