Which are the levels for the treatment of obesity?
	What is extreme or severe obesity?
	Which are the obesity categories?
	Which complications and diseases are brought about by extreme obesity?

Which are the levels for the treatment of obesity?

Throughout the treatment of obesity there exist different levels, according to the patients´ needs.

1^st level – Reduction and Alimentary Adaptation Program (Re-education)

It includes a high percentage of overweight patients, who can be treated with dietary regimes and other complementary measures to lose weight.

2^nd level – Obesity Aesthetic Surgical Program (Physical Reshaping)

Some surgical procedures, such as lipoaspiration and dermolypectomy (in the first case, adipose tissue is removed via aspiration; in the second case, skin and adipose tissue are removed), which are performed in patients with located obesities (abdomen, thighs, buttocks, arms, neck, etc.). These methods were not created for losing weight (although it is a secondary benefit), but to reshape the body in an aesthetic way.

3^rd level  - Bariatic Surgery Program

 Bariatric Surgery (from Greek Barus: weight and Iatrike: treatment) is performed in extreme or severe overweigh patients, in order to make them lose a significant amount of weigh during the first years and to maintain it, as well as to reduce the co-morbidities of morbid obesity and to improve the patients’ quality of life.

Thus mortality is reduced and life expectancy is improved by the decrease of health risks. This is not an esthetic surgery.

What is extreme or severe obesity?

 
The fact that there has been an increase in the number of obese patients during the last 10 to 15 years, with approximately a 65% of overweight population (BMI>25) (see categories) and a 31 % of obese population (BMI>30) (see categories), turns obesity into the First Non-Infectious Epidemy of History.

The proportion of obese patients has increased more than a 150% since the end of World War II.

This abnormal health condition is due to an excess of fat in the body, that is to say, an excessive number of fat cells, which size is enlarged (hypertrophied).

The lack of physical activity,  a sedentary life style (watching TV sitting down for a long time, relying increasingly on driving instead of walking), a high fat, calorie and sugar concentrated feeding –typical of Western world diet– and the choice of bad quality food (known as “junk” or “fast food”), as well as a genetic predisposition to overweight (genetic cause: 30-50%), are the main factors that cause this disease.

In other words, the most usual cause for severe overweight is to consume more calories per day than the ones we use up. The gained weight is reversible; however, when it reaches a certain level, it becomes unmanageable. Overweight diminishes physical activity and it contributes to a weight increase.

Although obesity is difficult to cure, it is possible to control it, being prevention the main challenge concerning public health, as well as its cause and consequences.

We speak about Morbid Obesity, Severe or Extreme Overweight, or Massive Obesity when there exists an exaggerated overweight, i.e. when the BMI (see categories) is higher than 35, thus becoming a medical problem that is usually underestimated, but one for which public health must pay a high price: this disease involves a 5 to 8 % of the population and it is linked to many chronic diseases which diagnosis and treatment today can prevent disabilities and mortality tomorrow.

The only treatment for this kind of obesity that allows patients to maintain their weight loss in the long term, as well as to improve comorbidities and their quality of life, is the Obesity or “Bariatric” Surgery.

Which are the obesity categories?

One of the best and objective methods to classify obesity is the Body Mass Index (BMI), which is the result of dividing one’s weight by one’s height in m².

When this index is lower than 25, then the person is classified as “normal”, and if it is larger, there exists “overweight”. This happens in nearly a  65 % of the adult population and in a 25 % of the children population. When BMI is larger than 30, then “Obesity” occurs.

30 to 34,9	Mild Obesity	Class I
35 to 39,9	Severe Obesity	Class II
40 to 49,9	Morbid Obesity	Class III
50 to 59,9	Superobesity	Class III
60 to 65,9	Supersuperobesity	Class III
66 and >	Triple Obesity	Class III

 Click here to calculate your Body Mass Index (BMI)

Fat body distribution is also important.

If fat is localised in the abdomen (generally globuled), it will reflect fat around the abdominal organs. This localisation, which is more often found among men, makes the person look like an “apple”, and it is indicating that the patient has more health risks because it is linked to comorbidities of morbid obesity, which  are arterial hypertension, diabetes and fat/lypids alterations (dislypidemia).

On the other hand, if fat is localised in the hips, buttocks and thighs area, then the patient will look like a “pear”. This is more frequent among women, and it is not linked to the apple-type risks.

Which complications and diseases are brought about by extreme obesity?

The word “morbid” means “disease” and this is why, when we say a person is morbidly obese, we refer to the disease that obesity causes .

Overweight problems are medical, psychological, social, physical and economic ones.

Different associated diseases are brought about by overweight.

PHYSICAL AND ECONOMIC COMPLICATIONS