Obal, D., Wadhwa, A. the Obesity Paradox
The obesity paradox: does it exist in the perioperative period? Detlef Obal, MD, PhD, DESAa,b,c, Anupama Wadhwa, MBBS, MSc, FASAc,d At least 30% of the surgical population consists of patients who hypertension, and hyperlipidemia, and an increased risk of fulfill the definition of obesity, mirroring the obesity epidemic in thrombosis and inflammation, leading to higher mortality rates.7 – the general population in the United States.1 3 Nearly 74% of the However, neither BMI nor waist circumference reflects the participants in the American College of Surgeons National metabolic and inflammatory profiles of the patient. Therefore, a Surgical Quality Improvement Program (NSQIP) had an abnor- new definition of obesity was introduced emphasizing the term mally high body mass index (BMI), including 17% of patients adiposopathy and acknowledging individual body fat composi- younger than 18 years of age.4,5 This development is of particular tion and functionality.8 According to the definition of adiposo- concern as obesity is associated with an increased risk of meta- pathy, 4 different types of phenotypes are distinguished as bolic syndrome, hypertension, coronary artery disease (CAD), follows: and diabetes mellitus. However, physicians, nutritionists, and the (1) Normal weight obese (NWO). general public struggle with definitions of obesity based only on (2) Metabolically obese with normal weight (MONW). total body weight proportionate to height and, therefore, BMI. (3) Metabolically healthy obese (MHO). This leads to the question of whether BMI can adequately (4) Metabolically unhealthy obese (MUO) or “at risk” obese describe the physical condition of and potential risks in our patients suffering from complications directly related to patients.
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