Look out below!

I have a number of patients who are morbidly obese and have a large panniculus (a dense layer of fatty tissue growth, consisting of subcutaneous fat in the lower abdominal area). As with most things, there's a grading system (developed by the American Academy of Plastic Surgeons) for abdominal panniculi:

Grade 1: Panniculus barely covers the hairline and mons pubis but not the genitalia

Grade 2: Extends to cover the genitalia

Grade 3: Extends to cover the upper thigh

Grade 4: Extends to cover the mid thigh

Grade 5: Extends to cover the knees or beyond

Below is an example of a grade 5 panniculus in a middle-aged male (this is not a picture of one of my patients but it very well could be-clearly this poor fellow's life sucks!). If he's a candidate, he needs psychological counseling, strict nutritional intervention, general medical care and also needs to be evaluated for bariatric and plastic surgery. It's a long process!