Susan stays home all day. She is ashamed to be seen in public. She has trouble moving about in her house. It tires her. Her life has become sedentary, and she continues to gain weight. She is depressed. She avoids the mirrors. Her family provides for her. She is in her 40s, never married and unable to work. She is morbidly obese.
Morbid obesity has become quite common in our society. Many people, even some medical professionals, think it is a rare condition. But it is not. The number of Americans with morbid obesity is growing three times as fast as the number of overweight and obese are, according to Web MD. One in 20, or 15 million are morbidly obese, with women having higher rates.
Who are the morbidly obese? According to the National Institutes of Health(NIH), anyone 100 pounds overweight, or double their ideal weight, or having a BMI of 40 or more is morbidly obese. Some consider having a BMI of 35 to 40 with diabetes and high blood pressure as morbidly obese.
Medical challenges
"Morbid obesity is when a person has gained enough weight that they actually are causing themselves harm carrying it around," according to Stephen Hamn, MD of Baylor University. The morbidly obese are prone to a host of complications, ranging from life-threatening to minor.
They include such cardiac conditions as:
* congestive heart failure
* atherosclerosis (thickening and hardening on the walls of the arteries)
* atrial fibrillation
* malignant arrhythmia – a serious irregular heartbeat which may lead to sudden death
* high blood pressure, possibly leading to stroke, or kidney failure
* enlarged heart
Other conditions may include:
* high cholesterol
* osteoarthritis
* gall bladder disease
* heartburn
* sleep apnea
* problems breathing
* fatty liver disease
* urinary incontinence
* carpal tunnel syndrome
According to the NIH, some cancers are more prevalent among the obese:
* in men, cancers of the colon, rectum, and prostate
* in women, cancers of the gall bladder, uterus, cervix, breast
* in both sexes, cancer of the esophagus
In obese women, conditions such as excess hair on the body (hirsutism), oily skin and skin discoloration are more common than in normal weight women. There are also complications of pregnancy, affecting mother and baby.
Psychological challenges
The morbidly obese are five times more likely to be depressed as an average weight person, according to the Journal of Epidemiology cited on suicide.org. The largest percentage of suicides are caused by untreated depression. A morbidly obese person who is depressed should receive treatment quickly.
They suffer from low self-esteem, and feel unattractive, due in part to the American ideal of slimness
Many, like Susan above, stay home and do not show themselves. They feel embarrassment when around the physically fit. Gym equipment is often not big enough for them.
An extensive investigation of discrimination against the obese, written by researchers Rebecca Puhl and Dr. Kelly Brownell in Obesity, a Research Journal, found that physicians and nurses harbor negative feelings toward the obese. A survey of nurses showed that the obese were viewed as unsuccessful (24%), overindulgent (43%), lazy (22%), and experiencing unresolved anger (33%). Another survey cited found that some nurses felt uncomfortable with the obese (48%) and 12% preferred not to touch them. A survey of physicians reported by Puhl and Brownell showed that two-thirds thought that the obese lacked self-control and that 34% thought they were "lazy." Even some dietitians have shown negative feelings.
The same study showed that there is prejudice and discrimination from employers, at school, and in social situations.
Financial Challenges
The non-medical costs of being morbidly obese are high. They need out-sized furniture, extra-large clothing and equipment to get around. Cars have to be purchased based on seating room, and gasoline use is higher, due to the extra weight.
A study done by Avi Dor of George Washington University on the extra costs of being obese found that extra expenses due to obesity for women is $4,879 and for men is $2,646 per year.
Puhl and Brownell also found that the morbidly obese tend to work in lower-paying jobs, get passed over for promotions, and are more likely to get fired. Higher rates of disability and sick days mean lower paychecks.
Other costs include weight loss programs such as Weight Watchers and Jenny Craig, and over-the -counter weight loss preparations.
Employees who are very obese cost businesses money, not only in lost productivity, but in higher health insurance premiums. There have been suggestions to raise premiums on the obese.
Practical challenges
There are many obstacles found by the obese:
* Narrow seats on buses, trains, airplanes, movie theaters, anywhere close seating is found
* Fitting into a restroom on an airplane or train
* Standing on a scale which is too narrow or high
* Fatigue due to the weight of the fat pressing down on the organs. This is a major stumbling block to getting around.
These are only a few of many such situations the morbidly obese face.
In our society, the morbidly obese are shunned and discriminated against. People tend to blame them completely for their condition. Yet there are many causes, not just poor habits.
According to the Centers for Disease Control and Prevention (CDC), genetic changes occur too slowly in people to cause the obesity epidemic...but "genes give the body instructions for responding to changes in its environment. Studies have identified variants in several genes that may contribute to obesity by increasing hunger and food intake."
Complex interactions between genes and environmental factions are poorly understood, according to the CDC.
Lack of exercise and poor dietary habits contribute, of course. But there have been many changes in our food habits throughout the years, including the rise of fast foods, super-sizing of meals, and a super-abundance of processed and unhealthy foods. And, of course, our sedentary lifestyles play a role.
The morbidly obese should be encouraged to engage in physical activity as much as is possible. Those who exercise are less prone to complications. Those who have not yet suffered from the many illnesses are lucky, so far. Bariatric surgery should also be considered.
