The obese or thin patient

The obese patient The subspecialty of medicine dealing with obese patients is called bariatric medicine. Bariatric patients are different! One unique aspect of anesthesia for an obese patient is that, unlike diabetes and hypertension, patients do not consider themselves to actually be ill, and a concept of an increased perioperative risk over the normal population does not, to them, seem to really be valid. These concerns become even more realistic when an ambulatory obese patient undergoes a bariatric surgery and suffers perioperative complications. Obesity is a global problem with rising trends: Recent data suggests that in both Europe and the U.S., more than 50% of the adult population is overweight and 20%–25% are obese. By 2015, a total of 2.3 billion of the populations are likely to be overweight and 700 million will be obese. In the past three decades, the incidence of obesity in children has increased from 5% to 20% in the U.S. When do we call a patient obese? The World Health Organization (WHO) defines the standard for obesity as body fat percentage of >25% and >35% in male and female adults, respectively [1]. Body Mass Index (BMI) (Quetelet’s index) is the most widely used convenient measure to diagnoses and quantify obesity. It is defined mathematically as: weight (kg)/height² (m) BMI-based grading of obesity in the adult is shown in Table 10.1. This classification may be limited in subjects with large muscular mass (athletes etc.), who may falsely be falling into the overweight category. A waist to hip ratio of >0.9 and >1 in females and males, respectively, predisposes the individuals to higher rates of obesity-related complications.