Obesity

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

Obesity is when one is very overweight, which can be harmful to health. Obesity is a chronic disease that is associated with a reduced quality of life and a high risk of secondary diseases. Those affected not only suffer from the physical consequences, but also from stigmatization from the environment. Read here what exactly obesity is, how it manifests itself and what you can do about it.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. E66

Obesity: Quick Reference

Description: morbid obesity, chronic illness, BMI of 30 and more
Symptoms: unusually strong accumulation of fat in the body, decreased performance, shortness of breath, excessive sweating
Consequential damage: diabetes, cardiovascular diseases, fatty liver, joint problems, back problems, gout, kidney stones, various cancers, psychological problems
Causes: genetic predisposition, unhealthy eating behavior, lack of exercise, slow metabolism, various diseases
Treatment: nutrition, exercise, behavioral therapy, medication, stomach reduction
Prognosis: difficult to treat, high risk of secondary diseases, shortened life expectancy

What is Obesity?

Obesity, or obesity, is not a figure problem for people with weak character, but a recognized, chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The German Obesity Society defines obesity as an accumulation of fat tissue in the body that exceeds the normal level.

Guide value body mass index (BMI)

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

A person becomes overweight or obese if he supplies his body with more energy than he consumes in the long term (positive energy balance). Food intake and exercise are two parameters that can be used to influence weight.

Individual factors influence weight

However, there are numerous factors that significantly influence the metabolism and thus the individual energy balance. This includes the genetic makeup, the mother's diet during pregnancy or the hormones. Therefore, someone who is overweight does not necessarily have to eat more or exercise less than a lean person.

Stress on the whole body

Obesity, also known as obesity, puts a strain on the whole body and therefore carries a high risk of secondary diseases - from heart attacks to diabetes to various types of cancer. The fact that a quarter of adults in Germany are now obese is therefore a major social problem.

Obesity permagna

From a BMI of 40, doctors also speak of adiposity permagna or obesity grade 3. The affected persons are very obese and therefore mostly severely restricted in their quality of life. They even find it difficult to walk or sit slowly.

They are particularly likely to suffer from secondary diseases such as diabetes and high blood pressure, and their life expectancy is reduced. Most of the time, self-confidence suffers from being overweight and those affected are stigmatized by their environment.

Losing weight significantly is crucial for very obese people in order to become healthier again. You can read more about grade III obesity in the article Obesity permagna.

Obesity: symptoms

The more pronounced the excess weight is and the longer it has existed, the greater the physical complaints, as a rule. The risk of secondary diseases also increases. The messenger substances that are formed in adipose tissue also contribute to this. They are called adipokines. While there are quite a few in the overweight sector who are physically fit and healthy, obese people are unlikely to be.

Main symptom of abnormal fat accumulation

The main symptom of obesity is the excessive accumulation of fat in the body. They put a strain on the body through the sheer burden it has to bear and which has to be supplied with oxygen and nutrients.

The fat deposits are also not just fat stores. They produce messenger substances that negatively affect 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. Fat stores in the abdominal region are considered to be particularly unfavorable in terms of health. The so-called visceral fat collects not only under the skin, but also around the organs. The body silhouette with this fat distribution is also known as the "apple type". It is especially typical for men.

In women, on the other hand, fat accumulates mainly on the hips and thighs. This is why this shape is known as the “pear type”. These deposits are less harmful to health than those of the apple type.

Abdominal circumference risk factor

As a rule of thumb, a waist circumference of over 80 cm is considered risky for women and over 94 cm for men. This increases the risk of stroke and type 2 diabetes, among other things. With a waist circumference of over 88 cm in women and 102 cm in men, the risk is even significantly higher.

Reduced physical performance

The heart and circulation are particularly stressed by being overweight. Even minor physical exertion becomes a strenuous undertaking. This is due on the one hand to the weight load, but also to the fact that more tissue has to be supplied with blood overall.

The limited physical performance is primarily noticeable through shortness of breath or shortness of breath. This occurs when the heart and lungs cannot compensate for the increased need for oxygen and there is therefore a lack of oxygen in the blood and tissue.

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

Joint wear

In addition to the cardiovascular system, the musculoskeletal system in particular suffers from obesity. Due to the high stress on the joints, they wear out prematurely. The fine layer of cartilage in various joints is gradually irreparably destroyed (osteoarthritis). The knees, hip joints and ankles are particularly often affected. Obesity can also lead to premature wear of the intervertebral discs between the vertebral bodies and thus also cause a herniated disc (disc prolapse).

Increased sweating (hyperhidrosis)

People with obesity often sweat excessively. One reason for this is the weight-related increased physical strain, another is the poorer heat dissipation via the fatty tissue. Many obese people feel uncomfortable with excessive sweating.

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) experience paused breathing during sleep. The most common form of this disease is what is known as obstructive sleep apnea syndrome (OSAS). The muscles of the upper respiratory tract relax during sleep. This obstructs the airflow for normal breathing and sleep quality is poor. This is often the case with very overweight people.

People with sleep apnea are often very tired and unable to concentrate. The psyche is also burdened by the lack of recovery during sleep.

Varicose veins (varicosis) and thrombosis

Varicose veins are more common in obese people. This is understood to mean an expansion of the superficial veins on the legs. Pronounced varicose veins carry an increased risk of blood clots (thrombosis) in the leg veins.

It has not yet been clearly clarified why people with obesity are more prone to varicose veins. Possibly the comparatively weaker connective tissue of obese people is the reason. Researchers also suspect that the fat cells release a number of messenger substances that weaken the vessel walls of the veins.

Gallstones (cholecystolithiasis)

Obesity is one of the major risk factors for gallstones. People who are obese often have high levels of cholesterol. When the cholesterol crystallizes, gallstones form. Cholesterol stones are the most common type of gallstone in developed countries.

Gout (hyperuricemia)

With obesity, the uric acid level in the blood often rises too. If the uric acid in the blood has exceeded a critical concentration threshold, it can crystallize out. The uric acid crystals are then deposited in joints, where inflammation can cause a gout attack with great pain.

Fatty liver

If a person eats too much and too fat, it also puts a strain on the liver. It stores ever larger amounts of fat - a so-called fatty liver develops, which usually does not cause any symptoms for a long time. It becomes really problematic when the liver begins to scar and rebuild: a shrunken liver (liver cirrhosis) forms.

Mental problems

People with obesity are often stigmatized because of their weight. Surveys show that two thirds of Germans suspect the reasons for obesity to be laziness and overeating. Most of the respondents assumed that obesity was self-inflicted. Those affected are often confronted with these general assessments in everyday life. Social withdrawal and possibly increased comfort food can be the consequences.

Stigmatization can trigger numerous mental illnesses: For example, people with obesity suffer more from depression and anxiety disorders. Children and young people in particular are affected by social isolation and rejection from their peers. Negative formative experiences at this age can massively damage the psychological stability of adolescents and cause lasting psychological disorders.

Obesity: causes and risk factors

The causes of obesity go far beyond eating too much and too little exercise. A number of factors seem to influence and reinforce one another. The exact mechanisms have not yet been fully clarified. It is becoming apparent, however, that the disease tends to take on a life of its own: the more overweight, the more stubbornly the body defends the extra pounds.

Eating behavior (alimentary obesity)

One thing is obvious: those who eat too much and also very high in calories are more likely to gain weight. But which amount is too much depends on many factors and is individually different.

Some researchers also take the view that it is not the total amount of calories that is decisive for the development of obesity, but the composition of the diet. For example, that 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 longer breaks, during which the body has time to break down food deposits, help to become or stay slim. If you often eat something in between, you might be more likely to gain weight with the same calorie intake. A minimum of four calorie-free hours between meals is recommended.

Sedentary lifestyle

If the daily calorie balance is "positive", ie more calories are consumed than are consumed, you gain weight. So if you don't like exercise, you can eat less without getting fat. On the one hand, of course, more energy is consumed during the movement itself. But there is also an afterburn effect: Even after the activity has ended, the body consumes more energy for a while than usual.

It is not just the current amount of exercise that is decisive: if you exercise little, you have less muscle mass. But muscles also consume more energy at rest than, for example, fat tissue. If the muscle mass decreases, the so-called basal metabolic rate also decreases, that is the energy requirement of the body at rest.

The problem is that social networks entice young people in particular to spend the day sitting with virtual friends rather than actually exerting themselves physically or being active in sports.

More and more adults also have a lifestyle that makes them prone to obesity: Many employees spend a large part of their time at the PC. Cycling and running have been replaced by driving a car or public transport, and in many places there is no need to climb stairs with escalators and elevators.

metabolism

The basal metabolic rate also depends on other factors. So there are actually people who eat normally and still get fat. They are called good feed converters. That sounds good at first, but is problematic in times of oversized food supply. This is partly predisposition, but it can also be caused or exacerbated by dieting. Then the metabolism slows down. Conversely, there are also very slim people who eat well enough - without moving too much to compensate.

Obese people also 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 they burn fewer calories.

Environment shapes eating behavior

Eating habits are significantly shaped in childhood and adolescence. However, an increasing number of children do not learn how to handle food properly either at home or at school. For example, uncontrolled access to sweets disrupts the natural rhythm of hunger and food intake: people eat constantly and constantly.

There is often not enough time in the family for cooking and meals together. The void is filled by fast food offerings. This means that some people consume high-calorie ready-to-eat foods practically around the clock. Sugary, fatty foods are also often significantly cheaper than high-quality foods.

Genetic causes

Genes play a major role in the development of obesity: The results of twin studies suggest that about 40 to 70 percent of obesity is due to genetic causes.

However, it is currently still unclear how many genes are actually involved in the development of obesity and in what way. About 100 genes are known 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 controlling appetite. People with a mutation in this gene may have a delayed feeling full and therefore gain weight more easily.

An “individual target weight” could also be genetically determined. The underlying mechanisms are so far completely unclear. However, studies with adopted children speak in favor of such a genetically programmed target weight: In these studies, the weight of the adoptive children in adulthood was less likely to be that of the adoptive parents, but more often to the weight of the biological parents and siblings.

Epigenetic Programming

Not only do the genes themselves have a huge impact on 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.

Which these are is influenced, among other things, in the womb. If the mother is overweight or develops what is known as gestational diabetes, the children are often big and too heavy. Your risk of obesity is then high because the body is used to an oversupply of food. The child has a lifelong tendency to overeat. In addition, his body tolerates higher blood sugar levels.

The so-called epigenetic imprint is particularly strong before birth and in childhood. But also in the further life the living conditions are decisive. Exercise, stress, hunger or constant overeating - cells can all change the way cells function. The good news is: through a healthier lifestyle, even in adulthood, it is possible to turn many negative genes off and on positive ones.

Diseases as a cause of obesity

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

Polycystic Ovary Syndrome (PCOS): Around four to twelve percent of women of childbearing age suffer from this cyst disease of the ovaries.Menstrual cycle disorders and obesity are characteristic of the disease.
Cushing's disease (hypercortisolism): In this disease, the adrenal glands release an unnatural amount of cortisone into the blood. If the blood level is permanently elevated, the hormone cortisone causes a strong increase in weight, especially on the trunk of the body ("trunk obesity").
Underactive thyroid (hypothyroidism): In the case of underactive thyroid, the thyroid hormones T3 and T4 are not produced in sufficient quantities. The energy expenditure is then lower than normal.
Testosterone deficiency in men (hypogonadotrophic hypogonadism): Due to insufficient hormone production in the pituitary gland (pituitary gland) or diencephalon (hypothalamus), men produce less testosterone in this condition. This also promotes fat deposits.
Genetic Syndromes: People with Prader-Willi Syndrome (PWS) or Laurence-Moon-Biedl-Bardet Syndrome (LMBBS) are often extremely obese.
Mental illnesses: People with depression or anxiety disorders often also suffer from obesity. Eating serves as a short-term relief for the psyche. The psychological stress, in turn, can increase due to the increasing body weight, which means that those affected eat even more in order to feel better again.
Binge eating disorder: A binge eating disorder, in which those affected repeatedly have binge eating, can also cause severe weight gain.

Medication

Some drugs have the undesirable side effects of stimulating the appetite or retaining more water. These drugs include:

Antihistamines (medicines for allergies)
Psychiatric drugs such as antidepressants and antipsychotic drugs
permanent cortisone with long-term and / or high-dose use
Antidiabetic drugs, especially active ingredients such as glibenclamide, glimepiride, nateglinide and repaglinide
Blood pressure medication, especially beta blockers
Anti-epileptic drugs, such as valproic acid and carbamazepine
Migraine drugs such as pizotifen, flunarizine or cinnarizine

Obesity: examinations and diagnosis

If you have symptoms because of your increased body weight or if you gain weight for no apparent reason, you should first see your doctor. In the so-called anamnesis interview, they will first ask you a few questions in order to narrow down the possible causes:

How long has you been overweight?
Have you had weight problems before?
Do you keep gaining weight?
Do you have physical complaints such as back pain, knee problems or shortness of breath?
What is your daily menu like?
Do you exercise regularly?
Do family members (parents, siblings) have problems with being overweight?
Do you regularly take medication?

Determination of the 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 the 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
Obesity grade 1: BMI 30 to 34.9 kg / m²
Obesity grade 2: BMI 35.0 to 39.9 kg / m²
Obesity grade 3: BMI from 40.0 kg / m²

Blood tests

Blood lipid levels are often elevated in people with obesity. Therefore, cholesterol and triglyceride levels are examined.

The liver also often suffers from being very overweight. The liver values provide information about this.

If there is a suspicion that obesity could be hormone-related, the doctor can also test various hormones in the blood, for example the thyroid hormones.

Cardiac examinations

If the patient complains of shortness of breath or shortness of breath, further cardiological examinations are necessary. Although a massive increase in body weight is the explanation for shortness of breath in many cases, heart disease can also trigger these symptoms. The following are mainly used:

Ultrasound of the heart (echocardiography)
EKG at rest and under physical exertion

Heart catheter, for example if there is a justified suspicion of coronary heart disease, heart failure or a heart valve defect

Obesity: Treatment

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

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

Nutritional therapy

Changing your diet is not easy. What has long crept in as dear habits, you won't get rid of anytime soon. People with obesity should therefore receive nutritional advice that is individually tailored to their needs. The personal and professional environment should be taken into account.

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

Exercise therapy

Movement is a central component of obesity therapy. To lose weight effectively, patients should exercise moderately for at least 150 minutes per week and consume 1200 to 1500 kilocalories in the process. If you are very overweight, you should do sports that do not put additional strain on your joints and skeleton.

Behavior therapy

The first step in fundamentally changing one's lifestyle is to develop an awareness of the problem. Specially trained therapists can help uncover the emotional causes of obesity as well as obesity-promoting behaviors and patterns.

Many overweight people compensate for negative feelings such as sadness, frustration and stress with food. It is not easy to get rid of such behavior patterns that have been ingrained over the years or even decades.

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

If this basic therapy consisting of nutrition, exercise and behavior therapy does not achieve its goal or if it does not promise sufficient success due to the excess weight, medicinal or surgical measures such as stomach reduction can also be considered.

Medication

There are countless tablets and powders that are supposed to help you lose weight. For example, by curbing the appetite, boosting the metabolism or channeling certain food components such as fats undigested through the intestine. These are known as anorectics.

However, many over-the-counter products are at best expensive and ineffective, and at worst dangerous to health. Talk to your doctor about sensible drug support for weight loss.

Stomach reduction

There are various methods of reducing the volume of the stomach. A gastric band or balloon prevents large amounts of food from being eaten. They are reversible - but also have less of an effect than surgical stomach reduction.

A simple gastric sleeve or gastric bypass can be surgically produced, in which a piece of the small intestine is bridged so that less of what has been consumed can be absorbed by the body.

It is interesting that stomach operations are often accompanied by astonishing changes in metabolism. For example, diabetes can improve quickly and dramatically. Stomach reductions are often very effective measures for weight loss. However, they represent a major intervention in the body's anatomy and cannot be reversed.

In Germany you can apply for a stomach reduction from a BMI of 40 or from a BMI of 35 if you have secondary diseases such as diabetes. Read more about the topic in the article stomach reduction.

Obesity cure

The goals and components of an obesity cure correspond to those of the basic therapy: change in diet, a sports program and behavioral therapy measures. However, they can be pursued more intensively as part of an obesity cure. Many patients also find it easier to change their lifestyle when it is done in a different environment.

An obesity regimen is usually carried out in a rehab clinic or a special obesity clinic. There are both inpatient and outpatient offers. The cure must be applied for together with a doctor. You can read about the requirements for a cure and how to apply in the article on obesity cure.

Obesity: disease course and prognosis

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

Secondary illnesses

One possible consequence of this chronic, silent inflammation is type 2 diabetes, which occurs mainly in overweight people. Atherosclerosis is also common in people with obesity. In turn, hardening of the arteries is the cause of the two most common causes of death worldwide: heart attack and stroke.

In addition, various cancers are more common in obese people. There is a particularly strong connection between obesity and breast cancer, but also other types of cancer such as colon cancer, esophageal cancer, kidney cell cancer, uterine cancer and pancreatic cancer.

Even a little helps a lot

Most people find it difficult to lose weight. Therefore, get professional support if you are very overweight. Even a comparatively small weight reduction can significantly improve the metabolism and thus reduce the risk of secondary diseases. It is also particularly important for overweight people to exercise. Physical activity not only helps to lose weight, it also improves the metabolism in the body.

Obesity in childhood and adolescence

Experts are very concerned about the rapid increase in obesity among children and adolescents. Around six percent of children in Germany are now obese, and another 15 percent are overweight.

If children are overweight before puberty, they have a high risk of being overweight in adulthood and thus developing various diseases at an early age.

But it is not only the physical consequences of obesity that are problematic: social exclusion and bullying in childhood can also lay the foundation for later psychological disorders and have a lasting effect on personality development.

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

Investigations in children and adolescents

The first point of contact for obesity at this age is the pediatrician. This can clarify whether a referral to an obesity center is necessary. The BMI is also used to determine obesity in children and adolescents. However, age and gender are included in the calculation. A BMI calculator for adults cannot be used to calculate the BMI in children.

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