What are the physical causes of morbid (severe) obesity?

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Last updated: April 15, 2025View editorial policy

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From the Guidelines

The primary physical causes of morbid obesity include genetic predisposition, hormonal imbalances, metabolic disorders, and neurological factors, as identified in the most recent study on obesity in South and Southeast Asia 1.

Key Factors Contributing to Morbid Obesity

  • Genetic predisposition: certain gene variants affect appetite regulation, metabolism, and fat storage
  • Hormonal imbalances: issues such as hypothyroidism, Cushing's syndrome, and polycystic ovary syndrome disrupt normal metabolic processes
  • Metabolic disorders: leptin and ghrelin imbalances affect hunger and satiety signals, while insulin resistance causes the body to store more fat
  • Neurological factors: involving the hypothalamus can disrupt appetite control mechanisms

Medical Conditions and Medications

  • Certain medications like antipsychotics, antidepressants, steroids, and some diabetes medications can contribute to significant weight gain as a side effect
  • Medical conditions such as Prader-Willi syndrome and hypothalamic obesity are rare but direct causes of severe obesity

Importance of Understanding Physical Causes

Understanding these physical causes is essential because they often require specific medical interventions beyond lifestyle changes, potentially including hormone replacement therapy, medication adjustments, or in some cases, bariatric surgery to effectively address the underlying physiological mechanisms driving excessive weight gain, as supported by the American Gastroenterological Association's clinical practice guideline on pharmacological interventions for adults with obesity 1.

From the Research

Physical Cause of Morbid Obesity

The physical cause of morbid obesity is a complex issue, and research suggests that it is often the result of a long-term energy imbalance between consumed calories and expended calories 2. This imbalance can lead to an accumulation of excess body fat, which can have negative effects on health.

Factors Contributing to Morbid Obesity

Several factors can contribute to morbid obesity, including:

  • Genetic factors 2
  • Epigenetic factors 2
  • Social and environmental factors 2, 3
  • Microenvironment factors 2
  • Diets with ultra-processed foods 3
  • Decreased levels of physical activity 3
  • Iatrogenic effects from commonly prescribed drugs with weight gain potential 3
  • Environmental-genetic factors, such as genetic predisposition, epigenetics, and composition of the gut microbiome 3

Treatment Strategies

Treatment strategies for morbid obesity may include:

  • Lifestyle intervention 4
  • Pharmacotherapy, such as semaglutide, liraglutide, and phentermine/topiramate 4, 5, 6
  • Bariatric surgery, such as laparoscopic sleeve gastrectomy 5, 6
  • Combination therapy, such as the use of phentermine and topiramate in combination with laparoscopic sleeve gastrectomy 5

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Obesity: Epidemiology, Pathophysiology, and Therapeutics.

Frontiers in endocrinology, 2021

Research

Obesity: Understanding Obesity.

FP essentials, 2020

Research

Drugs for Treating Obesity.

Handbook of experimental pharmacology, 2022

Research

Use of phentermine-topiramate extended release in combination with sleeve gastrectomy in patients with BMI 50 kg/m2 or more.

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 2019

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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