Forensic issues at the extremes of weight: From frailty syndrome through frail obesity to morbid obesity.

It is well recognised that there has been a striking increase in average body size (measured by the body mass index) in a number of countries over recent years, such that it has been referred to as an obesity epidemic. This has been associated with increased numbers of these cases in the forensic mortuary with the associated practical difficulties in body handling and the complexities of identifying multiple comorbidities. At the other extreme of body weight lies the frailty syndrome which manifests with unintentional weight loss, decreased muscle mass (sarcopaenia), reduced physical strength and activity, exhaustion and slow ambulation. Of note, morbid obesity and frailty syndrome involve the interaction of multiple environmental, genetic and neuroendocrine factors and are both characterised by systemic inflammatory responses and multifocal organ dysfunction. While cytokine upregulation could well be a secondary phenomenon, it appears that the extremes of weight are associated with significant metabolic disturbances and related diseases. It may be useful in forensic centres to identify decedents with either frailty syndrome or morbid obesity to enable better understanding of the true incidence of significant weight disturbance and its ramifications in medicolegal cases.