Introduction

Morbid obesity has always been a challenge to the anesthesiologist and surgeon. In the past, it was frequent to avoid any surgical procedure due to the increased risk observed among these subjects. It was common to hear, “if you do not lose weight you cannot be operated …”.

But this situation have changed, mainly in the last two decades.

Morbid obesity is actually one of the most prominent medical problems in the world. Two aspects support this concept: quantitative and qualitative.

Quantitative

Obesity prevalence is increasing. It has been recently reported that the incidence of all classes of obesity, those with body mass indexes (BMI) of 30, 40, or 50 kg/m2 have shown a dramatic growth from 1986 to 2000. One in five patients has a BMI over 30, one in 50 over 40, and one in 400 has a BMI over 50.

Similar incidence and tendency have been observed in the rest of the world.

Qualitative

Morbid obesity is a life-threatening situation in the long term. BMI over 40 if not treated, significantly shortens the individual's life expectancy. Apart from the increased morbidity associated with obesity, the excess mortality is substantial. It is principally caused by death from coronary heart disease, stroke, and diabetes mellitus, although sudden unexplained death, malignancies, and fatal accidents are also more prevalent in the obese.