The Effects of Obesity on the Cardiopulmonary System: Implications for Critical Care Nursing

Kim Garrett, RN, MS, CNP; Kathy Lauer, RN, PhD; Beth-Anne Christopher, RN, MS


Prog Cardiovasc Nurs. 2004;19(4) 

In This Article

Health Care Implications

The health care implications of the obesity epidemic on morbidity and mortality are profound. Obesity has been associated with a wide variety of serious health conditions, including cardiovascular and cerebrovascular disease, hypertension, obstructive sleep apnea syndrome (OSAS), obesity-hypoventilation syndrome (OHS), gallbladder disease, cancer, and a newly defined constellation of problems labeled "metabolic syndrome."[1,6,8,9] In addition, obeseindividuals have a 50%-100%increased risk of death from all causes compared to normal-weight individuals. An estimated 300,000 premature deaths occur each year as a result of obesity.[1,6,10]

A recent study[11] estimates that a 20-year-old white male with a BMI >45 will suffer 13 years of lost life due to obesity; a 17% reduction in life expectancy. A white woman with a similar BMI (not in similar shape) has 8 years of lost life, a 10% reduction in life expectancy. The same study,[11] however, showed that obesity resulted in a smaller increase in mortality in blacks until a BMI of ≈32-33 for men and ≈37−38 for women is applicable. Overall, the decrease in longevity was greatest in the younger years.[11]

The increase in morbidity and mortality associated with obesity has also been documented in critical care populations of obese patients. A 2001 study[12] demonstrated that hospital length of stay was significantly longer for morbidly obese patients (19.8 d) compared to nonobese patients (10.8 d). Likewise, intensive care unit length of stay was also longer (13.5 vs. 8.2 d).

Although overall obesity remains the most potent risk factor for increased morbidity and mortality, an additional risk factor involves the distribution of body fat. The presence of excess fat in the abdominal area- out of proportion to total body fat-is an independent predictor of risk factors and morbidity. Waist circumference and waist-to-hip ratio (WHR) are correlated with abdominal fat content. A WHR ≥ 1.0 is considered increased risk level. The preferred WHR for men is ≤0.9 and <0.8 for women. Waist circumference high risk is >102 cm (40 in) in men and >88 cm (35 in) for women.[1] For most people, increased adiposity at the waistline, as opposed to the hips and thighs, increases the risk for health problems. Individuals with increased risk by waist circumference and/or WHR have been shown to be at increased risk for type 2 diabetes, dyslipidemia, hypertension, and atherosclerotic disease.


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