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Kral JG: Morbid obesity and health related risks. Ann Intern Med 103:1043–1046, 1985. 9. Sarlio-Lahteenkorva S, Stunkard A, Rissanen A: Psychosocial factors and quality of life in obesity. Int J Obes Relat Metab Disord 19:1S–5S, 1995. 10. Stunkard AJ, Wadden TA: Psychological aspects of severe obesity. Am J Clin Nutr 55:532S–534S, 1991. 11. : Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab 54:254–257, 1982. 12. Reaven GM: Syndrome X: 6 years later.
Buffington CK, Cowan GS Jr, Smith H: Significant changes in the lipid-lipoprotein status of premenopausal morbidly obese females following gastric bypass surgery. Obes Surg 4:328–335, 1994. 54. Wolf AM, Beisiegel U, Kornter B, Kuhlmann HW: Does gastric restriction surgery reduce the risks of metabolic diseases? Obes Surg 8:9–13, 1998. 55. : Variation in lipid levels in morbidly obese patients operated with Lap-Band r adjustable gastric banding system: Effects of different levels of weight loss. Obes Surg 10:569–577, 2000.
To realize how high these pressures can be in severe obesity, one needs to relate them to the pressures seen in patients with an acute abdominal compartment syndrome28,29 where it is generally thought that a urinary bladder pressure of ≥20–25 cm H2 O is an indication to return the patient to the operating room for emergency laparotomy and abdominal decompression. Many severely obese patients have urinary bladder pressures well above 25 cm H2 O. 30 Hypertension We hypothesize that obesity-associated hypertension is secondary to an increased IAP rather than to increased insulininduced sodium reabsorption.