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The terms overweight, obese, and severe obesity refer to a
clinical continuum. Excess adiposity should be considered a
chronic disease that has serioushealth consequences. An
expert panel convened by the National Heart, Lung, and
Blood Institute stated that “obesity is a complex multifactorial
chronic disease that develops from an interaction ofgenotype and the environment.” In 1997, the World Health
Organization defined obesity as “a disease in which excess fat
is accumulated to an extent that health may be adversely
affected.” Since1979, the World Health Organization has
listed obesity as a disease in its International Classification of
Disease. Obesity has reached epidemic proportions in the
United States and in much of theindustrialized world.1 The
standard classification of obesity is expressed in terms of
BMI. Obesity is defined as a BMI
30 kg/m2 and may be
further subdivided into classes (Table 1).2 The most rapidlygrowing segment of the obese population is the severely
obese.3 Between 1986 and 2000, those with a BMI
30, 40,
and 50 kg/m2, are reported

quintupled, respectively, in the United States.4 Itis projected
that in the near future, there will be at least 31 million US
adults who are severely obese and may qualify for bariatric
surgery.
Severe obesity interferes with basic physicalfunctions
such as breathing and walking. There are important serious
deleterious long-term implications of severe obesity (Table
2). The loss of years of life resulting from obesity is profound.
Comparedwith normal-weight individuals, a 25-year-old
severely obese man has a 22% reduction in his expected
remaining lifespan. Thus, it was reported from National
Health and Nutrition Examination SurveyIII data that white
women 20 to 30 years of age with a BMI
45 kg/m2 will lose
8 years of life and their male counterparts will lose 13 years.5
Current data from the Behavioral Risk Factor...