Morbid Obesity (Class III Obesity)

Morbid obesity, which is now called class III obesity or severe obesity, is a complex condition that raises the risk of serious health problems. This condition occurs when your body develops an excessive number and size of fat cells. People with class III obesity have a body mass index (BMI) of 40 or above. BMI is a quick tool that healthcare providers use to assess a person’s height and weight. 

The National Institute of Diabetes and Digestive and Kidney Diseases estimates that 9.2% of adults in the United States have severe obesity. Risk factors for this condition include poor eating patterns, low physical activity levels, certain chronic health conditions, medications, and genetics. Fortunately, if you live with severe obesity, treatments like lifestyle changes, medications, or surgery can help you reverse the condition and reduce your risk of complications. 

Symptoms of Class III Obesity

The symptoms of severe obesity will vary from person to person. The most common sign is a larger amount of adipose tissue (fat). Adipose tissue is present in many areas of the body. But when there is a larger amount of adipose tissue around the waist, the risk of certain health conditions increases. 

Symptoms of severe obesity include:

• Larger waist circumference 
• Skin irritation from skin folds rubbing together
• Body aches
• Back pain
• Joint pain
• Fatigue
• Snoring
• Shortness of breath 
• Lower self-esteem

Causes

Severe obesity is a chronic condition that develops when the body accumulates a larger number of fat cells. When the body takes in more energy (calories) than you use or burn, the extra energy results in an imbalance. This imbalance causes an excess of energy to be stored as body fat. Over time, an increase in the amount of body fat can lead to obesity or severe obesity. 

Risk Factors

Several factors may raise the risk of excess adipose tissue and severe obesity, such as:

• Eating habits: Consuming large amounts of sugar and saturated fats can contribute to weight gain.
• Physical activity: Not moving your body or exercising daily contributes to an energy imbalance.
• Accessibility: Living in an area without access to grocery stores with healthy food or places to exercise can lead to eating and exercise habits that contribute to weight gain.
• Sleep: Sleep deprivation affects hormone levels, hunger cues, and obesity risk.
• Stress: Excessive levels of stress over time are associated with an increased risk of weight gain.
• Health conditions: Some chronic health conditions—including metabolic syndrome, hypothyroidism, Cushing's syndrome, and polycystic ovary syndrome (PCOS)—cause excess weight gain.
• Medications: Certain medications—including hormonal birth control, antidepressants, and beta-blockers—can contribute to weight gain.
• Family history: A family history of obesity or metabolic disorders may raise your risk of obesity.
  

Diagnosis

Most healthcare providers use body mass index (BMI) to diagnose obesity and severe obesity. The BMI tool has serious limitations and only gives a small picture of your overall health. BMI assesses your height and weight. It does not account for other factors influencing body shape and size including age, gender, race, ethnicity, muscle density, waist circumference, and body composition. 

To learn your BMI, see your healthcare provider or calculate it using the following formula: divide your weight by your squared height, and multiply that sum by 703. The Centers for Disease Control and Prevention (CDC) offers a free BMI calculator as well. BMI classifies measurements based on the following guidelines:

• Underweight: BMI of 18.4 or lower
• Healthy weight: BMI between 18.5 and 24.9
• Overweight: BMI between 25 and 29.9
• Obese: BMI of 30 or higher
• Severe obesity: BMI of 40 or higher

After calculating your BMI, your healthcare provider may recommend measuring your around your waist, known as your waist circumference. This measurement may be more helpful in determining your risk of health problems. Research shows that people with more adipose tissue around their waists are at a higher risk of developing heart disease, high blood pressure, and diabetes. Your risk of these conditions may be higher if your waist circumference is:

• 35 inches or more for people assigned female at birth
• 40 inches or more for people assigned male at birth
  

Treatments for Severe Obesity

There are several treatment options available for people with severe obesity, including lifestyle changes, medications, and surgical interventions. The goal of treatment is usually to lose weight and reduce adipose tissue—both of which lower your risk of complications and improve symptoms. 

Lifestyle Changes

Lifestyle changes are often the first line of treatment for people with obesity or severe obesity. You may have tried certain changes in the past. Work with your healthcare provider to identify lifestyle changes that help your body use the energy you consume and store. Possible lifestyle changes include the following:

• Create a nutritious eating plan: Consider meeting with a dietician or nutritionist to determine how many calories your body needs. From there, work together to develop an eating plan that fuels your body and includes a wide variety of nutritious foods like vegetables, fruits, whole grains, lean proteins, and healthy fats. 
• Get regular physical activity: Most adults require 150 minutes of moderate-to-intense physical activity each day. Moderate-to-intense varies from person to person. This may look like brisk walking for some, while heavy lifting or strength training for others.
• Try weight loss counseling: Severe obesity is a serious chronic condition, so consider getting support during your treatment journey. Weight-loss counseling involves meeting with a weight-loss specialist to monitor your health and provide resources as needed.

Medications

In addition to lifestyle changes, your healthcare provider may recommend medications to treat severe obesity. Medications used to treat obesity have different mechanisms. Some lower hunger cues, helping you to eat less. Others change how your body absorbs and stores fat tissue. Medications may be effective at treating obesity when used in conjunction with changes to your eating plan and exercise levels. 

Research shows that after one year of treatment, adults who took obesity medication lost an average of 3-12% more body weight than those who made lifestyle changes alone. Obesity medications change how your body absorbs fat, signals hunger, and may cause side effects. Talk with your healthcare provider about the risks and potential benefits before beginning a new medication. 

The U.S. Food and Drug Administration has approved the following drugs for obesity treatment:

• Alli (orlistat): Reduces the amount of fat your body can absorb from food
• Qsymia (phentermine-topiramate): Lowers appetite and causes you to feel full sooner
• Contrave (naltrexone-bupropion): Helps you to feel less hungry and fuller sooner
• Saxenda (liraglutide): Affects appetite and can treat type 2 diabetes
• Wegovy (semaglutide): Regulates appetite and may reduce cravings
• IMCIVREE (setmelanotide): Decreases appetite, increases feelings of fullness, and may improve resting metabolism 
  

Surgery

If lifestyle changes and medications have not been effective, your healthcare provider may recommend weight loss surgery. The goal of weight loss surgery is to reduce the size of your stomach and cause you to feel full quicker after eating.

People with severe obesity (people who have a BMI higher than 40) may benefit from weight loss surgery. Your healthcare provider may also recommend surgery if you are experiencing additional health conditions such as heart disease or sleep apnea. 

If weight loss surgery is right for you, your provider may recommend one of the following procedures:

• Gastric sleeve: The surgeon removes most of the stomach and leaves a small, banana-shaped pouch. This type of surgery cannot be reversed.
• Gastric bypass: The surgeon staples the top part of the stomach to make a small pouch, then attaches it to the middle part of the small intestine. This type of surgery is difficult to reverse. 
• Adjustable gastric band: The surgeon places an inflatable band around the top part of the stomach to create a small pouch. This type of surgery can be adjusted or reversed.
  

Devices

A new treatment option for severe obesity is an inflatable balloon or gastric emptying device. These devices are similar to surgery because the goal is to shrink the size of the stomach. However, unlike most weight loss surgeries, devices can be reversed. More research is needed to determine if devices are an effective treatment for severe obesity. However, current options for a weight loss device include:

• Inflatable balloon: Your healthcare provider places a balloon in your stomach and fills it with saline. This takes up space in the stomach to help you feel full sooner. The balloon is usually removed after six months. 
• Gastric emptying device: Your healthcare provider places a tube from the inside of your stomach to the outside of your abdomen. After a meal or snack, you then use the tube to empty your stomach and prevent your body from absorbing about 30% of the food you just consumed. 

Prevention

Fortunately, many cases of severe obesity can be prevented. If obesity runs in your family or you have other risk factors, talk with your healthcare provider about prevention strategies. To lower your risk of morbid obesity, consider implementing the following practices:

• Eat a nutritious diet of fresh fruits and vegetables, whole grains, legumes, nuts, lean proteins, and healthy fats
• Avoid foods high in sugar or saturated fats (such as sweets or processed foods) as these food groups increase the risk of obesity
• Engage in moderate-intensity exercise every day, such as walking, swimming, or biking
• Try to get seven hours of quality sleep every night
• Manage your stress levels as you are able with therapy, mindfulness practices, or hobbies you enjoy
  

Complications

Unfortunately, severe obesity raises the risk of several chronic health conditions. Having an excessive amount of adipose tissue affects how your body functions. Extra fat tissue around the waist interferes with the body’s ability to produce hormones and fight off infections. It also leads to inflammation or swelling in the body.

Severe obesity raises the risk of the following conditions:

• Type 2 diabetes
• Heart disease
• High blood pressure
• Stroke
• Gastroesophageal reflux disease (GERD)
• Gallbladder disease or gallstones
• Pancreatitis 
• Liver disease
• Sleep apnea
• Kidney disease
• Certain cancers, including endometrial, breast, ovarian, and prostate
  
• Asthma
• Arthritis
• Infertility or trouble conceiving
• Pregnancy complications like gestational diabetes and preeclampsia
• Dementia 
• Anxiety disorders
• Depression
  

Living With Obesity

Living with severe obesity likely affects several areas of your life and the overall quality of your well-being. People with severe obesity are more likely to experience mental health conditions like depression, anxiety, and stress. As you manage your condition and go through your treatment journey, being in touch with support groups with people also experiencing obesity may help.

Professional organizations that provide obesity support through education and support groups include:

• Obesity Action Coalition
• American Obesity Foundation
• Obesity Care Advocacy Network
• Academy of Nutrition and Dietetics

A Quick Review

Morbid obesity (also known as severe obesity or class III obesity) is a chronic health condition that occurs when your body has an excessive number and size of fat cells. Fortunately, severe obesity is treatable and even preventable.

To lower your risk of obesity, focus on eating a nutritious diet, getting physical activity every day, and sleeping well. Medical treatments may include medications, surgery, and devices.