Morbid and Super Obesity
(ICD-9 code 278.01)

   Morbid Obesity: The original definition of morbid obesity was any individual who was greater than or equal to twice their ideal body weight, or greater than or equal to 100 pounds above their ideal body weight as determined by the 1983 Height and Weight Standards of the Metropolitan Life Insurance Company. (Metropolitan provides an internet link to calculate ideal body weight, with help to determine frame size. The actual tables for men and women can be reviewed at Metropolitan's links: for MEN and for WOMEN.) Morbid obesity could also be defined by the amount of total body fat, although this value is not easily obtained. Normally 20 to 25 percent of body weight is fat. If 40 percent or more of the body weight is fat, morbid obesity is present.

    The modern definition of obesity is based on body mass index as presented in the Practical Guide to the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, a joint publication of the National Institutes of Health National Heart, Lung, and Blood Institute, and the North American Association for the Study of Obesity. Body mass index (BMI) compares body weight (in kilograms) to height ( in meters)  (BMI = weight/height2 ). "Normal" values are less than 24.9 kg/m2, and "overweight" individuals have a BMI between 25 and 29.9 kg/m2. "Obese" patients are placed in three classes: Class 1 = BMI 30 to 34.9 kg/m2, Class 2 = BMI 35 to 39.9 kg/m2, and the "Extreme Obese" Class 3 = BMI > 40 kg/m2. Although the BMI determination has the advantage of avoiding the technical problems of measuring total body fat, it obviously depends on an accurate weight - abnormal states of hydration can give spurious results as can measurements in very muscular patients.

Click HERE for linkage to a program to calculate BMI and interpret results.

    Waist circumference, measured at the level of the iliac crest, is also an important consideration in determination of the risks of obesity. Men with a waist circumference > 40 inches (>102 cm) and women with a waist circumference > 35 inches (>88 cm) are at increased risk of complications of obesity and the classifications defined by BMI are increased one level.

    Super Obesity: Recently a new degree of obesity has been defined - Super obesity. These patients include those that are 150 pounds or more than their ideal body weight or those with a BMI greater than 50 kg/m2.

Figure