Brief overview
- Treatment: dietary, exercise, behavioral therapy, medication, stomach reduction, obesity cure.
- Symptoms: Unusually high accumulation of fat in the body, reduced performance, shortness of breath, excessive sweating, joint and back pain, psychological disorders, fatty liver, gout, kidney stones as secondary clinical signs
- Causes and risk factors: genetic predisposition, unhealthy eating habits, lack of exercise, slow metabolism, various diseases as well as medication, psychological and social factors
- Course and prognosis: If left untreated, obesity is a progressive disease with a high risk of secondary diseases and a shortened life expectancy. The earlier treatment or cure is given, the better the prognosis. Possible sequelae are diabetes, cardiovascular diseases and various cancers.
What is obesity?
Obesity is not a figure problem of people with weak character, but a recognized chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The World Health Organization (WHO) and the German Obesity Society (DAG) define obesity as an accumulation of fatty tissue in the body that exceeds normal levels and causes damage to health.
Obesity, also known as obesity, puts a strain on the entire body and therefore carries a high risk of secondary diseases – from heart attacks and diabetes to various cancers. The fact that a quarter of men and women in Germany are now obese is therefore a major social problem. After all, 67 percent of men and 53 percent of women are considered overweight.
Obesity in childhood and adolescence
If children suffer from obesity before puberty, they have a high risk of also being overweight in adulthood and thus developing various diseases at an early age.
However, it is not only the physical consequences of obesity that are problematic: social exclusion and bullying in childhood also sometimes lay the foundation for psychological disorders later on and have a lasting impact on personality development.
There are many reasons for obesity in childhood and adolescence. In addition to genetic predisposition, lack of exercise and poor diet play a major role. Parents often pass on a lifestyle that promotes obesity to their children.
Guideline body mass index (BMI)
According to the guidelines of the World Health Organization (WHO), a person with a body mass index of 25 or more is considered overweight, and with a BMI of 30 or more is considered severely overweight (obese). The BMI is calculated by dividing the weight (in kilograms) by the height squared (m2). Thus, for example, a person with a height of 180 cm would be overweight at a weight of 81 kilograms and obese at 98 kilograms.
The BMI value is used to identify a corresponding weight status and thus different obesity types can be subdivided.
BMI table for adults
The term preadiposity is synonymous with the term obesity and is often used interchangeably, but it is not universal. Preadiposity is considered a precursor to obesity and indicates that individuals with a BMI greater than 25 are at significantly increased risk for obesity and its sequelae.
Here to the BMI calculator for adults
Accordingly, the BMI table for children and adolescents is as follows:
- Overweight: BMI percentiles > 90 – 97
- Obesity: BMI percentiles > 97 – 99.5
- Extreme obesity: BMI percentiles > 99.5
Adipositas permagna
From a BMI of 40, physicians speak of obesity permagna or obesity grade 3. Those affected are very obese and therefore usually severely restricted in their quality of life. Even slow walking or sitting is difficult for them.
They are particularly likely to suffer from secondary diseases such as diabetes and high blood pressure, and their life expectancy is reduced. In most cases, self-confidence suffers as a result of being heavily overweight, and those affected are stigmatized by their environment.
Significant weight loss is crucial for very obese people to become healthier again. You can read more about obesity grade III in the article Adipositas permagna.
What are the different forms of obesity?
In women, on the other hand, fat accumulates mainly on the hips and thighs. Therefore, this form is called “pear type” or gynoid fat distribution. These deposits are less harmful to health than those of the apple type, although both forms pose increased risks to health above a certain level of obesity.
What are the treatments for obesity?
To treat obesity, it is not enough to reduce some weight in the short term. To avert serious secondary diseases, people with obesity must permanently reduce their weight and restore their energy metabolism to normal.
For obesity therapy to be successful in the long term, far-reaching changes in lifestyle habits are necessary. Obesity therapy is always based on nutritional, exercise and behavioral therapy. The combination of these treatment methods is what physicians call multimodal conservative therapy(mmk).
Nutrition therapy
It is important that concrete goals are formulated. For example, to save 500 calories every day. In addition, the practical aspects of the change in diet should be taken into account. For example, patients learn what to look out for when shopping and how to cook varied meals with little effort.
For patients who have diabetes mellitus in addition to obesity, nutrition therapy is usually accompanied by diabetes counseling.
Exercise therapy
Exercise is a central component of obesity therapy. To lose weight effectively, patients should engage in at least 150 minutes of moderate exercise per week, consuming 1200 to 1500 kilocalories. The focus is usually on strength and endurance sports. In the case of severe overweight, these should be sports that do not place additional stress on the joints and skeleton.
Behavioral therapy
Many overweight people compensate for negative feelings such as sadness, frustration and stress by eating. It is not easy to discard such behavioral patterns that have become ingrained over years or even decades.
With the help of psychosomatic medicine and behavioral therapy, patients can find new ways to replace unhealthy behavior with healthier behaviors. This theoretical knowledge is consolidated and practiced in practical exercises.
If this basic therapy of nutrition, exercise and behavioral therapy does not lead to the desired result, or if it does not promise sufficient success due to the extent of the overweight, medication or surgical measures such as stomach reduction can also be considered.
Drug treatment
However, many over-the-counter remedies are expensive and ineffective at best, and hazardous to your health at worst. Talk to your doctor about sensible drug support for weight loss.
Stomach reduction (bariatric surgery)
There are various methods for reducing the volume of the stomach. A gastric band or gastric balloon prevents you from eating larger amounts of food. They are reversible – but also have less effect than surgical stomach reduction (bariatric surgery).
A simple tubular stomach can be surgically created, or a gastric bypass, which also bridges a section of the small intestine so that less of what was eaten is absorbed by the body.
In Germany, it is possible to apply for stomach reduction from a BMI of 40 or from a BMI of 35 if secondary diseases such as diabetes are added. You can read more about this topic in the article Gastric reduction.
Obesity cure
The goals and components of an obesity cure correspond to those of the basic therapy: dietary changes, a sports program and behavioral therapy measures. However, in the context of an obesity cure, a much more intensive treatment takes place. Many patients also find it easier to change their lifestyle habits in a different environment.
An obesity cure is usually carried out by rehabilitation clinics or special obesity clinics. There are both inpatient and outpatient offers. The cure must be applied for together with a doctor. You can read about the requirements for a cure and how to make an application in the article Adipositas-Kur.
Signs of being overweight or obese
Main symptom pathological fat accumulation
The main symptom of obesity is the excessive accumulation of fat deposits in the body. They put a strain on the body just by the sheer weight it has to carry as a result. The increased load causes the body to require more oxygen and nutrients.
Moreover, the fat depots are not mere fat stores. They produce messenger substances that negatively affect metabolism and many other bodily functions.
Limited physical performance
Excess weight places particular strain on the heart and the circulatory system. As a result, even low physical exertion is sometimes a strenuous undertaking. This is due on the one hand to the weight load, but also to the fact that more blood flows through the tissue overall.
Since any physical activity is very strenuous because of the weight and uncomfortable because of shortness of breath, many people with obesity shy away from physical exertion. But it is precisely the lack of exercise that is sometimes a major cause of obesity. Those affected often get caught in a vicious circle of lack of exercise and weight gain, which drives their weight ever upward.
Joint wear and tear
In addition to the cardiovascular system, the musculoskeletal system suffers most from obesity. Due to the high load on the joints, they wear out prematurely. In the process, the fine cartilage layer in various joints is gradually destroyed beyond repair (arthrosis). Knees, hip joints and ankle joints are particularly frequently affected. Obesity also frequently leads to premature wear of the intervertebral discs between the vertebral bodies and thus sometimes causes a herniated disc (disc prolapse).
Increased sweating (hyperhidrosis)
Reflux (heartburn)
In many cases, the fat stores in the abdominal cavity continuously press on the digestive organs, for example on the stomach. Acidic gastric juice is then forced back into the esophagus, where it causes heartburn. In the long term, the acid attacks alter the cells of the esophagus: a condition called Barrett’s esophagus develops, possibly progressing to cancer.
Sleep apnea
People with sleep apnea syndrome (SAS) suffer from pauses in breathing during sleep. The most common form of this condition is called obstructive sleep apnea syndrome (OSAS). In this case, the muscles of the upper airways slacken during sleep. This obstructs the airflow of normal breathing, and sleep quality is poor. This is common in people who are severely overweight.
People with sleep apnea are often very tired and unfocused. The lack of rest during sleep also puts a strain on the psyche.
Varicose veins (varicosis) and thromboses
It is not yet clear why people with obesity are more prone to varicose veins. The comparatively weaker connective tissue of obese people may be the reason. Researchers also suspect that the fat cells release a number of messenger substances that weaken the vascular walls of the veins.
Psychological problems
People with obesity are often stigmatized because of their weight. Surveys show that two-thirds of Germans believe the reasons for obesity are laziness about exercise and overeating. Most respondents assumed that obesity was self-inflicted. Those affected are often confronted with these sweeping assessments in everyday life. Social withdrawal and possibly increased comfort eating are possible consequences.
Other clinical signs in obesity
- Gallstones (cholecystolithiasis): Obesity is one of the most important risk factors for gallstones. People with obesity often have high cholesterol levels. When the cholesterol crystallizes, gallstones form, sometimes causing cramping abdominal pain (colic). Cholesterol stones are the most common type of gallstone in industrialized countries.
- Gout (hyperuricemia): Blood uric acid levels often increase with obesity. When uric acid in the blood exceeds a critical concentration threshold, it crystallizes. The uric acid crystals are then deposited in joints, where they cause an attack of gout with great pain due to inflammation.
Causes and risk factors
There are numerous, individual factors that significantly influence the metabolism and thus the individual energy balance and weight. These include genetic makeup, maternal nutrition during pregnancy, and hormones. Therefore, someone who is overweight does not necessarily have to eat more or exercise less than a slim person.
The causes of obesity go far beyond eating too much and exercising too little. A whole range of factors seem to influence and reinforce each other. The exact mechanisms are not yet fully understood. However, it is becoming apparent that the disease process tends to take on a life of its own: The more pronounced the obesity, the more stubbornly the body defends the excess pounds.
Eating behavior (alimentary obesity)
Some researchers also argue that it is not the total amount of calories that is decisive for the development of obesity, but the composition of the diet. For example, that oils with polyunsaturated fatty acids are less fattening than saturated fat. Or that sweets make you fatter than vegetables with the same amount of calories.
Still other hypotheses state that longer breaks between meals, in which the body has time to reduce food depots again, help to become or remain slim. People who often eat something in between meals are more likely to gain weight with the same calorie intake. Experts therefore recommend at least four calorie-free hours between meals.
Lack of exercise
It is not only the current amount of exercise that is decisive: those who exercise little have less muscle mass. Even at rest, muscles consume more energy than fatty tissue, for example. If muscle mass decreases, so does the basal metabolic rate, i.e. the body’s energy requirements at rest.
Problematically, social networks entice young people in particular to spend the day sitting with virtual friends rather than actually exerting themselves physically or being active in sports.
More and more adults are also adopting lifestyles that make them prone to obesity: many workers spend much of their time at their PCs. Cycling and walking have been replaced by driving or public transportation, and climbing stairs has been eliminated in many places by escalators and elevators.
Metabolism
Conversely, there are also very slim people who eat a lot – and without doing much exercise to compensate.
Obese people also lose less heat energy due to the insulating layer of fat under their skin. They therefore have to convert comparatively less energy into heat, which means they burn fewer calories.
Environment shapes eating behavior
Eating habits are significantly shaped during childhood and adolescence. An increasing number of children do not learn the correct way to handle food, either at home or at school. For example, uncontrolled access to sweets disrupts the natural rhythm of hunger pangs and food intake: as a result, children and adolescents eat constantly.
Genetic causes
Genes play a major role in the development of obesity: the results of twin studies suggest that obesity is due to genetic causes in about 40 to 70 percent of cases.
However, it is currently still unclear how many genes are actually involved in the development of obesity and in what way. Around 100 genes are known to date that are suspected of being linked to overweight and obesity.
The “FTO gene” in particular is the focus of obesity research. The gene appears to be involved in the control of appetite. People with a mutation in this gene may only become full with a delay and therefore gain weight more easily.
Epigenetic programming
Not only the genes themselves have a great influence on weight, but also how active they are in the body. A large number of genes are even completely muted and are not used at all.
Among other things, the genes are already influenced in the womb. If the mother is overweight or develops gestational diabetes, the children are often born large and too heavy. Their risk of obesity is then high, because the body is used to an excess of food. The child has a lifelong tendency to overeat. In addition, his body tolerates higher blood sugar levels.
Diseases as a cause of obesity
Certain diseases and medications also promote weight gain and thus obesity. Experts then speak of secondary obesity.
- Polycystic ovary syndrome (PCOS): Around four to twelve percent of women of childbearing age have this cystic disease of the ovaries. Characteristic of PCOS are cycle disturbances and obesity.
- Cushing’s disease (hypercortisolism): In this disorder, the adrenal glands secrete unnatural amounts of cortisone into the blood. When blood levels are permanently elevated, the hormone cortisone causes severe weight gain, especially on the trunk of the body (“truncal obesity”).
- Hypothyroidism: In hypothyroidism, the thyroid hormones T3 and T4 are not produced in sufficient quantities. Among other things, they regulate energy metabolism, which is lower than normal when T3 and T4 are deficient.
- Genetic syndromes: people with Prader-Willi syndrome (PWS) or Laurence-Moon-Biedl-Bardet syndrome (LMBBS) are often extremely obese.
- Mental illness: People with depression or anxiety disorders also often suffer from obesity in addition. Eating serves as a short-term relief for the psyche. In turn, psychological stress may increase as body weight increases, causing sufferers to eat even more to feel better again.
- Binge-eating disorder: Binge-eating disorder, in which sufferers repeatedly binge, sometimes also causes a sharp increase in weight.
Medications
Some medications have the unwanted side effect of stimulating appetite or increasing water retention. These medications include:
- Antihistamines (medications for allergies).
- Psychotropic drugs such as antidepressants and antipsychotic medications.
- Cortisone for long-term and/or high-dose use.
- Blood pressure medications, especially beta blockers
- Antiepileptic drugs, for example valproic acid and carbamazepine
- Migraine medications such as pizotifen, flunarizine or cinnarizine
Risk factor abdominal girth
As a rule of thumb, an abdominal girth of over 80 cm is considered risky in women, and over 94 cm in men. This increases the risk of stroke and type 2 diabetes, among other things. With an abdominal circumference of over 88 cm in women and 102 cm in men, the risk is even significantly increased.
Examinations and diagnosis
If you are experiencing discomfort because of your increased body weight or you are gaining weight for no apparent reason, first seek advice from your family doctor. He or she will first ask you a few questions in the so-called anamnesis interview in order to narrow down the possible causes:
- How long have you been overweight?
- Have you had problems with your weight before?
- Are you continuing to gain weight?
- Do you have physical complaints such as back pain, knee pain or shortness of breath?
- Do you exercise regularly?
- Do any family members (parents, siblings) have problems with obesity?
- Do you take medication regularly?
Determination of the body mass index
The doctor determines the extent of obesity by first calculating the body mass index.
Since the BMI is only a guideline value and gives an initial indication of possible obesity, the doctor usually takes other measurements that more clearly narrow down the extent of obesity and the risk of secondary diseases. These include waist and hip circumference, for example.
Blood tests
Blood lipid levels are often elevated in people with obesity. Therefore, the doctor additionally examines the cholesterol and triglyceride values.
The liver also often suffers in cases of severe obesity. The liver values provide information about this.
If there is a suspicion that the obesity may be hormonal, the doctor determines various hormones in the blood, such as thyroid hormones.
Cardiological examinations
- Ultrasound of the heart (echocardiography)
- ECG at rest and under physical stress
- Cardiac catheterization, for example, if there is a reasonable suspicion of coronary heart disease, cardiac insufficiency, or a valvular defect
Examinations in children and adolescents
The first point of contact for obesity at this age is the pediatrician and adolescent physician. This person clarifies whether a referral to an obesity center is necessary. The physician also uses BMI to determine obesity in children and adolescents. However, age and gender are included in the calculation (BMI percentiles). Therefore, a BMI calculator for adults is not applicable for calculating BMI in children.
Course of disease and prognosis
Consequential diseases
One possible consequence of this chronic, silent inflammation is type 2 diabetes, which occurs mainly in overweight people. Arteriosclerosis is also common in people with obesity. In turn, arteriosclerosis is the cause of the two leading causes of death worldwide: heart attack and stroke.
In addition, various cancers occur more frequently in obese people. There is a particularly strong link between obesity and breast cancer, as well as other cancers such as colon cancer, esophageal cancer, renal cell cancer, uterine cancer and pancreatic cancer.
Prevention
A person becomes overweight or obese if he or she supplies his or her body with more energy than it consumes in the long term (positive energy balance). Food intake and exercise are therefore two factors that can influence weight.
The development of obesity can already be prevented with sufficient physical activity and a balanced diet. For example, people who also have an increased risk of obesity should be moderate in their intake of sweets, high-fat foods and snacks, and sweetened beverages. Instead, regular meals are beneficial. Experts advise three main meals and a maximum of two snacks. If you get hungry in between meals, snacks of fruit and vegetables are a good option.
Unsweetened tea and water are ideal drinks because they contain no additional sugar. Drink enough and, above all, drink before you eat. Often, what is supposed to be appetite or hunger is simply thirst. For children and adolescents, experts strongly advise against forcing them to always empty their plates. They also often receive portions that are too large. Rather, serve smaller meals and add a little more if needed.
Other triggering factors such as stress or illnesses, on the other hand, are not so easy to counteract. Identifying these triggers is often difficult and usually only possible with medical advice. Therefore, ask your family doctor if you have any suspicions.