Morbid Obesity: When Are You Medically Overweight?

Being overweight is defined as having more body fat than is ideal for good health. Body mass index (BMI) is a measuring tool to define whether a person is in the overweight category.

While overweight is defined as having a body mass of 25 kilograms per meters squared (kg/m²), obesity begins at 30 kg/m². Morbid obesity is indicated by a BMI of 40 kg/m² or higher.

It's important to remember BMI is not an exact measure of health—it simply indicates that a person might want to get tested for health issues usually associated with higher BMI.

This article discusses morbid obesity and BMI, the risks associated with morbid obesity, how to treat morbid obesity, and getting support for recovery.

Morbid Obesity, BMI, and Weight Risks

Being about 80 to 100 pounds over the reference body weight for your height could put you in the category of morbidly obese on the BMI chart. A high BMI might not mean you are unhealthy since BMI is only a screening tool to determine risks to screen for.

However, knowing your BMI category could be a way for you and your healthcare provider to gauge which tests might be necessary to monitor your health and what risks you might face. For example, people with morbid obesity aged 25 to 35 could be 12 times more likely to die prematurely when compared to their peers.

A BMI in the morbidly obese category, or a BMI of 40 kg/m² (88 pounds per foot squared) or higher, could increase the chances of the following health conditions:

• Shallow or restricted breathing (hypoventilation), asthma, or sleep apnea
• Diabetes
• Cardiovascular (heart and circulatory system) issues like high blood pressure, higher risk of heart attack, or coronary artery disease
• Persistent heartburn or gastroesophageal reflux disease (GERD)
• Gallbladder disease or fatty liver disease
• Urinary tract infections (UTIs) and fertility problems
• Joint, hip, and back pain
• Increased risk of cancer, including breast cancer, colon cancer, prostate cancer, and pancreatic cancer
• A decreased life expectancy by 10 to 15 years

Chart to Visualize Morbid Obesity Classification

Below is an example of a BMI chart, which can classify people's weight and, as a result, screen for health risks. However, BMI is not a direct indicator of health problems. To determine if your BMI is a concern, discuss your symptoms and necessary lab work with a healthcare provider.

You can check your BMI by entering your height in the Adult BMI Calculator provided by the Centers for Disease Control and Prevention (CDC).

Treating Morbid Obesity: Where Do You Start?

The first step toward treating morbid obesity is to speak to a healthcare provider on how to do so safely. For instance, starting a new exercise regime with a high BMI could put you at greater risk for injury, and meeting with a trainer or speaking to your healthcare provider could be advised.

The following are some ways to begin morbid obesity treatment.

Behavioral Changes

If weight loss seems overwhelming, it might help to begin by trying new behaviors, such as:

• Recording what you eat daily and using a calorie counter
• Drinking more water
• Avoiding temptations, like alcohol with dinner, which can make it more difficult to limit calories, or skipping a meal and overeating later
• Setting healthy and safe weight loss goals
• Taking small steps toward your health and focusing on one goal at a time
• Having realistic standards for appearance and weight
• Creating a support network via support groups, family, and friends
  

Modifying Diet

Dietary changes can be done in a variety of ways, including:

• Swapping processed foods, like packaged meals, for fresh ingredients, including fresh vegetables or fruits
• Limiting added sugars or unhealthy fats, like saturated fat
• Finding physical activities you know you'll enjoy enough to stick with
• If possible, making a goal to decrease calorie intake by 500 to 600 calories a day via exercise, diet, or both, which could result in weight loss of about 1 pound a week
• Learning how to read nutrition labels and how to determine portion sizes
• Determining your calorie deficit for the day, which can depend on exercise and weight loss goals
  

Movement and Exercise

When starting an exercise program with a high BMI, it's recommended to start slowly, with shorter bouts of exercise, which could include:

• Parking your car farther from or walking a longer route to daily destinations
• Planning short, brisk walks, including a five-minute walk a couple of times a day
• Low-impact water aerobics
• Dancing or some other physical activity you enjoy

Other exercises that help with weight loss include:

• Running or cycling
• Weight lifting
• Group exercise classes
• Water aerobics
  

Some safety measures to incorporate when exercising could include:

• Watching for any difficulty breathing
• Using equipment correctly to maintain balance and prevent injury
• Modifying exercises if range of motion is limited

Prescription Medication

Weight loss medications can be prescribed by a healthcare provider or purchased over the counter (OTC). Prescription weight loss medications are meant for people with health problems because of their weight. The following are some prescribed weight loss medications:

• Adipex-P (phentermine): A stimulant that suppresses appetite
• Alli or Xenical (orlistat): Prevents fat from food from being absorbed, is also available without a prescription
• Topomax (topiramate): An anti-seizure medication that might help with binge eating
• Qsymia (phentermine and topiramate): A combination medication
• Contrave (naltrexone and bupropion): A combination of medications used to treat addiction and depression that might help with appetite and cravings
• Victoza or Saxenda (liraglutide): Injections that could lower appetite and help with cravings

Over-the-Counter Medication

Alli is an OTC version of orlistat that has been approved by the Food and Drug Administration (FDA).

While many OTC diet pills claim to help with weight loss, most are not approved by the FDA. It's advised to talk to your healthcare provider before taking any weight loss medication.

Weight loss pills usually claim to increase metabolism and suppress appetite. Most of these claims are not verified, and some can be unsafe. For instance, supplements could interfere with medications you're taking or cause high blood pressure or worsen heart problems.

Weight loss pills often contain one or more of the following:

• Caffeine
• Fiber
• Herbs and minerals

Some OTC weight loss supplements are simply diuretics, meaning they cause water loss. This could cause dehydration and loss of minerals. Therefore, diuretics are not recommended as a weight loss tool.

Surgery

A BMI over 40 can make a person a candidate for bariatric surgery, A candidate for bariatric surgery might:

• Not be able to lose weight through lifestyle changes
• Have health issues related to weight

Whether bariatric surgery is a safe option for you also requires medical and psychological analysis beforehand.

"Bariatric surgery" is a general term for weight loss surgery. Some common bariatric surgery options are

• Gastric sleeve: About 80% of the stomach is removed to make it smaller.
• Roux-en-Y gastric bypass (RYGB): A small part of the stomach is sectioned off and connected to the lower intestine. This creates a small pouch that cannot absorb as much food as before.
• Adjustable gastric band (AGB, or lap band surgery): A band is placed on the stomach to limit how much a person can eat.

Weight Loss Goals for Morbid Obesity

Weight loss generally consists of these three goals:

• Short-term goal: Losing 5% to 10% of your body weight
• Interim goal: Maintaining weight loss
• Long-term goal: Maintaining new weight or more weight loss

According to the National Institutes of Health (NIH), it's recommended to:

• Lose 10% of your body fat first before losing 10% more of your new weight.
• Reduce calories moderately.
• Expect to lose 1 to 2 pounds a week.

Support and Commitment to Morbid Obesity Recovery

Morbid obesity treatment does not have to be a solo effort. In fact, getting help from support systems could be key to recovery.

There are several ways to find support when recovering from morbid obesity, including:

• Support groups: These could be online or in-person groups via organizations like the Obesity Action Coalition (OAC) or group therapy.
• Commercial plans: Weight loss programs like Weight Watchers or fitness groups through a local gym could help you achieve your goals.
• Family and friends: Enlist family and/or friends to help you via support like exercising together or helping with maintaining a healthier diet.
• Professional groups: Your weight loss could include a team of professionals that might include a nutritionist, physical therapist, counselor, and primary physician.

Summary

Morbid obesity is defined as having a BMI of 40 or higher. Morbid obesity is associated with a host of health conditions, including heart problems, breathing difficulty, joint pain, mental health concerns, increased likelihood of cancer, and a decrease of 10 to 15 years in life expectancy.

Treating morbid obesity can start with behavioral changes like avoiding temptations or eating fewer processed foods. Dietary changes for weight loss might include reducing calories or a macronutrient, like carbohydrates.

Exercising for morbid obesity treatment can start small with actions like parking farther from destinations to increase steps or water aerobics.

Morbid obesity can also be treated via prescription medications, which might include appetite suppressants or medications like orlistat, which prevents fat absorption. Alli is the over-the-counter version of orlistat. Those diagnosed with morbid obesity might also be qualified for bariatric surgery.

When planning weight loss, losing 10% of your body fat at a time, or 1 to 2 pounds a week, is generally advised.

Support for weight loss can be found online or in person via group therapy, volunteer-run support groups, or weight loss programs like Weight Watchers.