Morbid Obesity

Morbid obesity is a serious and potentially deadly problem that until the past few decades received little attention in the scientific literature. However, there has been a dramatic increase in research on the phenomenology and treatment of severe weight disturbance recently, possibly because of the development of relatively safe and effective morbid obesity surgery.

The outcome of this increased attention has been a growing awareness that morbid obesity is qualitatively different from less severe forms of obesity and requires special attention in both assessment and treatment. The purpose of this article is to provide a practical outline of the assessment and treatment of morbid obesity from the perspective of the consulting mental health professional. We begin with a brief review of the literature on morbid obesity, with specific attention to morbidity and mortality, as well as psychosocial characteristics of morbidly obese patients.

Sever or morbid obesity is defined as either 100 pounds overweight or 100% above ideal weight. It has been estimated that an equal number of men and women suffer from morbid obesity but it is not common even among the obese population where the vast majority fall short of the benchmark for morbid obesity.

There is little doubt that morbid obesity is associated with a number of severe health problems that place individuals in danger of disability or early death. Severely obese persons are at a greatly increased risk of developing diabetes mellitus, hypertension, hyperlipidemias, coronary artery disease, and a host of other health problems such as obstructive sleep apnea.

Morbid obesity is also associated with increased mortality from medical complications. For example, compared with the general population, the mortality rate among those with morbid obesity is nearly three times higher. Younger people who are morbidly obese are at the greatest risk of death from obesity-related complications. It is clear that the significant medical risks of morbid obesity provide a striking rationale for treating this disorder.

Morbid obesity is a complex disorder believed to be induced by any one or more of a number of biological, psychological, or social elements, including genetic makeup, metabolic factors, certain medical conditions, behavioral patterns, and psychological issues.

While genetic and other biological factors are viewed as primary contributing factors, psychological factors have long been a central component of etiological theories about morbid obesity, dating from early psychoanalytic speculations about the oral personality.

As a result, the relationship between morbid obesity and psychopathology has been the subject of numerous investigations over the years. Despite the widespread popular belief that morbid obesity is associated with a much greater incidence of mental health problems, several large population studies have not provided striking evidence to support this assumption.