Significant increases in body mass indexes (BMI) in an adult autopsy population from 1986 to 2006--implications for modern forensic practice.

A study was undertaken of two coronial autopsy populations aged >or= 17 years in Adelaide, South Australia in 1986 and in 2006 to determine whether there had been any increase in body mass index over the intervening 21 years. In 1986 there were 689 cases; M:F=2.8:1. The average BMI was 25.1, with a range from 12.5 to 55.5. 47% of cases had a normal BMI (18.5-24.9), 14.8% were obese (BMI >or= 30), with a subset of 1.3% of cases classified as morbidly obese (BMI >or= 40). In 2006 there were 1176 cases; M:F=1.9:1. The average BMI was 27.1 with a range from 10.5 to 80.6. 32.1% of cases had a normal BMI, 27.2% were obese, with a subset of 4.8% of cases classified as morbidly obese. This study has confirmed that there has been a marked relative and absolute increase in numbers of obese individuals undergoing coronial post-mortem examinations in South Australia, with 218 more autopsies in 2006 involving obese bodies, including 47 more cases where morbid obesity was documented. This trend is undoubtedly occurring in other countries. Significant problems exist in trying to handle obese and particularly morbidly obese individuals in mortuaries designed for bodies with normal BMIs. Lifting, transport, transfer, storage and autopsy dissection are all difficult. Obesity enhances putrefaction that further complicates handling. Unless mortuaries are modified to deal with the increasing numbers of morbidly obese individuals, with reinforced and robust equipment including lifting hoists, the autopsy examination of such cases may be compromised, and staff will be confronted with ongoing and increasing risk of injury.