Obesity, or adiposity, particularly affects people in industrialized countries and the Western world. In Germany, more than 20 percent of people are considered obese.
What is obesity?
Obesity derives from the Latin word “adeps” for fat. According to experts, this increase in body fat can be classified as a chronic disease. However, not everyone who is overweight is also obese. According to the World Health Organization, obesity is defined as a BMI (body fat index) of 30 or more. A total of 3 degrees of severity are distinguished, which are also subject to the BMI in their classification. A grade I obesity is present at a BMI of 30-35, up to a BMI of 40 people are affected by a grade II obesity, above which is only grade III, which is also called morbid obesity. The quality of life is already significantly limited here, life expectancy is significantly lower than in normal weight people.
Causes
Obesity occurs increasingly in Western industrialized countries, which suggests that the causes can be inferred from living conditions. According to studies, there is a direct link between the daily intake of fat and obesity, but not the generally excessive caloric intake. Sugary drinks also lead to overweight and eventually obesity. In addition to the wrong diet, too little exercise is a cause of obesity. Lack of exercise in this context means not only too little sport, but also the general living conditions. Sedentary activities, passive leisure time activities and a good infrastructure can be found especially in western countries and thus, together with the wrong diet, quickly lead to weight gain. External factors are also reasons for obesity. The excessive supply of goods, the popularity of fast food, a lot of advertising and the habituation to sugar and fat (sugary teas, soft drinks, fast food) even in children lead to obesity. Metabolic diseases such as hypothyroidism can also be cited as a cause. According to studies, genetic predispositions can also lead to obesity.
Symptoms, complaints and signs
The most obvious symptom of obesity is the visible excess weight of the affected person or persons, which manifests itself in a plump and expansive body shape. Therefore, obesity is generally easy to diagnose – even though its causes can be quite different in nature. In all cases, obesity is acquired over a long period of time and can be treated by changing lifestyle habits. Symptoms of obesity include a gait that is usually sluggish, resulting from limited mobility. In most cases, movement is directly related to breathlessness because the cardiovascular system must move and maintain a mass for which it is not designed. Because of the impaired mobility, a conditional deficit usually results, as affected individuals are no longer able to engage in athletic activities. In the long term, problems occur in the musculoskeletal system, which are triggered by excessive loads on joints and tendons. Back problems such as slipped discs are also more common in obese patients. Last but not least, obesity is considered one of the main triggers of secondary diseases of the cardiovascular system. Blood values also deteriorate, usually due to an unhealthy, high-fat diet and too little exercise. Externally unnoticed, deposits form in veins and arteries, which can lead to diseases of the vessels and the heart. Strokes and heart attacks are the long-term result.
Diagnosis and progression
Obesity is primarily diagnosed by the measured BMI. Decisive for the sequelae of obesity, such as high blood pressure or cardiovascular disease, is not only the BMI, but the distribution of body fat. Fat deposits in the abdomen are considered bad because this fatty tissue often surrounds the organs, thus negatively affecting sugar metabolism. Abdominal fat produces bad blood fats that raise cholesterol levels and deposit on artery walls. If the fat is primarily distributed on the thighs or buttocks, this is known as the pear type – this person has a lower risk of developing secondary diseases. For diagnosis, the abdominal circumference and the waist-hip ratio are also measured. Both provide information about the fat distribution pattern.Accordingly, women with a waist circumference of more than 80 cm and men with a value of 92cm or more have an increased risk. The waist-to-hip ratio should be below 1 for men, and women with a value above 0.85 are considered at risk. In children, these values are rarely meaningful, which is why age in relation to height and weight must be added for them. This is done with percentile tables.
Differential Diagnosis
Nutritional obesity must be clearly differentiated diagnostically from conditions such as Cushing’s syndrome (hypercortisolism), hypothyroidism, dyslipidemia, and PCO syndrome (polycystic ovary syndrome).
Complications
Obesity can lead to the development of diabetes mellitus (type 2). Diabetes leads to a metabolic disorder, with the characteristic feature being resistance to the hormone insulin. If left untreated, severe diabetes can lead to death. In addition, other secondary diseases and accompanying symptoms such as neuropathy are possible. Often, obesity also causes complications affecting the cardiovascular system. This results in a higher risk of corresponding diseases, including heart attacks and strokes. In addition, obesity increases the risk of various cancers. Metabolic syndrome is a combination of abdominal obesity, insulin resistance, hypertension and dyslipoproteinemia. The latter describes a disturbance in protein concentrations in the blood serum. High density lipoprotein (HDL) and low density lipoprotein (LDL) are present in altered proportions. In many cases, obesity is accompanied by elevated cholesterol levels. This favors arteriosclerosis and gallstones. The excessive weight also leads to increased strain on the musculoskeletal system. The joints and intervertebral discs in particular suffer from obesity. A further complication during sleep can be snoring or a temporary cessation of breathing. This sleep apnea syndrome can in turn lead to disturbed sleep patterns: Affected individuals thus wake up more frequently from the deep sleep phases that are important for the body’s normal regeneration.
When should you see a doctor?
Many people suffer from increased weight. Probably most of those affected will not go to the doctor because of obesity, as long as they do not suffer from serious secondary symptoms. The reason: Often the insight into the health late consequences, which can have strong predominance, is missing despite all mediale information. Many overweight people no longer dare to go to the doctor. Increasing feelings of shame ensure that body weight continues to rise. Thus sooner or later possible consequence symptoms of the obesity occur. Even if no pathological complaints are present as a result of the excess weight, the doctor should be consulted. As a minimum, an annual health check and all preventive examinations scheduled for the age group are advisable. In case of occurrence of vegetative disorders such as excessive sweating, shortness of breath or increasing shortness of breath or heart palpitations during minor exertions, the visit to the doctor is necessary. The symptoms can be reduced by diet. Even if there are symptoms in the musculoskeletal system, pain and constant muscle tension, visits to the doctor are necessary. Otherwise, there is a risk of permanent damage. Obesity can lead to chronic diseases with progressive progression. Regular visits to the doctor can prevent this. Visits to the doctor are also advisable if the person concerned notices that he is missing out on opportunities socially and professionally and is being sidelined by his weight problem. If the massive overweight exists because of psychological problems, a psychotherapist should be consulted.
Treatment and therapy
The doctor measures the abdominal circumference and body fat percentage, as well as the body mass index of the patient, in order to be able to initiate an accurate diet and further therapy. The primary goal of therapy is always weight loss. This often requires severe interventions in the patient’s lifestyle. In the majority of obese patients, diet is the main cause of obesity. Education about healthy eating is the first step in treating obesity. Since incorrect behavioral and dietary patterns develop over years, behavioral therapy is often advisable. An attacked self-image and psychological causes also often need to be treated, which is why psychotherapy is often indicated.The second important pillar in the fight against obesity is exercise. The WHO recommends 30-60 minutes of exercise at least 3 times a week for weight reduction. However, detailed counseling is also necessary here to prevent damage to the joints and tendons of the obese person. In the case of children, the families and relatives must be strongly involved in the therapy process. In cases of severe obesity of grade II or higher with concomitant other diseases such as diabetes or heart disease, surgical measures are also available. Gastric banding or stomach reduction are restrictive procedures and hinder the person from eating. Combined surgeries can also affect the gastrointestinal tract and directly affect not only food intake but also fat metabolism. Medications, such as appetite suppressants, are not suitable for obesity therapy. The only approved drug is orlistat, which interferes with fat metabolism and disrupts the absorption of dietary fats. However, this drug should also be used only as an adjunct to therapy, since eating habits and lack of exercise must be primarily treated by means of a change in behavior.
Outlook and prognosis
Schematic diagram showing the anatomy involved in gastric reduction. Click to enlarge. People who are severely overweight tend to be at risk for metabolic syndrome. Likewise, the likelihood of heart attacks, heart failure and high blood pressure is greatly increased. As a rule, obesity represents a relatively dangerous and also very unhealthy condition for the patient’s body. If it is not treated or the weight is not drastically reduced, it can lead to life-threatening symptoms and, in the worst case, death. In most cases, patients suffer from restricted movement and are quickly exhausted when the body is strained. The increased sweating often leads to an unpleasant body odor and the increased weight causes pain in the joints. Furthermore, discomfort in the heart also occurs, so that most patients are exposed to cardiovascular disease and may suffer a heart attack. The obese figure of the patient sometimes leads to psychological discomfort and social exclusion. Children in particular may suffer from bullying and teasing due to obesity and develop severe psychological complaints as a result. Furthermore, it can lead to the development of diabetes. Obesity can be treated, but the patient is responsible for proper treatment. Only in a few cases an exclusively medical treatment is possible. The disease can be counteracted by a healthy lifestyle and sports activities. Psychological treatments may also be necessary to address the causes of obesity.
Prevention
A healthy lifestyle from childhood, is the best prevention against obesity. The diet should contain as little fat and sugar as possible, exercise 2 to 3 times a week on the program. Especially children are very receptive to preventive measures and healthy eating habits and plenty of exercise become the norm, which carry into adulthood.
Aftercare
Along with gastric reduction, gastric banding is one of the options for bariatric surgery. When conservative weight loss methods have failed, it is usually a last resort. Click to enlarge. Follow-up after bariatric surgery is lifelong. Six appointments are scheduled in the first year, two in the second, and one annually thereafter. If the patient has any complaints, he or she should contact the attending physician regardless of the appointment. The challenge for those affected is to change their lifestyle, which primarily involves diet and exercise behavior. Here they usually need support in order not to fall back into old patterns. It can take the form of nutritional counseling, a doctor or a self-help group. A diet plan is an essential part of the first few weeks. In addition, concomitant symptoms of obesity such as diabetes and high blood pressure will most likely decrease. Accordingly, the drug treatment must be adjusted. If the intestine is less able to obtain nutrients from food due to the surgical procedure, then dietary supplements must be prescribed. The dose of these must be adjusted annually depending on the patient’s state of health.Since patients with obesity often have lowered self-esteem, it is important that social inclusion is part of aftercare to prevent relapse. This can be done by starting work soon or finding new hobbies. If needed, behavioral therapy can be prescribed to help the patient with the challenges of everyday life.
Here’s what you can do yourself
People affected by obesity can do quite a bit to reduce their weight. Basically, when it comes to obesity, insight into the disease and the will to change are considered indispensable in terms of weight loss. Anyone who does not want to admit to being massively overweight and does not see the sense in a significant change in diet and exercise habits will not lose weight sustainably and healthily through practically any medical treatment. If necessary, therefore, psychological counseling and therapy is an important component that can be addressed in parallel with a medically supported diet. Only those who eat less than they consume every day can successfully counteract obesity within the framework of a diet. The negative calorie balance is therefore the goal. As long as no specific health concerns stand in the way, everyone can do something to lose weight in everyday life by eating a diet low in fat and calories and at the same time increasing calorie consumption through exercise. It is important to know that weight loss in everyday life should be achieved slowly and not by crash diets. These cause a significant reduction in the basal metabolic rate and thus significantly increase the yo-yo effect. Well-founded knowledge about nutrition is therefore advisable if you want to do something against obesity yourself. This can be acquired by oneself, but also supported by courses, for example those offered by health insurance companies. Self-help groups can also be a great help in everyday weight reduction.