Obesity • Consequences of being overweight

Obesity (obesity) is a chronic health disorder that manifests itself in a pronounced increase in body fat and can favor various diseases such as type 2 diabetes, coronary artery calcification, depression and certain types of cancer. Due to its complications, being very overweight is one of the most common causes of death worldwide.

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What is Obesity?

According to the World Health Organization (WHO), people are considered obese if they have a body mass index (BMI) of at least 30. The BMI is the quotient of weight and height squared (kg / m²).

Calculation example: The BMI of a person who is 1.70 meters tall and weighs 90 kilograms is 31.1 kg / m².

90 kg / (1.70 m x 1.70 m) = 31.1 kg / m²

The BMI is only a guideline that does not take into account factors such as gender, age, ethnicity, health, fitness level and stature of a person. For example, people with fat pads in the stomach area (apple type) have a higher risk of cardiovascular and metabolic diseases than people with overweight hips, thighs and buttocks (pear type). The critical limits for waist circumference are 102 centimeters for men and 88 centimeters for women. Doctors use the waist-to-hip ratio as a measure, which should be below 0.8 for women and below 0.9 for men.

Obesity is a growing problem worldwide. The nation hardest hit by obesity is the United States. In Germany around 24 percent of adults have a BMI of 30 and higher. For children and adolescents, the proportion is around six percent. The risk of overweight and obesity increases with age.

Obesity permagna and other degrees of severity

Obesity is divided into degrees of severity. Pre-obesity is a preliminary stage, morbid obesity (also called obesity permagna, obesity grade 3 or pathological overweight) is by definition associated with a BMI of 40 or more. If those affected suffer from chronic comorbidities such as diabetes, lipid metabolism disorders, high blood pressure or paused breathing during sleep, a BMI from 35 is considered morbid.

Therapy: what to do with obesity?

Overweight from grade 1 obesity is considered to require medical treatment. If there are chronic illnesses, other physical side effects and risks, or severe suffering, therapy may be necessary even with pre-obesity.

The aim of treatment is a slow weight reduction (no radical diet) with subsequent stabilization of the ideal weight. Newly diagnosed type 2 diabetics often regain normal blood sugar levels simply by reducing their excess weight.

It is important to set realistic goals for the weight-loss program that are tailored to any accompanying illnesses. As a rule of thumb for the amount of weight reduction within a period of six to twelve months, the following recommendations apply:

• BMI 25 to 35 kg / m²: more than five percent of the initial weight
• BMI> 35 kg / m²: more than ten percent of the initial weight

Obesity therapy should not be started during pregnancy or if there are addiction problems.

Basic therapy for obesity: what does it include?

Conservative therapy for obesity relies on three components that should be combined to increase effectiveness:

• Nutritional therapy: Reduction in calorie intake (around minus 500 kilocalories per day), for example through less sugar, carbohydrates and fat.

• Exercise therapy: We recommend 30 to 60 minutes of endurance sports three to five days a week (medical recommendation and control). From obesity grade 2, sports that are gentle on the joints (swimming, aqua gymnastics) should be preferred. In addition, it is important to integrate a lot of movement (climbing stairs, brisk walking) into everyday life.

• Behavioral Therapy (Psychotherapy): The goal is a cognitive restructuring (harmful behavior and thought patterns are replaced by positive ones). For example, long-term strategies for dealing with food, for self-observation and self-control and for interpersonal conflicts are learned in a protected setting.

When choosing conservative weight loss programs, you should pay attention to scientific evidence of effectiveness, as there are many commercially driven providers in this area. According to the German Obesity Network (D.N.A.), serious basic therapy against obesity takes the following points into account:

• The therapy should be long-term and last at least a year.
• (Nutrition) physicians, diet therapists (nutritionists), sports or physiotherapists and psychologists (educators) should work together on an interdisciplinary basis.
• The program should be accompanied scientifically.
• The treatment must not require commercial weight loss products.

Studies have shown that obese people who have the support of family, partners, and friends are more successful at long-term weight loss.

Obesity medication: when is it useful?

If a change in diet, exercise and behavioral therapy does not result in any relevant weight loss (loss of less than five percent of the original weight within six months), it is possible, under certain conditions, to supplement the program by taking medication.

In Germany (as of March 2019), the active ingredients liraglutide, naltrexone / bupropion and orlistat are approved for this purpose, of which only orlistat, which inhibits the absorption of fat from the intestine, is recommended in the obesity guideline so far. Drug therapy should only be continued if the user loses at least two kilograms in the first four weeks after starting it.

Dietary supplements, which the manufacturers claim to help you lose weight, are ineffective in many cases. There is a high risk of taking drugs for weight loss that are intended to treat other ailments, such as stimulants, drainage drugs or hormone preparations.

Obesity Surgery: What Methods And Risks Are There?

In the case of obesity grade 2 and obesity permagna, surgical intervention against the severe overweight can be considered. The prerequisites for this are that:

• the conservative therapy did not lead to a relevant weight reduction (loss of less than ten percent of the original weight within six months)

• the person concerned suffers from severe concomitant obesity diseases and

• is ready for a permanent change in diet.

Established OP procedures in obesity surgery:

• Gastric band: A (silicone) tape is placed around the upper part of the stomach. If the divided part is filled, a feeling of satiety occurs. The operation is reversible and the gastric band can be adjusted to different lengths via a tube that is connected to a fluid chamber placed under the skin.

• Sleeve stomach: During this operation, around 70 percent of the stomach is removed so that the remaining stomach looks like a continuation of the esophagus and is quickly filled. Because the procedure also removes stomach cells that produce hunger-inducing hormones, the appetite also decreases.

• Gastric bypass: The surgeons create a small forestomach that can only hold around 30 milliliters. An attached loop of the small intestine ensures that the digestive juices from the pancreas and bile are only supplied to the lower part of the small intestine, as these are necessary for the nutrients it contains to be absorbed into the blood. Vitamin and mineral supplements must be taken for life after the procedure.

Surgery better in the obesity center

Obesity operations have not inconsiderable risks: On the one hand, as with any other surgical procedure, complications can arise, and on the other hand, gastric reductions and bypasses pose a risk of nutrient deficiencies, osteoporosis, digestive problems, intolerance and figure problems (excess skin). In the long term, physical problems can also result in psychological problems.

To minimize the risks, a certified obesity center should be selected for surgery. In addition, long-term follow-up care is important for the success of the operation and for ensuring the patient's state of health.

Are There Any Alternatives to Obesity Surgery?

One procedure that does not involve a surgical change, but can produce an effect similar to that of stomach reduction, is Gastric balloon: With an endoscope, a balloon is inserted through the mouth into the stomach, which is filled with sterile saline solution and thus fills part of the stomach volume, which leads to a premature feeling of satiety. Treatment with the gastric balloon is already approved for pre-obese patients. Because the balloon only stays in the stomach for six (in the newer version also for twelve) months, it is important that the patient learns a healthier way of eating and living during this time. Otherwise, weight gain is likely again after removing the gastric balloon.

The mode of action of a Gastric pacemaker is based on the fact that very overweight people usually have an increased stomach activity with rapid emptying, which leads to more hunger and higher calorie intake. Using an endoscope, sensors are attached to the stomach wall, which are controlled by a computer (under the skin). Among other things, the vegetative nervous system can be stimulated with electrical impulses so that stomach activity is normalized.

Causes: what can cause overweight and obesity?

Everyone has an individual basal metabolic rate. This is the term used to describe the body's energy requirements in a state of rest, which depends, among other things, on weight, muscle density and metabolic activity. In general, overweight and obesity are caused by an imbalance in energy supply and consumption: If the body absorbs more energy (calories) than it uses over the long term, more body fat can build up.

The causes of overweight and obesity are manifold. Special risk factors include:

• Genetic causes (familial predisposition): Children whose parents are very overweight have a significantly higher risk of obesity. Twin studies suggest that 40 to 70 percent of all cases, susceptibility to obesity is genetic. A total of around 100 genes that have an influence on BMI have been identified today. Children are more prone to obesity if they had a very low or very high birth weight or if their mother gained significant weight during pregnancy.

• Unhealthy diet: An unbalanced, high-sugar and high-fat diet can lead to weight problems in the long run. The high consumption of sugary drinks is also associated with an increased risk of obesity.

• Sedentary lifestyle: Sedentary work, sedentary leisure activities as well as injuries, illnesses or disabilities that limit motor skills reduce the basal metabolic rate.

• Too less sleep: Studies show that even a sleepless night can result in an unfavorable change in energy metabolism. A lack of sleep leads to reduced glucose and increased protein consumption in the muscle cells.

• Stress: The release of cortisol leads to increased appetite.

• Social status: According to studies, a lack of education and a low income are a barrier to preventive measures against obesity.

• Mood swings and depression: Mental health problems are often associated with increased food intake to regulate mood and a lack of exercise. People with obesity are often assumed to be weak-willed and lazy. Such stigmatization can lead to depressive and other psychosomatic disorders, which in turn are often regulated with increased food intake. There is a risk of a downward spiral.

• Eating disorder: A disorder in eating behavior (for example, regular binge eating or eating at night) can lead to severe overweight in the long term.

• Constant availability of food: It is evolutionary in humans to build up reserves – to eat when food is available. An always available supply of food can become a problem.

• Drug: The use of various medications, for example anti-epileptic drugs, antidepressants, antidiabetic drugs, beta blockers, glucocorticoids, neuroleptics and hormonal contraceptives, can cause weight gain for a variety of reasons.

• Metabolic disorders: Thyroid diseases (e.g. hypofunction) or other metabolic disorders (e.g. high cortisol levels) are also possible triggers of obesity.

• Pregnancy: Pregnancy can disrupt eating and exercise habits. Women who put on excess weight during pregnancy are more likely to have problems losing weight after giving birth.

• Smoking cessation: Nicotine increases the basal metabolic rate of the metabolism by about 200 kilocalories per day and suppresses the appetite. After quitting smoking, the metabolism normalizes, which is why there is often slight weight gain. It is problematic when sweets, soft drinks and snacks are used as substitute satisfaction.

Symptoms: What are the secondary diseases associated with obesity?

So far, obesity has not been recognized as an independent disease in the German health system. What is certain, however, is that people with a BMI of 30 or higher have a lower life expectancy than people of normal weight: Statistically, a BMI of 30 to 35 can shorten life by up to four years, with a BMI of 40 to 45 it is up to ten years . With increasing body weight, the risk of concomitant or secondary diseases, which are sometimes dangerous and often begin gradually, increases.

Metabolic disorders often occur that weaken the effect of insulin in the body (insulin resistance) and thus trigger type 2 diabetes. High blood pressure, increased blood lipid levels, hardening of the arteries, fatty liver, lipid metabolism disorders and sleep apnea (breathing pauses) can also be consequences of obesity. These in turn are often the trigger for strokes, heart attacks and other cardiovascular diseases.

Obesity is also associated with hormonal disorders, infertility, chronic inflammation, certain types of cancer (e.g. tumors of the uterine lining, gall bladder and kidneys), dementia, gout, blood clotting disorders and diseases of the digestive tract, kidneys, bladder and musculoskeletal system (e.g. Arthrosis).

The risk of accidents and operations is also significantly increased in people with obesity. Many sufferers perceive their weight as a severe impairment of their quality of life and develop psychosomatic disorders.

How does the doctor make a diagnosis?

The first point of contact in the event of obesity is the family doctor. He not only checks the general state of health, determines the BMI and, if necessary, hip and waist circumference, but usually also arranges a blood and urine sample in order to be able to determine relevant laboratory values.

The medical history includes inquiries about the medical history and lifestyle. Weight history, diet attempts, family history, risks for concomitant diseases (for example of the cardiovascular system), physical activity, eating habits, family and professional environment and psychological well-being are important.

Electrocardiography (EKG, measurement of the heart current curve), ergometry (stress EKG), echocardiography (ultrasound examination of the heart), long-term blood pressure measurement, upper abdominal ultrasound (ultrasound) and sleep apnea screening (which searches for nocturnal breathing interruptions) can also be important examinations. If necessary, the family doctor will refer you to the responsible specialist or recommend a nutritional outpatient clinic or an obesity clinic.

How does obesity work?

Obesity often begins in childhood or adolescence and then increases over the years without successful treatment (yo-yo effect). Which comorbidities occur depends on the extent and duration of the obesity. Due to their high weight, many sufferers have joint pain, so that mobility suffers. Shortness of breath and sweating are common symptoms.

The more overweight a person is, the more difficult it is to counteract it and the higher the risk of developing a so-called metabolic syndrome, which is understood to be the entirety of symptoms and risk factors for cardiovascular diseases such as heart attack and stroke.

Statistically, the higher the BMI, the shorter the life expectancy of a person who is overweight. Since it is difficult to fight the pounds on your own, medical and therapeutic support is essential when losing weight.

How can obesity be prevented?

A healthy, varied diet combined with plenty of exercise and sport is the best way to prevent obesity. It can be helpful to keep a diet and exercise diary and to check body weight at regular intervals.

The menu should be rich in fresh, nutritious, high-fiber foods such as vegetables, fruits, and whole grains, and low in highly processed, high-sugar, and spicy products such as sausage, chips, chocolate bars, candy, ready-made meals, fast foods, and white flour baked goods. It is advisable to consume animal products in moderation and to rely on vegetable origin for the supply of fats.

Anyone who also drinks a lot (at least 1.5 liters per day) and primarily uses water or unsweetened herbal tea is doing everything right.

To ensure that you have sufficient exercise, it is advisable to cover as many distances as possible on foot or by bike and to train your endurance.

Studies indicate that pregnant women who watch for moderate weight gain, eat a wholesome, nutrient-rich and low-sugar diet and, if they have gestational diabetes, adhere to the appropriate dietary rules, protect their child from later overweight and obesity.

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