'American Idol' alum Mandisa died from complications of class III obesity. Here's what that means.

Grammy Award-winning singer and American Idol alum Mandisa died of complications from class III obesity, according to an autopsy report obtained by People. The 47-year-old was found dead by friends in her Franklin, Tenn., home on April 18 and her manner of death was listed as natural.

What does it mean to die from obesity?

Typically, obesity isn’t listed as the cause of death on a death certificate, Dr. Katherine Saunders, clinical assistant professor of medicine at Weill Cornell Medicine and co-founder of Intellihealth, tells Yahoo Life. However, “weight-related health complications” from the chronic disease are associated with “very significant morbidity and mortality,” she says.

The World Health Organization (WHO) reports that higher-than-optimal body mass index (BMI) “caused an estimated 5 million deaths from noncommunicable diseases such as cardiovascular diseases, diabetes, cancers, neurological disorders, chronic respiratory diseases, and digestive disorders,” in 2019.

Saunders says that life-threatening complications from obesity can also include heart attack, heart failure, sudden cardiac death, stroke and pulmonary embolism. And while Mandisa’s specific health status at the time of her death is unclear, the information on the autopsy lets examiners know that they were likely related to her weight.

What is class III obesity?

Obesity as a disease is broken into the following three classes, according to Cleveland Clinic:

• Class I obesity: BMI of 30–34.9 kg/m²

• Class II obesity: BMI of 35–39.9 kg/m²

• Class III obesity: BMI of 40 kg/m² or higher

“In general, class III obesity is associated with greater risk of morbidity and mortality compared to class I and II obesity,” says Saunders. However, an individual’s risk of developing cardiometabolic diseases like hypertension, stroke and diabetes is usually determined with additional factors, as BMI is considered a flawed tool for indicating health on its own.

Like any form of obesity, the disease is caused by an imbalance of energy stored and used by the body. Genetics, hormone imbalances, environment and socioeconomic factors all play a role. One study shows that class III obesity disproportionately impacts Black women above the age of 40. However, there are ways to manage and treat it through lifestyle changes, behavioral and psychological therapy, medications and surgery.

Why does this matter?

“While there is increasing recognition of obesity as a complex, heterogeneous, chronic disease, many people don’t realize how serious obesity is,” says Saunders. “Obesity is treatable, but it is massively undertreated.”

She attributes that to various barriers of care like weight bias, which even impacts insurance coverage of comprehensive obesity care.

“Mandisa’s passing is a tragedy,” Millicent Gorham, CEO of the Alliance for Women’s Health and Prevention, tells Yahoo Life. “Unfortunately, there is still a stigma around obesity, and this heartbreaking event underscores the importance of recognizing obesity as the serious chronic disease it is, meaning there is no place for shame.”