Let’s Talk More About Morbidity

“Threat multiplier” is a term that refers to something that needs to be taken into consideration when preparing for defense. A military installation might have a plan in place to protect the buildings, equipment, communications, and personnel. But climate change is a threat multiplier that needs to be also taken into consideration. What if a flash flood occurs? Both the attackers and the defenders had better give some thought to how their operations will be handled in case of an unexpected weather event.

In the same way, in conjunction with any number of disease processes, obesity is a threat multiplier. It works both ways, and while it has become fairly obvious how pre-existing obesity can negatively impact the treatment of many conditions in adulthood, not enough is known about problems in childhood (aside from overeating) that can contribute to obesity in the short term. As one group of researchers described the situation in a paper about the hip disorder, slipped capital femoral epiphysis,

Long-term outcomes of childhood obesity are well described; however, there is poor understanding of short-term outcomes that may cause early childhood disability.

When taken together with already existing obesity, many common conditions will function as threat multipliers. In many cases, the whole becomes more than the sum of its parts. Obesity alone needs A, B, and C in the management plan. Cancer alone needs D, E, and F. But for an obese patient who develops cancer, the treatment and management plans will probably need more than A, B, C, D, E, and F. When the patient’s life is threatened by more than one morbidity, the problems can become exponential.

For instance, there is extensive literature on the subject of anesthesia when an obese patient needs a surgical intervention. In 2012, bioengineering students at Rice University had to invent a device that used suction cups to hold up a patient’s abdominal fat so his lungs could expand and take in oxygen during surgery.

After interviewing heart surgeon and electrophysiologist Mehdi Razavi, journalist Brian Alexander wrote,

Medicine is struggling to make accommodations. Doctors often check blood pressure using cuffs meant for thighs… Surgical tools have to be enlarged in order to reach through layers of fat. Obese patients require higher doses of radiation during imaging tests like CT scans.

Some patients won’t fit into MRI scanners. Surgical tables have been redesigned to handle patients weighing up to 450 pounds. Needles for injections have made been longer so they can penetrate fat layers and reach muscles. Even lab test results have to be interpreted differently.

Dr. Razavi also pointed out that if a patient needs a higher dose of radiation to effectively perform a test, the doctors and other medical personnel are also exposed to higher doses, a risk factor they do not welcome.

Your responses and feedback are welcome!

Source: “Childhood Obesity and Slipped Capital Femoral Epiphysis,” PublicationsAAP.org, October 2018
Source: “Too fat for anesthesia? Suction cups hold up patients’ guts during surgery,” NBCNews.com, 05/10/12
Image by Presidencia de la República Mexicana/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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