Obesity is defined as an increase in body fat that exceeds normal levels. It is also referred to as obesity.
The body mass index(BMI) is used for the medical assessment of weight. The BMI is calculated as the quotient of body weight [kg] and height squared [m²].
An example:
Weight = 87 kg, height = 1.69 m
BMI = 87 kg / (1.69m x 1.69m) = 87 / 2.86 m² = 30.4 kg/m²
Based on the BMI, the WHO (World Health Organization) classifies overweight as follows:
Studies show that an increasing BMI is associated with an increasing reduction in life expectancy.
Obesity is defined as being morbidly overweight © New Africa | AdobeStock
However, the respective health risk is not only determined by the extent of obesity, but also by the distribution of body fat. A waist circumference of ≥ 88 cm in women and ≥ 102 cm in men significantly increases the risk of metabolic and cardiovascular complications.
Less problematic is the more feminine fat distribution type with fat deposits mainly on the hips and thighs (so-called pear shape).
The percentage distribution of fat and muscle must also be taken into account. For example, a high BMI can also conceal a very muscular person with only a low body fat percentage.
The basic rule is: obesity occurs when the energy intake is permanently higher than the body's energy requirements(positive energy balance).
Various factors influence the energy balance:
A major factor in the development of obesity is the modern lifestyle with little exercise and poor nutrition. With little physical activity, energy consumption is low. And if a lot of foods (including drinks) high in fat and sugar are consumed, there is a great risk of obesity.
However, a family predisposition also plays a role in the development of obesity. The so-called basal metabolic rate, i.e. the number of calories burned at complete rest, appears to be genetically determined. This means that people can eat different amounts without becoming obese.
The psyche can also play a role.
etc. can trigger food cravings and thus lead to obesity. Stress also increases the cortisol level in the blood. This also promotes weight gain and even obesity.
Eating disorders such as
can also trigger overweight and obesity.
Binge eating can be the cause of developing obesity © Prot | AdobeStock
Very rarely (in approx. 3-5%), obesity is caused by organic causes, i.e. endocrine (hormonal) diseases. These include, for example
Obesity can also be caused by medication such as some
are favored.
There are also a number of other causes of obesity, for example
Obesity should be treated if the patient
Even a moderate weight loss of less than 10% will improve many of the comorbidities and complications of obesity.
The treatment of obesity should be based on three pillars
and behavioral therapy.
Compared to their previous diet, obesity patients should consume 500 to 1000 kcal less per day.
It makes sense to give preference to foods with a low energy density. They should be low in fat and sugar but high in water and fiber. Plenty of fruit and vegetables enrich the diet, ensure a consistent level of satiety and provide vitamins and healthy phytochemicals.
In the long term, a balanced mixed diet in accordance with the guidelines of the German Nutrition Society (DGE) is recommended.
Extremely one-sided diets (e.g. total fasting) carry a high medical risk and are not successful in the long term.
For people with obesity, a formula diet (under medical supervision) may be appropriate for initial (i.e. temporary) weight reduction. However, weight loss is only permanent if it is followed by behavioral and exercise therapy at the same time and in the long term.
A change in diet and exercise help to lose weight and keep it off © M.studio | AdobeStock
The increase in energy consumption achieved through physical activity contributes to weight reduction and - even more so - weight maintenance. A good start is 30 to 50 minutes of physical activity three to five days a week.
In addition to structured exercise programmes, increased exercise in everyday life also helps to stabilize weight. Even a simple but regular walk can have a positive effect.
Behavioural therapy is particularly useful with regard to long-term weight reduction and stabilization.
The following measures are developed in weekly sessions over several months:
The basic program should lead to a weight reduction of at least 5% after three to six months. If this is not the case, further efforts in the areas of diet and exercise can be supported by certain medications.
According to the recommendations of the interdisciplinary guideline on the "Prevention and treatment of obesity", the drug orlistat can be used for this purpose. The active ingredient inhibits fat digestion by blocking digestive enzymes known as lipases.
Orlistat can be prescribed by a doctor from a BMI of 28 and only supplements obesity therapy with the basic program described.
The aim of the therapy is a change in lifestyle. It may therefore be appropriate for obesity patients to be monitored by doctors, nutritionists, physiotherapists and behavioral therapists for years or for the rest of their lives.
The requirements for surgical obesity therapy( bariatric surgery) are defined in the medical guidelines of the relevant professional associations.
If conventional measures have not led to the desired success after at least 24 months, surgical intervention may be recommended. In Germany, the following indications apply to obesity patients:
In Switzerland, patients with a BMI of 35 or more may undergo bariatric surgery. The operation should be preceded by two years of basic therapy. This is the guideline of the SMOB (Swiss Society for the Study of morbid Obesity and metabolic disorders). Patients with a BMI of 50 or more should undergo 12 months of non-surgical therapy before surgery.
Contraindications for surgery as an obesity treatment are
Two groups of bariatric surgery procedures can be distinguished according to the mechanism by which weight loss is achieved:
In 1-2% of obesity patients, complications occur after bariatric surgery. These mainly include
Long-term follow-up care for obesity patients is essential in order to counteract possible late complications. This includes lifelong care by the obesity center or the interdisciplinary team of doctors and therapists at the treating clinic.
The aim is to ensure the patient's well-being and long-term therapeutic success. The patient must learn to ensure an optimal supply of nutrients and vitamins . This prevents deficiency symptoms.
Above all, the aim is to stabilize weight in the long term and prevent relapses into previous obesity-promoting habits. Specialized medical specialists and obesity patients work hand in hand.
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