Overweight (Obesity): Therapy

The basic obesity therapy program consists of nutrition therapy, exercise therapy, and behavior therapy (see Nutritional and Sports Medicine and Psychotherapy below). Indications for the basic program are BMI (body mass index) ≥ 25 kg/m2 + medical risk factors and BMI ≥ 30 kg/m2. The therapy goal is moderate weight loss (reduction phase) within 6-12 months (short-term effect) followed by weight stabilization or consolidation of the achieved weight loss (maintenance phase) (long-term effect).

General measures

  • Aim for normal weight!
  • Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and participation in a medically supervised weight loss program. If the BMI is between 25 and 35, individuals should lose at least 5% of their initial weight within six to 12 months (at least 10% for BMI > 35). Predictors of long-term weight maintenance are: weight loss induced changes in angiotensin converting enzyme (ACE) activity ↑, free fatty acids (FFS) ↑ and retinol-binding protein 4 (RBP4) levels ↓ have predictive significance (three parameters can predict 28% of the variability of weight progression).
  • Nicotine restriction (abstaining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Review of permanent medication due topossible effect on the existing disease.
  • Increase energy consumption by turning down the heating (room temperature: 18 to maximum 19 ° C); a reduction in room temperature by 1 ° C also reduces the energy bill by 5-10 %.
  • Get enough sleep! (ideal is a sleep stint between 6.5 and 7.5 hours)
  • Avoidance of psychosocial stress:
    • Mental reasons such as frustration and boredom.
    • Stress
    • In children, excessive television and video games and lack of sleep continued to show up as other causes

Conventional non-surgical therapy methods

  • Bariatric embolization (embolization of arteries supplying blood to the gastric fundus) → Decreased secretion of ghrelin: this is produced mainly in the gastric fundus and stimulates the appetite center in the hypothalamus, leading to weight loss.The procedure led to a gradual weight loss (mean: 7.2 kg) in obese participants (BMI 45 kg/m2) in a small study: the reduction in body weight after
    • 1 month averaged 8.2% (95 percent confidence interval 6.3-10%).
    • After three months 11.5 % (8.7-14 %)
    • After six months, 12.8% (8.3-17%) and after 12 months, 11.5% (6.8-16%).

    The effect of therapy on laboratory parameters was moderate. Participants noted as a positive the decrease in the feeling of hunger:Conclusion: the weight reduction was thus less than after bariatric surgery. The procedure is unlikely to gain importance for the treatment of obesity.

  • Transcranial direct current stimulation (tDCS) – Procedure in which a weak electric current is applied to the brain through the skull bone. An electrode is placed over the left dorsolateral prefrontal cortex; this location is important for executive functions, i.e. decisions of will, thus also for food intake. In a double-blind trial, it was shown that this significantly reduced the appetite of obese subjects, potentially influencing obesity. [is not yet available for treatment.]

Nutritional Medicine

  • Diets without medical supervision almost never lead to the desired result.
  • Nutritional counseling based on a nutritional analysis → permanent change of diet.
  • Observance of the following specific dietary recommendations:
    • Energy-reduced mixed diet (a daily energy deficit of at least 500 kcal is recommended).
    • In the context of a reduction diet, the composition of carbohydrates, fats and proteins hardly plays a role. Decisive is only the total number of calories (according to the S3 guidelines of the German Obesity Society).
    • Dietary changes can be guided by the principles of a low-fat diet (minimize intake of animal fats), the principles of a low-carbohydrate diet, or a high-protein diet.
      • Choose food with a low caloric density (defined as kilocalories per gram). The effect is greatest if the patient eats little fat-fat has the highest caloric density (9.3 kcal/g)-and also prefers food with a high water content-that is, fruits, vegetables, or low-fat soups. Participants who followed these dietary recommendations had lost an average of 7.9 kg after one year, obese with only low-fat food only 6.4 kg.
      • But also the so-called “low-carb therapy” (low-carbohydrate diet) is suitable for weight reduction. Within the framework of this applies: low-carbohydrate foods such as meat, poultry, fish, eggs and dairy products prefer and carbohydrate-rich foods such as bread, pasta, rice, potatoes, sweet fruit, desserts or candy avoid.
      • A Mediterranean diet rich in vegetable fat from olive oil or nuts lowered body weight better than a low-fat diet. [Authors withdrew study due to poor randomization]Here are the study results after re-analysis of the data: Meals with olive oil: 31% less likely to cause severe cardiovascular events (hazard ratio 0.69; 95% confidence interval 0.53-0.91); group that consumed nuts: risk reduction lowered by 28% (hazard ratio 0.72; 0.54-0.95).
    • Distribute food over 3 meals a day, no snacks in betweenNote: The total number of calories also determines the weight gain or loss here. Participants in one study consumed significantly fewer calories on average throughout the day without breakfast – averaging 260 calories less than those with breakfast. The initial BMI was also irrelevant. See also under the topic “Intermittent fasting” (interval fasting).
    • Replacing white flour products with whole grain products can save up to 100 calories per day. This is due to increased resting metabolic rate (accelerated metabolism by the whole components of the grain) and larger amounts of excreted stool.
    • High-fiber diet (whole grain products).
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Slow and deliberate chewing, so that a feeling of satiety can arise; slow eaters protect themselves from obesity and its secondary diseases
  • Selection of suitable food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training) → athletic activity (e.g. aquaplaning) is an important measure for weight reduction and leads to keeping the weight permanently afterwards (min. 150 min/week or 20-30 min/day)
  • Endurance and strength training combined with caloric restriction (diet that has a daily energy deficit of 500 to 750 kilocalories) can reduce body weight in obese seniors without increasing frailty.
  • Cycling to work in the morning (about 14 km a day) had the same effect on body weight as exercising at the gym (35 min 50 percent of maximum power; 55 min 70 percent of maximum power): after six months, cyclists had lost an average of 4.5 kg more fat mass (participants in the intensive fitness program: lost 4.2 kg fat; participants in the moderate fitness program: lost 2.6 kg fat).
  • Exercise does not stimulate appetite or does not lead to increased calorie intake after exercise; furthermore, hormones that stimulate satiety increase after exercise and food intake in overweight or obese people more than in normal weight people, the hunger-appetite hormone ghrelin also falls more.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy

  • Weight reduction results not only from improved dietary behavior and increased physical activity, but desirably also from lifestyle and behavior modification. Personal support during the weight reduction and also in the stabilization phase by appropriately qualified personnel such as a nutritionist increases the success rate.
  • Behavioral therapy and behavior modification: first, as with any eating disorder, the will of the affected person must be present to reduce the excess weight and thus also the numerous associated health risks. Once this step is taken, it is important to modify the eating and exercise and health behavior so that a long-term successful weight loss and improvement of the health condition is possible.
  • The cognitive-behavioral therapy interventions consist of, among other things:
    • Psychoeducation or building motivation.
      • Obesity: conditions and correlations; consequences for body and psyche.
      • Knowledge transfer about healthy nutrition and sufficient movements.
    • Agreement of therapy goals: Weight goals and weight-independent goals (increase quality of life).
    • Stimulus control/control of food stimuli: recommended actions for eating and shopping plans, etc.
    • Problem-solving strategies: stress management, if necessary; conflict management strategies.
    • Social skills training
    • Relapse prevention
  • Detailed information on psychosomatics (including stress management) is available from us.

Training

  • Education of children of primary school age, involving the family – with the aim of changing their personal lifestyle in a multimodal obesity therapy: Combination of exercise, nutrition and behavioral therapy (guideline on obesity therapy in children).