Increases in Clinically Severe Obesity in the United States, 1986-2000

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Abstract
IN THE United States, different studies have documented that most Americans are overweight (a body mass index [BMI; calculated as weight in kilograms divided by the square of height in meters] ≥25) or obese (BMI ≥30). About 1 in 5 adult Americans would be classified as obese based on self-reported weight and more than 1 in 4 based on objectively measured weight.1-4 The typical definition of obesity, a BMI of 30 or greater, obscures the heterogeneity of this group. Severely obese individuals who are 100 to 200 lbs (45-90 kg) or more overweight encounter different challenges in the health care system than most obese individuals. Many physician offices and hospitals are not equipped for severely obese patients, who may not fit standard imaging equipment, operating tables, or wheelchairs. Even seemingly minor problems, such as the lack of a scale to weigh patients over 300 lbs (135 kg) in ambulatory settings, could conceivably affect quality of care and invite lawsuits. Recent high-profile newspaper articles have also reported anecdotes of injuries among health care personnel caused by severely obese patients and the lack of equipment to move those patients.5,6