Beyond Body Mass Index (BMI): The Role of Obesity in the Trauma Patient

Abstract Purpose of Review Trauma remains a leading cause of death worldwide while nearly 50% of adults in the United States have obesity. Obesity is presently defined by body mass index (BMI) and has doubled worldwide since 1990. While obesity is often a risk factor for poor health outcomes, recent literature has suggested that the impact of obesity on trauma might be more nuanced. Since trauma surgeons do not have the luxury of patient optimization and modifying risk factors, it is imperative to have a clear understanding of the impact of obesity on their patients. Recent Findings Some studies demonstrate a paradoxically lower mortality in patients with mild obesity compared with underweight or non-obese patients. However, in most studies the highest BMI classes were still associated with increased mortality, and morbidity was almost universally increased. Interestingly increased adiposity may provide a cushioning/armor effect that reduces the severity of select injuries, including penetrating trauma. Summary Patients with obesity have special considerations in trauma care. Overall physiology is affected and physical exam and diagnostic imaging may be more difficult. Although classically seen as a universal predictor of worse morbidity and mortality, a closer inspection of outcomes points to areas where mild obesity may be associated with more favorable outcomes in trauma patients. Trauma surgeons should take obesity into consideration when caring for trauma patients as another factor to tailor individualized care.c