Obesity has been labeled a public health crisis with nearly one-third of adults in the United States classified as obese. Morbid obesity (also referred to as clinically severe obesity) affects about eight to 10 million American adults (about five to 10 percent) and represents the fastest-growing group of obese individuals in the nation. It is estimated that about 8 percent of all adults, and specifically 2 percent of men, are morbidly obese. In addition to increased risks for heart disease, hypertension, Type 2 diabetes, and other obesity-related conditions experienced by both obese men and women, severely obese men are also at higher risk for aggressive prostate cancer and premature mortality.

Life expectancy may be as much as 20 years less for severely obese men compared to that of males at a healthy weight. Although a modest weight loss of 5 to 10 percent can reduce risks of comorbid conditions and mortality, diets and medically supervised weight-loss programs have proven to be largely ineffective for treating morbid obesity. Surgical treatment may represent a more effective option, given the currently available outcomes data that demonstrate the improvement or resolution of comorbid conditions, a reduction in mortality risk, and sustained long-term weight loss.

Body mass index (BMI) is the most commonly accepted measure used for categorizing individuals as under- or overweight, obese, or severely obese. BMI is calculated by dividing a person's weight in kilograms by his or her height in meters (weight [kg]/height [m2]). BMI is not gender-specific and does not differentiate the amount of weight from muscle mass versus fat, so very muscular individuals could be misclassified by using BMI alone. A person with a BMI below 18.5 is considered underweight, while a healthy-weight individual has a BMI in the range of at least 18.5 to 25. A BMI of at least 25 to 30 indicates that a person is overweight. Individuals with a BMI of at least 30 are considered obese. A person with a BMI of at least 40 (or at least 35 with a significant comorbid condition) is classified as morbidly or severely obese. Waist circumference or waist-to-hip ratio and percent body fat are also sometimes used to classify the degree of overweight and obesity. Men with a waist circumference of over 40 inches, or who have more than 25 percent body fat, are considered at risk for complications of obesity. In addition, an individual may be considered severely obese when he or she is 100 pounds or more over ideal body weight, as specified by the Metropolitan Life Insurance Company standard height and weight tables for men and women. he tables were originally developed to indicate a range of desirable weights associated with the lowest mortality rates.

Although BMI does not take into account gender differences, studies have demonstrated variability as to where fat accumulates (regional fat distribution) and its associated risks between males and females. Women tend to accumulate larger amounts of gluteal fat, resulting in a larger hip circumference (creating an "apple shape"), while men tend to store fat in the abdomen, resulting in a larger waist circumference ("pear shape"). Abdominal (upper body or visceral fat), has been correlated with a greater risk for cardiovascular disease, diabetes, hypertension, and hyperlipidemia. Morbidly obese men may experience more carbohydrate intolerance and decreased endurance, and in turn, be less physically it than severely obese women. In addition, morbidly obese men are also more likely than women to have sleep apnea, obesity hypoventilation syndrome, and venous stasis disease.

Severely obese men are also two and a half times more likely than women to have nonalcoholic steatohepatitis, an obesity-related condition that interferes with liver function. Furthermore, the accumulation of abdominal fat may play a role in the development of colon, rectum, and aggressive prostate cancer. Recent studies have suggested that severe obesity may double the risk of developing prostate cancer. Finally, in economic terms, healthcare costs are estimated to be 69 percent higher for severely obese men than for healthy-weight males.

Severe obesity also substantially increases the risk of premature mortality in men. he risk of mortality for severely obese men is approximately 12 times higher than healthy weight males of the same. In addition, life expectancy for severely obese males may as much as 20 years less as compared to a reduction of five years for morbidly obese females. Although data on racial/ethnic differences are sparse, research indicates that there may be a difference between populations in ideal BMI ranges for optimal life expectancy. The ideal BMI range is estimated to be 25-30 for African Americans, about 23-25 for Caucasians, and much lower for Asian Americans.

The prevalence of severe obesity has increased at a rapid rate over the past 20 years. From 2000 through 2005, the number of individuals classified as morbidly obese (BMI of at least 40) increased by 50 percent. Since the late 1980s, the prevalence of severe obesity has risen over 500 percent as compared to moderate obesity and overweight. About 2 percent of adult males, over two million individuals, are severely obese. Although a modest weight loss of 5 to 10 percent can reduce the risk for and improve obesity-related conditions, commercially available diets and medically supervised weight-loss programs have, for the most part, proven ineffective in treating morbid obesity. Surgical treatment for severe obesity may be a more effective option in that outcomes data demonstrate a reduction or resolution of many comorbid conditions, a reduced risk for mortality, and sustained long-term weight loss for many individuals.

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