Obesity is now among the most significant chronic diseases—and it calls for specialized, interdisciplinary care rather than blame. At the Obesity Center within the Clinic for MIC, state-of-the-art medicine is paired with a distinctive perspective: it is the only center in Berlin led by a woman, Dr. Anke Richter, a board-certified specialist in General Surgery and Visceral Surgery. With comprehensive diagnostic capabilities, individualized treatment programs, and a great deal of empathy, the center offers patients a clear, structured path out of the disease. The editorial team at Leading Medicine Guide took the opportunity to speak with Dr. Richter at length and learn more about the causes, symptoms, and treatment options for obesity.
Fotostudio Urbschat Kleinmachnow, Inh. Martin Urbschat
Obesity is far more than being “overweight”—it is a chronic disease that affects physical and mental health alike. Early recognition and a targeted approach are crucial to preventing secondary conditions and achieving a lasting improvement in quality of life.
“Obesity, also known as severe overweight, is defined when the Body Mass Index (BMI) exceeds a value of 30. BMI is a calculated measure derived from height and weight using a specific formula. It is important to note that BMI alone is not always meaningful, as people with pronounced muscle mass can also have a BMI over 30. For this reason, hip and waist circumference as well as the presence of comorbidities should be considered alongside BMI. The severity of overweight can also be classified medically, mentally, and functionally without the need to weigh patients. A score developed in Canada—the Edmonton Obesity Staging System by Professor Sharma—offers a differentiated view of obesity (based on mental health, comorbidities, and functional limitations),” Dr. Richter explains at the beginning of our conversation.
In diagnostics, BMI is often used as the primary criterion, even though a comprehensive body fat analysis (bioelectrical impedance analysis, BIA) could provide far more accurate data. Unfortunately, such detailed examinations are frequently not covered by health insurers.
The formula for the Body Mass Index (BMI) is: BMI = body weight (in kg) ÷ (height in m)² Example:
70 kg ÷ (1.75 m × 1.75 m) = 22.9
Obesity is considered a chronic disease when the Body Mass Index (BMI) in adults is 30 or higher. But it is about far more than weight alone: obesity can impair numerous organ systems.
Dr. Richter comments: “Excess weight contributes to numerous health problems, including cardiovascular disease, diabetes, joint problems, and sleep apnea, and it even increases the risk of many types of cancer. These risks are often associated with a specific inflammatory process in the body that is triggered by excess weight. In addition, many people with obesity experience significant psychological strain shaped by societal stigmatization as well as feelings of shame and guilt. Repeated failures in attempts to lose weight—often accompanied by the so-called yo-yo effect—intensify this psychological pressure. Obesity is a chronic, progressive disease that typically develops gradually and ultimately significantly impairs quality of life for those affected, although to varying degrees. Those affected often struggle with reduced self-esteem, social isolation, or stigmatization. Depression, anxiety, or eating disorders such as ‘binge eating’ (uncontrolled eating episodes) frequently develop. Stress, negative emotions, and psychological distress can in turn worsen the course of the disease, as they negatively affect eating behavior and motivation to be physically active. The course of obesity is generally chronic and progressive. Without targeted interventions, body weight and health risks increase over the years while psychological distress grows. Early therapeutic measures that combine healthy nutrition, physical activity, changes in behavioral patterns, and, if appropriate, surgical interventions are crucial to limiting both physical and psychological consequences and sustainably improving quality of life,” and she continues:
“Public perceptions of people with excess weight are often linked to negative stereotypes. They are stigmatized (as ‘the fat fool’), and this outdated societal attitude is further reinforced by media and advertising. Idealized images conveyed through social media platforms also contribute to stigmatization. Perfect—often filter-edited—images are presented there that seem unattainable for many people. This increases pressure and often pushes the reality of individual life circumstances into the background. At the same time, there are serious concerns about the marketing of quick fixes such as injections with so-called weight-loss shots offered without medical supervision, which can be potentially dangerous. Obesity remains a chronic disease that requires both dietary changes and physical activity to create meaningful change. Patients must understand that only they themselves can change their lives, even if they receive support through medical interventions such as surgery or medication therapy. These additional options also require long-term commitment, and funding must be ensured because not all costs are covered by health insurers. Obesity is a chronic disease; it cannot be cured, but it can be treated for life.”
Patients benefit in multiple ways from an obesity center that brings all diagnostic and therapeutic pillars together in one place. For one, centralized care enables especially fast and coordinated diagnostics: blood tests, metabolic analyses, physical examinations, and imaging can be efficiently combined so physicians gain a comprehensive picture of the individual situation.
“We try to provide patients with a clear roadmap so we can shape the therapy together. That is exactly what defines an obesity center: having a functioning network and working interdisciplinarily, for example in collaboration with internists at the Medical Care Center (MVZ). Beyond that, it is extremely important to bring the primary care physician into the process, because they are the first point of contact for these patients. It is alarming that even within the medical community, the chronic disease of obesity is still not adequately recognized as such. While there is now a so-called DMP Obesity (Disease Management Program for Obesity), comparable to the well-established DMP for diabetes, in practice it is largely a concept with a good name but very little substance. Added to this is the fact that many insurers do not even cover the cost of nutrition counseling for these patients. At our annual Obesity Update, we inform colleagues in private practice about current developments and use this meeting for intensive exchange to expand our network. Germany is significantly behind in this field. At international congresses, we are regularly asked why our patients undergoing surgery are so old, so sick, and so heavy. The answer is sobering: because for a long time our health care system did not allow anything else. While some things have improved over the last ten years—back then you practically had to beg insurers to cover costs, write endless justifications, and were often rejected—today the required prerequisites are usually in place, patients undergo surgery, and at most there are occasional follow-up questions. One major problem, however, is reimbursement for caring for patients before and after surgery. For initial consultations and follow-up care—even when the patients had their surgery with us—we receive no compensation. That means an enormous time and staffing burden. Nevertheless, the underlying issue remains: preventive medicine still plays hardly any role in Germany, even though the long-term health and financial consequences have been known for a long time,” Dr. Richter criticizes sharply.
After an in-depth consultation, the patient is weighed and measured; this is initially followed by nutrition counseling and a recommendation for exercise therapy.
“That naturally raises the question of how closely the patient is then supported—whether they have to come in for regular checkups and how everything is monitored, especially if we are not yet talking about surgery or if we are in the preparation phase for a possible operation. If we are considering surgery, we generally need a six-month preparation period. For patients with extreme obesity, this can be a shorter timeframe. During this period, patients meet once a month with our cooperation partner for nutrition counseling and are therefore also under regular review. The nutrition counselors also offer exercise therapies. We have found that it is easier for patients to integrate it into everyday life if they use local options close to home or online courses. As part of the six-month multimodal program, after four months there is another appointment including a psychological assessment; contact with our self-help group is also an important component and a valuable source of information for those affected. If the therapy continues conservatively, contact with nutrition counseling can remain in place, and ongoing care is provided primarily through cooperation partners such as the primary care physician or the MVZ, while we remain available as points of contact. It is also important to know that patients do not necessarily have to lose weight before surgery. Ideally, they maintain their weight—that alone makes us very happy. But there are also patients who gain weight during the preparation phase, for example because they quit smoking, can no longer exercise due to severe knee problems, or eat healthfully but with larger portion sizes. All of that has to be taken into account and explained,” Dr. Richter says, adding:
“In general, it is not possible to predict how much weight a patient will lose after surgery. It depends on starting weight, how well dietary recommendations are implemented, how much the patient increases physical activity, and individual metabolic factors. Some patients achieve weight reduction very quickly, others more slowly over a longer period. What counts as success is also highly individual: one person absolutely wants to lose 110 pounds, the next is satisfied after losing 44 pounds because they no longer need to inject insulin or take blood pressure medication. Here too, many factors come together.”
Fredrich, Maximilian
An interdisciplinary network is essential because obesity is a complex, multifactorial disease that affects physical, psychological, and social aspects alike. Surgery alone is not enough to ensure long-term success, because the causes and consequences of excess weight are diverse.
After a successful operation, the question naturally arises of the patient’s long-term motivation and ongoing support.
“If, for example, a patient has lost 110 pounds after a sleeve gastrectomy, feels good, and has achieved a lot, we still recommend ongoing medical monitoring. We can show patients pathways and provide ideas, but only patients themselves can implement the changes. In general, we advise checking vitamins and trace elements once a year, as these must be supplemented long term, especially after gastric bypass. In the first two years, follow-up care is very close: at three, six, and twelve months, and then once a year. During that time, patients send us their lab results, complete a standardized questionnaire about symptoms and how they are feeling, and follow-up usually takes place in writing or by phone. All patients know they can contact us at any time if there are problems, and that explicitly applies even after the two years have passed. The annual lab monitoring can then be handled well through the MVZ, which is very experienced and provides corresponding recommendations. If there are difficulties—for example if weight starts to increase again—an appointment at our center can be scheduled at any time. Of course, there is always the risk of falling back into old behavioral patterns, especially if it is not possible to break them permanently. In conversation, it often becomes clear very quickly what the cause is: larger portions are reported, extended eating with multiple small meals in a row, or stressful situations such as illness in the family that led to neglected physical activity. Patients often name their own tipping points when asked targeted questions. Sometimes that small nudge is enough to get back on track—for example with renewed nutrition counseling or an adjustment in physical activity. In a few cases where weight increases significantly again, additional medication therapy can also be considered; however, this remains difficult because there are major gray areas and, without a diagnosis of diabetes, the costs are usually not covered by insurers. In some cases, repeat surgery may also be necessary,” Dr. Richter concludes.
Female leadership in a specialty that has traditionally been strongly male-dominated opens up new perspectives. Structurally, it serves as a role model and motivator for younger female physicians and residents, demonstrating that clinical excellence and leadership responsibility are possible regardless of gender. At the same time, a female approach to patients can sometimes differ from a male one.
Dr. Richter notes: “I quickly realized that a physician’s gender can indeed play a role in caring for patients. Personally, I’m more likely to ask questions that touch on a ‘personal setting’—to inquire how patients are doing in everyday life and what problems there are or have been. Many patients find it easier to confide in a woman. This means I lean more strongly into non-surgical therapy, even though my male colleagues of course do that as well. Bariatric surgery is, after all, an area that includes a lot that is ‘non-surgical.’ While many surgeons tend to solve problems more technically—problem identified, operated on, done—bariatric surgery requires a holistic approach. Here in Berlin, we have only a few women in senior surgical positions; I am the only one in the field of obesity. In communication, we tend to convey trust in a holistic way and show empathy.”
Nutrition, behavior, and physical activity—together with modern bariatric surgery—form the foundation for sustainable weight loss and improved overall health. Surgery alone is a medical intervention that restricts food intake or influences metabolism, but without accompanying lifestyle changes, long-term results are limited.
AI generated
“The main problem is that we consume far too much sugar, fat, and unhealthy products—often from foods that are heavily advertised. There are now approaches such as traffic-light labeling or the Nutri-Score, but that still does not apply to all products. I also ask myself why certain manufacturers resist so vehemently printing the Nutri-Score on their products. The lobby of the confectionery and food industry certainly plays a role, but even greater is the influence families have on eating habits. If children do not learn healthy eating at home, it is very difficult for them to pick it up elsewhere. Health education and nutrition education should be a fixed part of the curriculum starting in kindergarten, with structured offerings supplemented by physical activity. When we talk with patients, many report that their problems began in childhood. In others, there were triggering events such as the death of close relatives, separations, or injuries in competitive athletes who had to stop their sport abruptly. Even though there are cases in which people use food as a substitute gratification because they are emotionally unstable, unhappy, or lonely, that is only one part of the overall picture. The psychological components of eating disorders are very broad; loneliness or the desire for substitute gratification alone do not adequately explain the issue. Rather, it is a complex interplay of family, psychological, and societal factors,” Dr. Richter emphasizes.
The Nutri-Score is a voluntary front-of-pack nutrition labeling system for foods that makes a product’s nutritional quality visible at a glance. It ranges from A (green) for a more favorable composition to E (red) for a less favorable one, and considers factors such as sugar, fat, salt, and calorie content as well as fiber and protein. The Nutri-Score is intended to compare similar products within a category and help make purchasing decisions easier.
Even today, people with obesity still encounter barriers in society. Comprehensive care within a large, interdisciplinary Medical Care Center (MVZ) is needed to support patients holistically.
To conclude our conversation, Dr. Richter says: “When I look to the future, my first wish would be for far better recognition of obesity as a chronic disease across all areas of medicine. The problem is so widespread, and yet those affected still encounter barriers in many areas. It starts with appropriate seating—not only in health care facilities. I would like to see prevention and long-term treatment for these patients funded, because over the long term, committed teams in obesity centers—whether surgical or conservative—cannot provide this without adequate financing. Surgical therapies take place in the hospital, but the comprehensive care that addresses all comorbidities and psychological aspects should ideally take place in a large MVZ where internists, endocrinologists, gynecologists, and psychologists work under one roof and provide holistic care for patients. At the moment, we are still miles away from that. Such an MVZ would enable continuous, structured care for patients without sending them from one practice to the next. My wish would be a center with all of these specialties, with an exercise space and a café as a meeting place where patients with excess weight can relax, have healthy snacks, and connect. A place like that would make it possible for prevention, therapy, and follow-up care to truly go hand in hand and be tailored to patients’ needs.”
Thank you very much, Dr. Anke Richter, for this in-depth insight into the chronic disease of obesity!
- Experienced bariatric surgeon with extensive expertise in all modern bariatric procedures.
- Part of the MIC Clinic’s multiple award-winning Obesity Center—specializing in gentle, minimally invasive surgery.
- Fast, structured care from initial diagnosis through long-term follow-up.
- Interdisciplinary team spanning surgery, nutrition, psychology, and exercise—all under one roof.
- State-of-the-art surgical technology & obesity-friendly inpatient units for maximum safety and comfort.
- Holistic approach that not only reduces weight, but sustainably improves health.
