Obesity Class III

Obesity Class III, commonly referred to as morbid or severe obesity, is a complex and chronic medical condition characterized by a Body Mass Index (BMI) of 40 or higher. This level of obesity significantly increases the risk of severe health complications, including cardiovascular diseases, type 2 diabetes, and certain cancers, and often impacts overall quality of life.

It is not just a result of excessive calorie consumption but is influenced by a combination of genetic, environmental, psychological, and lifestyle factors. Managing Obesity Class III requires a multidisciplinary approach, emphasizing medical intervention, lifestyle modifications, and psychological support.

Class III Obesity: What Is It?

A person who has a body mass index (BMI) of 40 or higher or a BMI of 35 or higher and is dealing with obesity-related health issues is considered to be class III obesity, previously as morbid obesity. Healthcare professionals may employ additional tests and instruments, such as measuring waist circumference, to evaluate obesity because the BMI scale is not always reliable.

Many types of severe medical disorders, including heart disease and Type 2 diabetes, can be exacerbated by class III obesity.

Why was morbid obesity the name given to class III obesity?

Two healthcare providers first used the phrase “morbid obesity” in 1963 to support insurance coverage of intestinal bypass surgery for weight loss in patients with a BMI over 40.

Since class III obesity is regarded as an illness and frequently co-occurs with other chronic health disorders, the medical definition of “morbid” is applicable when describing this type of obesity.

The issue is that “morbid,” like many other terms, has multiple meanings. Outside of the medical context, “morbid” refers to unpleasant or upsetting. The majority of individuals associated morbid (class III) obesity and obese people with those derogatory terms because they were unfamiliar with the medical definition. When used to describe obesity, the term “morbid” contributes to the problematic and unfounded social stigma that implies obese people lack the willpower to shed weight, which is nearly never the case.

“Class III obesity” is now the phrase used by medical professionals, researchers, and organizations like the World Health Organization (WHO) to refer to obesity.

Body mass index (BMI): what is it?

One test used to determine your height-to-weight ratio is the body mass index or BMI. BMI typically corresponds to body fat, however it might be inaccurate in some situations. Body fatness and health are not diagnosed by BMI alone.

The BMI ranges shown beneath (in kg/m2) describe various kinds of weight:

• Underweight: Less than 18.5.
• Optimum range: 18.5 to 24.9.
• Overweight: 25 to 29.9.
• Class I obesity: 30 to 34.9.
• Class II obesity: 35 to 39.9.
• Class III obesity: More than 40

BMI isn’t always a reliable indicator of a person’s health. For instance, your BMI could not be an accurate measure of your body fat percentage if you have more or less muscle than is ideal. It is also possible to have conditions like Type 2 diabetes or high blood pressure, which have a direct connection to class III obesity, without being obese.

The following people frequently have inaccurate BMIs using the conventional scale:

Bodybuilders and professional athletes: Exceptionally muscular People may have a high BMI even though they have optimal levels of fat because muscle is stronger than fat.

People older than 65: A BMI between 25 and 27 is frequently better than one under 25 for adults over 65. This is caused by the possibility that having a slightly higher BMI can prevent osteoporosis or the breaking of the bones.

Children: The traditional BMI chart should not be used to assess a child’s weight, even if many children are obese. You should talk to your kid’s medical doctor about a suitable weight range for their height and age.

When determining a person’s risk for a particular health problem, persons of different races may find that the standard BMI scale is not correct. According to studies, Black people are more likely to experience health problems at a greater BMI than what is deemed at-risk on the standard scale, whereas those of Asian heritage are generally more likely to have health risks at a far lower BMI.

The usual cutoff BMI number linked to an increased risk of Type 2 diabetes (T2D) differs among individuals of different ethnicities, serving as an illustration of racial BMI errors. Among the differences are:

• An increased risk of type 2 diabetes corresponds with a BMI of 23.9 or higher in people of South Asian ethnicity.
• An increased risk of type 2 diabetes corresponds with a BMI of 26 or higher for people of Arabic ethnicity.
• Black people have an increased risk of type 2 diabetes if their body composition index (BMI) is 28 or above.
• White people are more likely to develop type 2 diabetes when their BMI is 30 or above.

What differentiates class III obesity from just being obese?

Adults with a body mass index (BMI) between 30 and 39.9 are typically, though not always, classified as obese. Adults are classified as class III obese if their BMI is 40 or over.

Who is affected by class III obesity?

Class III obesity, however, tends to impact individuals differently because of its complexity. According to a 2017–2018 study on the prevalence (commonness) of class III obesity in US adults, the following are the effects of class III obesity on various individuals:

Sex: Class III obesity affects about 11.5% of women and those assigned female at birth, compared to 6.9% of males and those assigned male at birth.

Age: 11.5% of individuals between the ages of 40 and 59, 9.1% of adults between the ages of 20 and 39, and 5.8% of those 60 and more suffer from class III obesity.

Race: Class III obesity found that be prevalent in non-Hispanic Black adults (13.8%) and the smallest percentage in non-Hispanic Asian adults (2.0%).

Symptoms and Causes

Causes of Class III Obesity?

Class III obesity is a complicated condition with multiple underlying causes. To put it another way, weight gain results from your body storing more calories than it needs for physical activity and vital bodily functions like breathing and digesting throughout the day.

How much food we eat, what kind of food we eat, and how our body uses that energy are all influenced by a number of different factors. Because each person’s biology is distinct, they all utilize energy in different ways.

Obesity is caused by many factors, including:

• Genetic factors: Many research investigations demonstrate that obesity may occur in families and that excess weight corresponds with various genes.
• Hormone imbalances: There are hundreds of hormones produced by your body, and each one serves a distinct and significant purpose. For instance, the stress hormone cortisol increases the metabolism of fat and carbohydrates, giving your body a boost of energy. This procedure makes you more hungry even though it’s necessary for survival (fight-or-flight) scenarios. Hypothyroidism, or low thyroid hormone levels, is another example.
• Socioeconomic and geographical factors: Obesity can result from having a poor socioeconomic standing and having easy access to unhealthy fast food compared to healthier whole foods, either financially or geographically. Obesity can also result from a lack of safe or convenient walking routes in your community, as well as restricted access to parks or recreational facilities.
• Cultural factors: Obesity can result from the widespread promotion and marketing of foods high in calories and larger portion sizes.
• Environmental factors: Hormone changes and an increase in body fat can result from exposure to substances called obesogens.

Signs and symptoms of class III obesity

Class III obesity has no specific symptoms. A body mass index (BMI) of 40 or greater and/or an undesirable distribution of body fat, as determined by your waist circumference and skin thickness, are indicators of class III obesity. Numerous body components may have problems and adverse effects as a result of class III obesity.

Diagnosis and Tests

Medical professionals use a patient’s body mass index (BMI) to help identify class III obesity. If an adult satisfies one of the following requirements, they may be classified as class III obese:

• One hundred pounds above the ideal body weight range for their height and sex
• Have a BMI of 40 or more.
• individuals with a body mass index (BMI) of 35 or greater are affected by diseases related to obesity which includes diabetes or high blood pressure.

When determining childhood obesity, medical professionals employ a different scale because the BMI isn’t always reliable for some groups.

Waist circumference measurements are another tool used by medical professionals to diagnose obesity.

A waist circumference of more than 35 inches for women and more than 40 inches for men can be used to diagnose obesity in non-pregnant adults. Your doctor might diagnose obesity based on reduced waist circumference measurements if you are South Asian or of Central and South American heritage. Despite having abnormal levels of fat deep in their abdomens and possibly being classified as obesity, people from these backgrounds frequently don’t exhibit symptoms of a big waist circumference.

The following body parts’ skin thickness can be used by doctors to determine obesity:

• The back of your upper arms (triceps).
• The front of your upper arms (biceps).
• Under your shoulder blades (subscapular).
• Above your hip bones (supra-iliac).

Medical Tests:

• Complete blood count.
• Basic metabolic panel.
• Kidney (renal) function tests.
• Liver function tests.
• Lipid panel.
• Hemoglobin A1C (HbA1C).
• Thyroid-stimulating hormone (TSH) test.
• Vitamin D levels test.
• Urinalysis.
• C-reactive protein (CRP) test.

Also, doctors could suggest more investigations, such as sleep studies and an electrocardiogram (EKG) to assess your heart health.

Management and Treatment

Class III obesity requires highly customized treatment. Since each person is different, their treatment plan must be tailored to their circumstances and objectives. If you have any health concerns associated with obesity, you and your healthcare practitioner can work together to develop a strategy that addresses the underlying secondary causes of fat.

Class III obesity requires a multifaceted approach to treatment. Class III obesity treatment options include:

• Healthy lifestyle changes.
• Behavioral and psychological therapy.
• Medications.
• Surgical procedures.

Healthy lifestyle changes

You can control obesity, enhance your general health, and reduce weight by adopting certain lifestyle modifications, such as:

• Heart-healthy eating: Your doctor might advise you to consult a nutritionist or approved dietitian to find out what foods and serving sizes are appropriate for a balanced diet. It’s crucial to try lowering your daily caloric intake gradually if you need to lose weight.
• Physical activity: Someone’s capacity to maintain a healthy body weight, eliminate extra weight, or maintain healthy weight loss is mostly determined by their level of physical activity, which has numerous health benefits. Ask your healthcare physician what kind and quantity of physical activity is best for you before beginning any exercise program.
• Healthy sleep: To control obesity, it’s important to get back to a regular sleep schedule and/or obtain treatment for any sleep disorders you may have.
• Stress management: Chronic stress may result in weight increase, so it’s critical to learn effective strategies for coping, such as breathing techniques or meditation, and to reduce stress as much as you can.

Behavioral and psychological therapy

To help treat obesity, your healthcare physician might advise you to sign up for behavioral weight-loss programs, either individual or group.

Mood disorders, including anxiety and depression, are common among obese individuals. Because of this, if you have a mental health condition, your provider might also suggest psychological therapy.

The following are some examples of behavioral and psychological therapies that can be used to treat obesity:

• Motivational interviewing: One kind of therapy that aids in behavior modification is motivational interviewing. Identifying your significance, importance, and ability to change, is intended to empower you to make changes.
• Cognitive behavioral therapy (CBT): In this type of therapy, a psychologist or therapist works with you to alter negative or ineffective thought and behavior patterns. CBT often involves several sessions. Asking questions and talking to your therapist or psychologist can help you see things from a different angle. As a result, you get better at handling stress, anxiety, and challenging circumstances.
• Dialectical behavioral therapy (DBT): Cognitive behavioral psychology has been verified in this particular kind of treatment. It might prove an ideal match if you have difficulty handling your emotions or take part in negative habits like eating disorder structures.
• Interpersonal psychotherapy (IPT): The primary objective of IPT is to enhance social functioning and interpersonal interactions (your relationships with other people) to minimize stress.

Medications

Your doctor might suggest FDA-approved drugs to treat obesity if healthy lifestyle modifications are insufficient. These drugs function by altering your gastrointestinal system or brain:

• Your brain: Food cravings can be reduced by taking some drugs that alter how your brain controls hunger. Diethylpropion, phendimetrazine, lorcaserin, naltrexone/bupropion, and liraglutide are some of these drugs.
• Your gastrointestinal tract: Your intestines are prevented from absorbing fat from the meals you eat by a drug called orlistat. Because it has fewer adverse effects than other prescriptions, it is typically the first pick when it comes to weight loss pills.

Surgical therapy

You might qualify for one of the following bariatric surgery procedures if you have class III obesity and lifestyle modifications and weight loss drugs aren’t helping:

• Gastric bypass surgery: Bypassing the first section of your intestine, the surgeon performs this procedure by joining a tiny portion of your stomach to the middle section. This will limit the quantity of food (calories) your body can absorb and retain as fat, and you will feel fuller after eating less.
• Sleeve gastrectomy: A large section of your stomach is removed during this procedure, which makes you feel full after eating less.
• Gastric band surgery: A hollow band is placed around the upper portion of your stomach by the surgeon during this procedure, making it smaller. You will feel satisfied after eating less as a result.

Generally speaking, the following issues may arise soon after surgery:

• Infection.
• Postoperative bleeding.
• Thrombosis (when veins or artery walls become plugged by coagulation of blood).
• Cardiac events.

Longer-term problems may consist of:

• Malabsorption (inability to appropriately digest or extract substances from meals).
• Vitamin and mineral deficiencies (malnutrition).
• Refeeding syndrome (When a seriously famished individual begins to consume food once more this may occur).
• Dumping syndrome (when the fluids of your gastrointestinal tract enter faster than usual into the first section of the small intestinal tract).

Class III obesity has some risk factors. Certain risk factors, including lifestyle choices, are modifiable. It is impossible to alter other risk variables like age, genetics, race, and ethnicity. Maintaining a healthy lifestyle can lower your chance of becoming obese.

Warning signs for the growth of obesity include the ones that follow:

• Certain eating behaviors Eating foods high in saturated fats, trans fats, and added sugars, as well as regularly consuming more calories than your body requires, can all lead to fat formation.
• Lack of physical activity You are more inclined to become obese if you have a sedentary lifestyle and don’t engage in regular physical activity.
• Lack of sleep Numerous research have shown a connection between individuals with high BMI and sleep deprivation. A hormone imbalance brought on by sleep deprivation encourages overeating and weight growth.
• High amounts of stress Prolonged stress has an impact on your brain and causes the release of hormones like cortisol, which regulate your energy levels and hunger signals.
• Your age As you age, you are more likely to gain weight and store fat.
• Your race In the US, non-Hispanic Black people have the greatest obesity rates, followed by Hispanics and white people. Although Asians are the least likely to have high BMIs, they may also have high levels of harmful abdominal fat.

Improvements in lifestyles involve:

• Eating a heart-healthy diet.
• Being physically active and exercising.
• doing to preserve a healthy weight that is consistent with your height, gender, and health concerns.
• Managing stress.
• Getting healthy amounts of sleep.

Outlook / Prognosis

Class III obesity is linked to a lower quality of life, less social and economic prospects, and possibly even more serious health issues. Prescribed drugs for weight loss have been scientifically proven to contribute to some obese patients maintaining as much as 10% of their original body mass index. Research on the implications of a gastric bypass operation reveals that patients could lose 77% of their extra body weight in more than one year, and as much as 30% of it after its initial year post-surgery.

complications of class III obesity

• Metabolic syndrome: The combination of at least three of the following conditions—central obesity, higher fasting blood glucose (blood sugar) levels, low HDL cholesterol, high blood pressure, and high triglyceride (TG) levels—indicates metabolic syndrome.
• Type 2 diabetes: Type 2 diabetes (T2D) can result from insulin resistance brought on by excessive fat buildup. For every unit increase in BMI, the chance of acquiring type 2 diabetes rises by 20%. Not everyone with T2D is obese, and not everyone with obesity has T2D.
• Heart disease: Long-term obesity exposure contributes to heart disease and cardiac (heart) function. Larger ventricular mass, systolic dysfunction (impaired ventricular contraction), and atrial fibrillation (a quivering or irregular heartbeat) are all consequences of obesity.
• High blood pressure (hypertension): The risk of high blood pressure, which raises the risk of heart disease, is 3.5 times higher in obese people.

FAQs

References

• Class III obesity (Formerly known as morbid obesity). (2024, October 11). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21989-class-iii-obesity-formerly-known-as-morbid-obesity
• Seladi-Schulman, J., PhD. (2024, February 5). Understanding the three different classes of obesity. Healthline. https://www.healthline.com/health/obesity/obesity-vs-morbid-obesity