PICKWICKIAN SYNDROME

a complex of respiratory and circulatory symptoms associated with some cases of extreme obesity. The name originates from the fat man depicted in Charles Dickens' The Pickwick Papers, who showed some of the same traits. (By some definitions, to be obese is to exceed one's ideal weight by 20 percent or more; an extremely obese person would exceed the optimum weight by a much larger percentage.) The main symptoms are breathlessness on exertion and drowsiness. There may also be a bluish tint to the skin, increased heartbeats, high blood pressure with dilation of the vessels, enlargement of the liver, and an abnormally high number of red blood cells. The increased abdominal fat causes elevation of the diaphragm, diminished total lung volume, and more airway resistance during breathing. The oxygen saturation level of the blood may be much reduced, particularly during sleep, and there is retention of carbon dioxide in the bloodstream. Obesity causes an increased workload, which always places stress on the heart. With a low oxygen level and high blood pressure in the pulmonary circulation, heart and lung failure eventually ensue. The abundance of fat in the chest muscles and diaphragm has been blamed for the reduced ability to expand and contract the lungs; some authorities think that merely the added body weight on the chest restricts respiratory movements. The treatment is directed toward loss of weight.