Chapter 296

Obesity is the condition of an excess proportion of adipose tissue to total body weight (TBW). The prevalence of obesity in the U.S. has doubled in the past 20 years, with 34% of adults being obese in 2006.1 The U.S. has the highest prevalence of obesity worldwide, but rapid increases in the prevalence of obesity have occurred in most economically developed countries and many developing countries. Obesity rates >20% have been reported in the United Kingdom, China, and Mexico. Because body fat is difficult to measure, body mass index (BMI) is used to define obesity. BMI is calculated by dividing the patient’s weight in kilograms by the square of their height in meters. For example, an average male with a weight of 80 kg and a height of 1.80 m has a BMI of 25 kg/m2. Obesity is defined as a BMI >30 kg/m2; morbid obesity is defined as a BMI >40 kg/m2.

Obese patients visit their primary care physicians more than nonobese patients2; obese children have higher rates of hospitalization.3 Two studies of obese patients presenting with abdominal pain found that resource use is similar to that of nonobese patients, although neither study looked specifically at morbidly obese patients.4,5

Despite the existing data on resource use by obese patients, the morbidly obese individual poses a number of challenges for emergency providers. Prehospital care may be delayed due to problems in moving and transporting these patients. Appropriate-sized gurneys may not be readily available. Access to body fluids and body cavities can be a formidable task, and advanced imaging procedures are often not possible due to equipment weight limits. Finally, morbidly obese patients have different cardiopulmonary physiology and patterns of traumatic injury, which must be considered for delivery of optimal care.6–8

The etiology of obesity is heterogeneous and may result from increased caloric intake, a low level of habitual physical activity, a low resting metabolic rate, and, possibly, high insulin sensitivity. Factors strongly associated with childhood obesity, listed in decreasing strength of association, include parental obesity, low socioeconomic status, high media consumption, high meat consumption, and total beverages.9 On average, life expectancy is shorter in obese patients compared with nonobese patients; this difference is even greater for morbidly obese individuals.10 Obese patients have higher rates of diabetes, hypertension, coronary heart disease, stroke, sleep apnea, venous thromboembolism, gall bladder disease, kidney stones, and some types of cancer.11–15

Obesity is, in part, responsive to behavioral changes on the part of the patient. Simple lifestyle changes such as walking for 20 minutes every day16 or eliminating sodas or other sweet beverages may provide obese patients with an obtainable initial step toward weight loss and improved health.

### Cardiopulmonary Disease

Morbidly obese patients have higher cardiac output requirements and higher systemic blood pressures than nonobese patients. This ...

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