Clinical presentation of obesity The morbidly obese patients often presents with chronic weight-related problems such as migraine headaches; back and lower extremity joint pain from degenerative joint disease; venous ulcers; dyspnea on exeion; biliary colic; stress urinary incontinence; dysmenorrhea; infeility; gastroesophageal reflux; and inguinal, umbilical, and incisional hernias. Obesity has a profound effect on overall health and life expectancy. The morbidly obese are predisposed to developing serious weight-related comorbidities, including hypeension, CAD, adult onset DM, sleep apnea and/or obesity hypoventilation syndrome (Pickwickian syndrome), deep venous thrombosis, pulmonary embolism, hypercoagulability, hyperlipidemia, and depression among others. Physiological abnormalities resulting from OSA include hypoxemia, hypercapnia, pulmonary and systemic vasoconstriction, and secondary polycythemia (from recurrent hypoxemia). These result in an increased risk of ischemic hea disease and cerebrovascular disease. Right ventricular failure can occur from hypoxic pulmonary vasoconstriction. Obesity is now considered to be the second leading cause of preventable death behind cigarette smoking. The incidence of comorbidities and moalities is directly related to the degree of obesity. in a study with 12 year follow up, moalities rates for those weighing 50% over average weight were doubled. Moalities and morbidities is largely attributable to the comorbidities of obesity. Ref: Schwaz 9/e, Page 1743.