Obesity is now recognized as a major health epidemic in the United States and around the world, both in adults and children, and has coincided with the increase in the availability of high calorie/low nutrient foods and changes in lifestyle, particularly the decrease in physical activity. Obese individuals have shorter life spans, increased risk for sudden cardiac death and a number of comorbidities such as diabetes mellitus, venous thromboembolism and respiratory dysfunction, which can negatively affect their quality of life. The increased prevalence of obesity has affected every field of medicine and the costs of treating obesity and its complications are staggering. Forensic pathology has been impacted as well, with obese and morbidly obese decedents posing major technical and practical challenges in transport, handling and autopsy procedures. This article will review the epidemiology and causes of obesity and address the impact of obesity on mortality and the everyday practice of forensic pathology.
KellyT., YangW., ChenC.S.Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond).2008 Sep; 32(9): 1431–7.
2.
FinucaneM.M., StevensG.A., CowanM.J.National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet.2011 Feb 12; 377(9765): 557–67.
3.
de OnisM., BlossnerM., BorghiE.Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr.2010 Nov; 92(5): 1257–64.
World Health Organization [Internet].Geneva: World Health Organization; c2006. Global database on Body Mass Index; [cited 2013 Jan 29]. Available from: http://apps.who.int/bmi/index.jsp.
6.
StunkardA.J., FochT.T., HrubecZ.A twin study of human obesity. JAMA.1986 Jul 4; 256(1): 51–4.
7.
StunkardA.J., SorensenT.I., HanisC.An adoption study of human obesity. N Engl J Med.1986 Jan 23; 314(4): 193–8.
8.
FarooqiI.S., O'RahillyS.Monogenic obesity in humans. Annu Rev Med.2005; 56: 443–58.
9.
LicinioJ., CaglayanS., OzataM.Phenotypic effects of leptin replacement on morbid obesity, diabetes mellitus, hypogonadism, and behavior in leptin-deficient adults. Proc Natl Acad Sci U S A.2004 Mar 30; 101(13): 4531–6.
10.
YeoG.S., FarooqiI.S., AminianS.A frameshift mutation in MC4R associated with dominantly inherited human obesity. Nat Genet.1998 Oct; 20(2): 111–2.
11.
VaisseC., ClementK., Guy-GrandB.A frameshift mutation in human MC4R is associated with a dominant form of obesity. Nat Genet.1998 Oct; 20(2): 113–4.
12.
JacksonR.S., CreemersJ.W., OhagiS.Obesity and impaired prohormone processing associated with mutations in the human prohormone convertase 1 gene. Nat Genet.1997 Jul; 16(3): 303–6.
13.
JacksonR.S., CreemersJ.W., FarooqiI.S.Small-intestinal dysfunction accompanies the complex endocrinopathy of human proprotein convertase 1 deficiency. J Clin Invest.2003 Nov; 112(10): 1550–60.
14.
ZalesinK.C., FranklinB.A., MillerW.M.Impact of obesity on cardiovascular disease. Med Clin North Am.2011 Sep; 95(5): 919–37.
15.
DuflouJ., VirmaniR., RabinI.Sudden death as a result of heart disease in morbid obesity. Am Heart J.1995 Aug; 130(2): 306–13.
16.
PoirierP., DespresJ.P.[Obesity and cardiovascular disease]. Med Sci (Paris).2003 Oct; 19(10): 943–9.
17.
SmithH., WilliusF.Adiposity of the heart: a clinical and pathologic study of one hundred and thirty six obese patients. Arch Intern Med (Chic).1933; 52(6): 911–931.
18.
WarnesC.A., RobertsW.C.The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy. Am J Cardiol.1984 Nov 1; 54(8): 1087–91.
AlpertM.A.Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci.2001 Apr; 321(4): 225–36.
22.
MesserliF.H.Hypertension and sudden cardiac death. Am J Hypertens.1999 Dec; 12(12 Pt 3): 181S–8S.
23.
AlexanderJ.K.Obesity and coronary heart disease. Am J Med Sci.2001 Apr; 321(4): 215–24.
24.
McGillH.C.Jr., McMahanC.A., HerderickE.E.Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation.2002 Jun 11; 105(23): 2712–8.
25.
MokdadA.H., BowmanB.A., FordE.S.The continuing epidemics of obesity and diabetes in the United States. JAMA.2001 Sep 12; 286(10): 1195–200.
26.
El-AtatF.A., McFarlaneS.I., SowersJ.R.Sudden cardiac death in patients with diabetes. Curr Diab Rep.2004 Jun; 4(3): 187–93.
27.
KurthT., GazianoJ.M., BergerK.Body mass index and the risk of stroke in men. Arch Intern Med.2002 Dec 9–23; 162(22): 2557–62.
28.
RexrodeK.M., HennekensC.H., WillettW.C.A prospective study of body mass index, weight change, and risk of stroke in women. JAMA.1997 May 21; 277(19): 1539–45.
29.
BeckmanM.G., HooperW.C., CritchleyS.E.Venous thromboembolism: a public health concern. Am J Prev Med.2010 Apr; 38(4 Suppl): S495–501.
30.
GoldhaberS.Z., GrodsteinF., StampferM.J.A prospective study of risk factors for pulmonary embolism in women. JAMA.1997 Feb 26; 277(8): 642–5.
31.
SeverinsenM.T., KristensenS.R., JohnsenS.P.Anthropometry, body fat, and venous thromboembolism: a Danish follow-up study. Circulation.2009 Nov 10; 120(19): 1850–7.
32.
HolstA.G., JensenG., PrescottE.Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation.2010 May 4; 121(17): 1896–903.
33.
LucenaJ., RicoA., VazquezR.Pulmonary embolism and sudden-unexpected death: prospective study on 2477 forensic autopsies performed at the Institute of Legal Medicine in Seville. J Forensic Leg Med.2009 May; 16(4): 196–201.
34.
RosenfeldH.E., TsokosM., ByardR.W.The association between body mass index and pulmonary thromboembolism in an autopsy population. J Forensic Sci.2012 Sep; 57(5): 1336–8.
35.
PiperA.J., GrunsteinR.R.Obesity hypoventilation syndrome: mechanisms and management. Am J Respir Crit Care Med.2011 Feb 1; 183(3): 292–8.
36.
LurieA.Obstructive sleep apnea in adults: epidemiology, clinical presentation, and treatment options. Adv Cardiol.2011; 46: 1–42.
37.
GilbertC.A., SlingerlandJ.M.Cytokines, obesity, and cancer: new insights on mechanisms linking obesity to cancer risk and progression. Annu Rev Med.2013 Jan 14; 64: 45–57.
38.
HurstingS.D., DunlapS.M.Obesity, metabolic dysregulation, and cancer: a growing concern and an inflammatory (and microenvironmental) issue. Ann N Y Acad Sci.2012 Oct; 1271: 82–7.
39.
CalleE.E., RodriguezC., Walker-ThurmondK.Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med.2003 Apr 24; 348(17): 1625–38.
40.
ByardR.W., BellisM.Significant increases in body mass indexes (BMI) in an adult autopsy population from 1986 to 2006—implications for modern forensic practice. J Forensic Leg Med.2008 Aug; 15(6): 356–8.
41.
ByardR.W., BellisM.Increase in adult body weight in coronial autopsies: an impending crisis?Med J Aust.2007 Aug 6; 187(3): 195–6.
42.
GindeA.A., FoianiniA., RennerD.M.The challenge of CT and MRI imaging of obese individuals who present to the emergency department: a national survey. Obesity (Silver Spring).2008 Nov; 16(11): 2549–51.
43.
ByardR.W.The complex spectrum of forensic issues arising from obesity. Forensic Sci Med Pathol.2012 Dec; 8(4): 402–13.
