obesity

Obesity: Short overview

• Description: morbid obesity, chronic disease, BMI of 30 and more
• symptoms: unusually strong accumulation of fat in the body, reduced performance, shortness of breath, excessive sweating
• Consequential damages: Diabetes, cardiovascular diseases, fatty liver, joint problems, back problems, gout, kidney stones, various types of cancer, psychological problems
• Causes: genetic predisposition, unhealthy eating habits, lack of exercise, slow metabolism, various diseases
• Treatment: Nutrition, exercise, behavioral therapy, medication, stomach reduction
• Forecast: difficult to treat, high risk of complications, shortened life expectancy

What is obesity?

Obesity or obesity is not a figurative problem of low-character people, but a recognized, chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The German Obesity Society defines obesity as an excess of normal fat accumulation in the body.

Standard Body Mass Index (BMI)

As of a body mass index of 25, a person is considered to be overweight according to the guidelines of the World Health Organization (WHO), as obese from a BMI of 30. The BMI is calculated from the weight (in kg) divided by the height squared (m2). Thus, for example, a person 180 cm tall, weighing 81 kilograms, would be overweight and 98 kilograms obese.

A person becomes overweight or obese if he supplies his body with more energy over the long term than he consumes (positive energy balance). Nutritional intake and exercise are thus two adjusting screws, over which the weight can be influenced.

Individual factors influence the weight

However, there are numerous factors that significantly affect the metabolism and thus the individual energy balance. These include the genetic make-up, the diet of the mother in pregnancy or the hormones. Therefore, someone who is overweight does not necessarily have to eat more or move less than a slim person.

Strain on the whole body

Obesity, also called obesity, affects the whole body and therefore carries a high risk of complications – from heart attack to diabetes and various cancers. That now a quarter of adults in Germany are obese, is therefore a major social problem.

Obesity permagna

From a BMI of 40, doctors also speak of obesity permagna or of obesity grade 3. Those affected are very obese and are therefore severely limited in their quality of life. Even slow walking or sitting is difficult for them.

The likelihood that they have complications such as diabetes and high blood pressure is particularly high for them, their life expectancy is reduced. Self-esteem usually suffers from heavy obesity and sufferers are stigmatized by their environment.

Significant weight loss is crucial for very strong obese to become healthier again. You can read more about grade III obesity in the article Adipositas permagna.

Obesity: symptoms

The more pronounced the overweight is and the longer it is, the greater the physical discomfort. The risk of complications increases as well. The messenger substances that are formed in the fatty tissue also contribute to this. These include angiotensinogen, interleukins and cytokines. While there are quite a few in the overweight segment who are physically fit and healthy, this is unlikely in obese people.

Main symptom of morbid fat accumulation

The main symptom of obesity is the excessive accumulation of fat deposits in the body. They burden the body already by the sheer load that it has to carry and which must be supplied with oxygen and nutrients.

The fat deposits are also no mere fat storage. They produce messengers that adversely affect the metabolism and many other bodily functions.

Fat distribution: apple type and pear type

How dangerous the fat is depends not only on the amount, but also on where it accumulates. As a particularly unfavorable health fat store in the abdominal region. The so-called visceral fat accumulates not only under the skin, but also around the organs. The body silhouette in this fat distribution is also referred to as “apple type”. It is especially typical for men.

In women, however, fat accumulates mainly on the hips and thighs. Therefore, this form is called “pear type”. These depots are less harmful to health than those of the apple type.

Risk factor abdominal circumference

As a rule of thumb, in women a waist circumference of over 80 cm is considered risky, in men over 94 cm. Among other things, this increases the risk of stroke and type 2 diabetes. With an abdominal circumference of over 88 cm in women and 102 cm in men, the risk is even significantly increased.

Limited physical efficiency

Heart and circulation are particularly stressed by the overweight. Even low physical stress becomes a strenuous exercise. This is partly due to the weight load, but also because of the fact that more tissue has to be perfused.

The limited physical performance is primarily due to shortness of breath, or respiratory distress noticeable. This arises when the heart and lungs can not compensate for the increased oxygen demand and thus there is a lack of oxygen in the blood and in the tissue.

Since any physical activity is very strenuous due to the weight and uncomfortable because of shortness of breath, many people with obesity shy away from physical exertion. But just the lack of exercise can be a major cause of obesity. Those affected may find themselves in a vicious circle of lack of exercise and weight gain that pushes their weight higher and higher.

Osteoarthritis

In addition to the cardiovascular system, especially the musculoskeletal system suffers from obesity. Due to the high stress on the joints, they wear out prematurely. In the process, the fine cartilaginous layer in various joints is irreparably destroyed (osteoarthritis). Knee, hip joint and ankle joint are particularly common. Obesity can also lead to premature wear of the intervertebral discs between the vertebral bodies and thus cause a herniated disc (Diskusprolaps).

Increased sweating (hyperhidrosis)

People with obesity often sweat excessively. One reason for this is the weight-related increase in physical stress, and another is the poorer heat dissipation via the fatty tissue. For many people with obesity, their heavy sweating is very uncomfortable.

Reflux (heartburn)

The fat stores in the abdomen can continuously press on the digestive organs, for example on the stomach. Then acidic gastric juice is forced back into the esophagus causing heartburn. In the long term, the acid attacks change the cells of the esophagus: a so-called Barrett’s esophagus develops, which can degenerate into cancer.

sleep apnea

People with sleep apnea syndrome (SAS) suffer from respiratory distress during sleep. The most common form of this disease is obstructive sleep apnea syndrome (OSAS). The muscles of the upper respiratory tract relax during sleep. This obstructs the airflow of normal breathing and the quality of sleep is poor. This is often the case for severely overweight people.

People with sleep apnea are often very tired and unfocused. Also, the psyche is burdened by the lack of recovery during sleep.

Varicose veins and thromboses

In obese people, varicose veins are more common. This is an extension of the superficial veins on the legs. Marked varicose veins pose an increased risk of blood clots (thrombosis) in the leg veins.

Why people with obesity are more prone to varicose veins, is not yet clear. Perhaps the comparatively weaker connective tissue of obese people is the reason. Researchers also suspect that the fat cells release a number of messengers that weaken the vascular walls of the vessel.

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. Cholesterol stones are the most common type of gallstone in industrialized countries.

Gout (hyperuricemia)

With obesity, the uric acid level in the blood often rises. If the uric acid in the blood has crossed a critical concentration threshold, it can crystallize out. The uric acid crystals are then deposited in joints and can there cause an attack of gout with great pain by inflammation.

fatty liver

If a person is eating too much and too fat, it also puts a strain on the liver. She stores ever larger amounts of fat – it creates a so-called fatty liver, which usually causes no long-term discomfort. It really gets problematic when the liver starts to heal and change: a shrinking liver (liver cirrhosis) is formed.

Mental problems

People with obesity are often stigmatized due to their weight. Surveys show that two-thirds of Germans suspect the causes of obesity in laziness and overeating. Most respondents assumed that obesity was self-inflicted. With these general assessments, those affected are often confronted in everyday life. Social withdrawal, and possibly increased consolation may be the consequences.

The stigma can cause many mental illnesses: People with obesity, for example, increasingly suffer from depression and anxiety disorders. Especially children and adolescents meet social isolation and peer rejection. Negative formative experiences at this age can massively damage the psychic stability of adolescents and cause lasting mental disorders.

Obesity: causes and risk factors

The obesity causes go far beyond too much food and too little exercise. A whole range of factors seem to influence and reinforce each other. The exact mechanisms are not fully understood yet. However, it is becoming clear that the disease tends to become independent: the more pronounced the obesity is, the more stubbornly the body defends the extra pounds.

Eating Behavior (Alimentary Obesity)

One thing is obvious, if you eat too much and also very high in calories, it is very likely to increase. But which amount is too much depends on many factors and is individually different.

Some researchers also believe that it is not the total calorie intake that is decisive for the development of obesity, but the composition of the diet. For example, oils with polyunsaturated fatty acids are less potent than saturated fat. Or that sweets make you thicker than vegetables with the same amount of calories.

Still other hypotheses suggest that prolonged periods of eating, in which the body has time to deconstruct eating depots, help to get slim or stay thin. Anyone who eats often in between, could therefore tend to increase with the same calorie intake. At least four calorie-free hours between meals are recommended.

lack of exercise

If the daily calorie balance is “positive”, ie more calories are consumed than consumed, you gain weight. If you are reluctant to move, you can eat less without getting fat. On the one hand, of course, more energy is consumed during the movement itself. However, there is also an afterburning effect: even after the activity is over, the body consumes more energy for a while than usual.

Not only the current movement is crucial: Who moves little, has less muscle mass. But muscles consume more energy in peace than, for example, fatty tissue. If the muscle mass decreases, so does the so-called basal metabolism, which is the energy requirement of the body at rest.

The problem is that social networks especially entice adolescents to spend the day sitting with virtual friends rather than physically trying or being physically active.

Even more and more adults maintain a lifestyle that makes them susceptible to obesity: Many workers spend much of their time on the PC. Cycling and running have been replaced by driving or public transport, staircases omitted in many places by escalators and elevators.

metabolism

The basal metabolic rate depends on further factors. So there are actually people who eat normally but still get fat. Good feeders are called them. That sounds good at first, but is problematic in times of an oversized food supply. This is partly predisposition, but can also be caused or exacerbated by diets. Then the metabolism slows down. Conversely, there are also very slim people, the neatly achieve while eating – and without moving in the balance to move a lot.

In addition, obese people lose less heat energy due to the insulating layer of fat under the skin. Therefore, they have to convert comparatively less energy into heat, so burn less calories.

Environment characterizes eating behavior

Eating habits are significantly influenced in childhood and adolescence. However, an increasing number of children do not learn how to handle food properly at home or at school. For example, uncontrolled access to sweets disturbs the natural rhythm of hunger and food intake: it is eaten constantly and always.

Often the family lacks the time to cook together and share meals. The gap is filled by fast food deals. This means that some people consume highly calorific convenience foods practically around the clock. Sugary, fatty foods are also often much cheaper than high-quality foods.

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 unclear how many genes are actually involved in the development of obesity and how. About 100 genes are known, which are suspected to be associated with overweight and obesity.

In particular, the “FTO gene” 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 not get full until late and therefore gain weight more easily.

Genetically conditioned could also be an “individual target weight”. The underlying mechanisms are so far completely unclear. However, studies with adopted children speak for such a genetically programmed target weight: In these studies, the weight of adopted children in adulthood seldom resembled that of the adoptive parents, but often the weight of the biological parents and siblings.

Epigenetic programming

Not only the genes themselves have a big impact on the weight, but also how active they are in the body. What many do not know: a large part of the genes is even completely muted and is not used at all.

What these are, among other things, already influenced in the womb. If the mother is overweight or develops a so-called gestational diabetes, the children are often born big and too heavy. Your risk of obesity is high then, because the body is used to an oversupply of food. The child tends to overeat for life. In addition, his body tolerates higher blood sugar levels.

Before birth and childhood, the so-called epigenetic imprinting is particularly strong. But also in the further Laben the living conditions are decisive. Sports, stress, hunger or constant over-nutrition – all of them can change how cells work. The good news is that a healthier lifestyle will make it possible to turn off many negative genes while still adulthood.

Diseases as an obesity cause

Some diseases and medications can also promote weight gain and thus obesity. Then experts speak of a secondary obesity.

• Polycystic Ovary Syndrome (PCOS): Around four to twelve percent of women of childbearing age suffer from this ovarian cystic disease. Characteristic of the disease are cycle disorders and obesity.
• Cushing’s disease (hypercortisolism): In this condition, the adrenals release unnaturally much cortisone into the blood. The hormone cortisone causes a permanently increased blood level, a strong weight gain, especially on the trunk (“Stammfettsucht”).
• Hypothyroidism (hypothyroidism): In hypothyroidism, the thyroid hormones T3 and T4 are not produced in sufficient quantities. The energy turnover is then lower than normal.
• Testosterone deficiency in men (hypogonadotrophic hypogonadism)Due to inadequate hormone production in the pituitary gland or hypothalamus, men produce less testosterone in this condition. This also favors fat deposits.
• 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 often also suffer from obesity. Eating serves as a short-term relief for the psyche. In turn, mental stress can increase as body weight increases, causing those affected to eat even more to feel better again.
• Binge-eating disorder: Also, a binge eating, in which the affected get bingeing again and again, can cause a strong weight gain.

drugs

Some medications have the undesirable side effect of stimulating appetite or storing more water. These medications include:

• Antihistamines (medicines for allergies)
• Psychotropic drugs such as antidepressants and antipsychotic drugs
• permanent cortisone for long-term and / or high-dose use
• Antidiabetics, in particular active substances such as glibenclamide, glimepiride, nateglinide and repaglinide
• Blood pressure medicines, especially beta-blockers
• Antiepileptic drugs, for example valproic acid and carbamazepine
• Migraine medications such as pizotifen, flunarizine or cinnarizine

Obesity: examinations and diagnosis

If you have discomfort because of your increased body weight or if you are gaining weight for no apparent reason, you should first visit the family doctor. This will ask you in the so-called Anamnesegespräch first some questions in order to narrow down the possible causes:

• How long has the overweight already existed?
• Have you ever had problems with your weight?
• Are you still gaining weight?
• Do you have physical ailments such as back pain, knee problems or shortness of breath?
• What is your daily diet?
• Do you move regularly?
• Do family members (parents, siblings) have problems with being overweight?
• Do you regularly take medication?

Determination of body mass index

The doctor will now determine the extent of obesity by calculating the body mass index. The body weight is set in relation to body size. The body mass index is calculated from the weight, divided by the height in meters squared, or as a formula: BMI = weight [kg] / (height [m]) 2.

Example calculation for a person with a height of 1.75 m and a weight of 70 kg: BMI = 70 / 1,752 = 22.86 kg / m2

BMI table

• Underweight: Under 18.5
• Normal weight: BMI 18.5 to 24.9
• Overweight: BMI 25 to 29.9 kg / m²
• Grade 1 obesity: BMI 30 to 34.9 kg / m²
• Grade 2 obesity: BMI 35.0 to 39.9 kg / m²
• Grade 3 obesity: BMI from 40.0 kg / m²

blood tests

In people with obesity, blood lipid levels are often elevated. Therefore, cholesterol and triglyceride levels are examined.

The liver also often suffers from severe overweight. The liver enzymes provide information about this.

If it is suspected that obesity could be hormonal, the doctor can also determine various hormones in the blood, such as the thyroid hormones.

Cardiological examinations

If the patient complains of breathlessness and shortness of breath, further cardiological examinations are necessary. Although a massively increased body weight is in many cases already the explanation for shortness of breath, but also a heart disease can trigger these symptoms. Above all, the following are used:

• 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, a heart failure or a heart valve defect

Obesity: treatment

To treat obesity, it is not enough to reduce weight in the short term. In order to avert serious complications, people with obesity must permanently lower their weight and normalize their energy metabolism.

In order for obesity therapy to be successful in the long term, profound changes in lifestyle habits are needed. Obesity therapy is always based on the combination of nutritional, exercise and behavioral therapy.

nutritional therapy

Changing his diet is not easy. What has long crept in as love habits, you will not go away so fast. People with obesity should therefore receive nutritional advice tailored to their needs. The personal and professional environment should be taken into account.

It is important that concrete goals are formulated. For example, to save 500 calories every day. In addition, the practical aspects of diet change should be taken into account. For example, patients learn what they need to look out for when shopping, how to cook a varied diet with little effort.

movement therapy

Exercise is a central component of obesity therapy. To effectively lose weight, patients should exercise at least 150 minutes a week, consuming 1200 to 1500 kilocalories. In case of severe overweight should be the sports that do not burden the joints and skeleton additionally.

behavior therapy

The first step to fundamentally changing your lifestyle is to develop an appropriate awareness of the problem. Specially trained therapists can help uncover the mental causes of obesity and obesity-promoting behaviors and patterns.

For example, many obese people compensate for negative feelings such as grief, frustration and stress with food. It is not easy to discard such patterns of behavior that have worn over years or even decades.

With the help of psychosomatic medicine and behavioral therapy, however, new ways open for the patient to replace harmful behavior with healthier behaviors. This theoretical knowledge is solidified and practiced in practical exercises.

If this basic therapy of nutritional, exercise and behavioral therapy does not aim to achieve or if it does not promise sufficient success due to the severity of the overweight, medical or surgical measures such as gastric reduction may also be considered.

Medication

There are countless pills and pills to help you lose weight. For example, by curbing appetite, boosting the metabolism or feeding certain food components such as fats undigested through the intestine. These are called anorectics.

However, many over-the-counter medicines are at best expensive and ineffective, at worst dangerous to health. Talk to your doctor about meaningful medication for weight loss.

stomach stapling

For reduction of stomach volume there are various methods. A gastric band or gastric balloon prevents you from eating larger quantities. They are reversible – but have less of an effect than surgical gastric reduction.

Operatively, a simple tubal stomach can be made, or a gastric bypass that also bridges a portion of the small intestine so that less of what is consumed can be absorbed by the body.

Interestingly, gastric surgery is often accompanied by astonishing changes in metabolism. For example, diabetes can improve rapidly and drastically. Stomach reductions are often very effective weight loss measures. But they are a major intervention in the body anatomy and are irreversible.

In Germany, from a BMI of 40, you can apply for gastric reduction or, if you have a BMI of 35 or more, if you have complications such as diabetes. Read more about this topic in the article Magenverkleinerung.

Obesity cure

The goals and components of an obesity treatment are the same as those of the basic therapy: diet change, a sports program and behavioral therapy. As part of an obesity treatment, however, they can be pursued more intensively. Also, changing the lifestyle of many patients is easier when done in a different environment.

An obesity treatment is usually performed in a rehab clinic or a special obesity clinic. There are both inpatient and outpatient offers. The cure must be requested together with a doctor. What conditions you need to bring for a cure and how to make an application read in the article Obesity treatment.

Obesity: disease course and prognosis

Obesity is rapidly becoming a worldwide problem. The German Obesity Society estimates that around 16 million people in Germany are currently obese. Being overweight not only reduces quality of life, it increases the risk of various serious illnesses. The reasons for this include messenger substances that are produced in adipose tissue: interleukins and cytokines. Among other things, they trigger chronic inflammatory reactions in the body.

Follow Erkankungen

One possible consequence of these chronic, silent inflammations is type 2 diabetes, which mainly occurs in overweight people. Arteriosclerosis is also common in people with obesity. The arteriosclerosis in turn is the cause of the two most common 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, but also other types of cancer such as colon cancer, esophageal cancer, renal cell cancer, uterine cancer and pancreatic cancer.

Even little helps a lot

Losing weight is difficult for most people. Get professional support if you are severely overweight. Even a comparably low weight reduction can significantly improve the metabolism and thus reduce the risk of secondary diseases. Similarly, it is particularly important for overweight people to do sports. The physical activity not only helps to lose weight, it also improves the metabolism in the body.

Obesity in childhood and adolescence

The rapid increase in adiposity in children and adolescents is causing great concern to experts. In the meantime, around six percent of children in Germany are already obese and another 15 percent are overweight.

If children are already overweight before adolescence, they are at high risk of being overweight even in adulthood and thus develop various diseases at an early age.

But not only the physical consequences of obesity are problematic: Even social exclusion and bullying in childhood can lay the foundation for later mental disorders and sustainably impair the personality development.

The reasons for adiposity in childhood and adolescence are manifold. In addition to genetic predisposition, lack of exercise and poor nutrition play an important role. Often, parents pass on an obesity-promoting lifestyle to their children.

Investigations in children and adolescents

The first contact for obesity at this age is the pediatrician. This can clarify whether a transmission to an adiposity center is necessary. Children and adolescents also use BMI to determine obesity. However, age and gender are included in the calculation. An adult BMI calculator is not applicable to children’s BMI calculation.