Have we lost the war on obesity?

Overweight and obesity in adults

Overweight: Too high body weight due to increased accumulation of fat tissue in the body; mainly defined as a BMI of 25–30.

Obesity (pathological overweight, obesity, obesity): significantly too high body weight; mainly defined as a BMI over 30.

The life expectancy of obese people is shortened, especially if they have diabetes at the same time, if they have an unfavorable fat distribution (apple shape) and an unfavorable lifestyle (sedentary lifestyle). A BMI of 30 to 35 shortens life by two to four years, a BMI of 40 to 45 by eight to ten years. With "simple" overweight, ie a BMI between 26 and 29, according to recent studies, health risks only exist if further risk factors are present - otherwise life expectancy is even slightly longer. Many experts even reject the definition of a "healthy" BMI of 25: at least for older men and women over 45 years of age, a BMI of 26-28 correlates statistically with the best well-being and the highest life expectancy.

Leading complaints

Most overweight people have no complaints. The more overweight, the more likely it is that:

  • Back and joint problems
  • Inflamed or infected skin folds: In “skin-on-skin” areas, the “trapped sweat” promotes fungal infections
  • Shortness of breath and shortness of breath
  • Increased sweating
  • Breathing pauses in sleep
  • Mental health problems or depression.

When to the doctor

In the next few weeks if

  • Complaints occur
  • A significant change in eating behavior is noticed
  • An unexplained weight gain occurs
  • Help with weight loss is needed.

The illness

Whether obesity is a disease is debatable. There are consequences of being overweight, such as: B. the painful joint wear that directly related to the increased body mass. Most - and most threatening - episodes, however, just hang indirectly with being overweight. They arise in the wake of the lifestyle that is often (but not always) associated with being overweight: lack of exercise and unhealthy diet.

The physical burden that fat people have to bear is not so much the outwardly visible excess weight, but rather that which is often less visible outwardly Risk behavior from sedentary lifestyle and malnutrition.

Causes. In the vast majority of cases, obesity is not due to a disease - it is primary overweight or primary obesity. The body is functioning normally, and that is precisely where the problem lies. Because the metabolism of all mammals - and thus also of humans - has developed under the conditions of a strongly fluctuating food supply and therefore takes into account a future deficiency when eating. Today there are only good times, however, we always live only a few steps away from the nearest refrigerator - the predictive metabolism is thus turned into a curse.

There are a number of causes that lead to obesity:

  • Genetic influences play a large part in this, e.g. B. Children of overweight parents are more likely to be overweight themselves.
  • Our current way of life suggests a lack of exercise and overeating, both of which play a major role in the development of fat deposits.
  • Obesity also has social causes: people from socially disadvantaged backgrounds in particular are overweight.
  • Last but not least, obesity also has psychological causes, whereby a large part of the psychological problems can be traced back to social influences or arise from being overweight itself.
  • Many overweight people continue to eat even though they are full. This is because the forebrain, which is responsible for behavior control, is particularly active in overweight people.
  • The hormone insulin has less of an effect on fat people than on lean people: the feeling of satiety therefore sets in later.
  • A gene mutation in the BDNF (brain-derived neurotrophic factor) gene disrupts communication between the nerve cells, which means that no saturation signal is sent to the brain.

Obesity due to illness. Obesity very rarely occurs as a result of certain diseases (these forms are also called secondary, i.e. other forms of obesity). The vernacular often speaks of "glandular disorders" and initially suspects obesity that it is "due to the glands". However, this is only very rarely true: Less than 2% of overweight cases are caused by hormonal diseases. So are secondary forms of obesity very rare.

Secondary overweight or obesity can be traced back to underlying diseases with disorders of fat storage, such as:

  • Hormonal disorders such as Cushing's syndrome or hypothyroidism.
  • Obesity can very rarely be the result of a circadian rhythm disorder known as night eating syndrome.
  • Some drugs lead to weight gain, sometimes severe, e.g. B. tricyclic antidepressants, cortisone supplements (if these are swallowed or injected), estrogens, beta-blockers, lithium and psychotropic drugs. The sulfonylureas used to treat type 2 diabetes also increase obesity.
  • Nicotine withdrawal after years of smoking can also trigger or worsen obesity. In 80% of those weaned, the weight increases by around 2 kg - but in 15% by more than 10 kg.

Secondary illnesses. Obesity can be damaging in two ways: on the one hand, it represents mechanical overstrain, and on the other hand, being overweight is often associated with pathological changes in the metabolism. Possible consequences of being overweight are:

  • With increasing body weight, the incidence of metabolic syndrome and diabetes increases. A woman with a BMI of over 35 is 80 times more likely to have diabetes than a woman of normal weight.
  • Fat metabolism disorders: In addition to obesity, there is a reduction in HDL cholesterol, an increase in triglycerides and, if you are significantly overweight, an increase in LDL cholesterol.
  • Atherosclerosis and coronary artery disease: Vascular problems arise as a result of metabolic changes that are common in overweight people. In very severe cases, an enlarged heart with cardiac insufficiency can develop.
  • High blood pressure: for every 10 kg of excess weight, the systolic blood pressure (the upper value of the blood pressure) rises by 3 mmHg and the diastolic by 2 mmHg.
  • Nocturnal breathing is difficult in overweight people due to the fat deposits in the abdomen and a fat-related narrowing of the upper airways. This can result in a sleep apnea syndrome with chronic fatigue, high blood pressure in the pulmonary circulation with cardiac stress and even sudden cardiac death.
  • Behavioral problems and depression can be increasingly detected in overweight people. There is not always a direct link to being overweight, but in many cases overweight people suffer from being overweight and the associated disability and social exclusion.
  • Gallstones and gout can develop because crystals form in the bile or kidney.
  • Overweight people are two to three times more likely to suffer from cirrhosis of the liver, reflux disease and heartburn than people who are slim.
  • Obese adults are at higher risk of colon and prostate cancer, and obese women are also at higher risk for uterine and breast cancer.
  • Overweight people are prone to osteoarthritis (especially of the knee joints) and back problems.
  • Leg vein thrombosis is more likely to develop because of the poorer blood flow back into the veins. Doctors recommend thrombosis prophylaxis for severely overweight patients on long journeys.

Fat Distribution Types. Whether an overweight person has to reckon with secondary diseases depends not only on the extent of their overweight, but also very much on how the extra fat is distributed on his body.

Medicine has repeatedly identified two prototypes of fat distribution in many thousands of overweight people: the pear and the apple type. People with the latter type are particularly at risk in terms of health risks.
www.salevent.de, Michael Amarotico, Munich

  • In male or android fat distribution, the fat is mainly stored in the abdomen or on the trunk of the body. The belly is thick, buttocks and thighs are relatively thin (Apple type). This form is associated with a higher risk of secondary diseases.
  • With female or gynecoid fat distribution, the fat is mainly stored in the subcutaneous tissue on the hips, buttocks and thighs (Pear type). With this distribution, consequential damage is much less likely.
By nature, women are better prepared for storing fat: Pregnancy (which costs 80,000 additional calories) can only be sustained through previously accumulated fat. This also explains why the fat in women is usually mainly deposited on the hips and buttocks: there is room in the stomach for pregnancy.

The assessment of the fat distribution is very easy by measuring the waist circumference. The determination of the Ratio of waist to hip circumference (waist to hip ratio) has no advantages.

An increased risk of secondary diseases exists with the following waist measurements:

  • For men: Slightly increased risk from a waist circumference of 94 cm, moderately increased risk from 102 cm, strongly increased risk from 112 cm
  • For women: Slightly increased risk from a waist circumference of 80 cm, moderately increased risk from 88 cm, strongly increased risk from 96 cm.

That's what the doctor does

Diagnostic assurance. The doctor first examines overweight patients to see whether the obesity is caused by an illness (secondary obesity). In addition, he checks whether there are additional health risks or whether there are already consequential damages.

The routine program includes a physical examination, determination of the fat distribution pattern (abdominal circumference), blood pressure measurement and a blood test (fasting blood sugar, blood lipids, uric acid, kidney function values, thyroid hormones, possibly other hormones) and a urine test (protein excretion in the urine). If necessary, further examinations such as stress ECG, 24-hour blood pressure measurement or ultrasound can be added.

That is also common Survey of eating and exercise habits. It is helpful to record a few days in advance of what time, what form of food and beverages were consumed and what physical activity took place. On the basis of these notes, the doctor can give tips on changes in lifestyle in the first conversation.

When does treatment make sense? It is not possible to generally say from how much overweight a treatment is appropriate. In addition to the BMI, the waist circumference, accompanying risks and any existing diseases must be taken into account to answer this question.

In general, most people with a BMI over 30 will benefit from treatment or if:

  • The BMI is between 25 and 30 and diseases such as high blood pressure, type 2 diabetes or lipid metabolism disorders exist.
  • There is a male fat distribution type, especially if the waist circumference is over 100 cm.
  • There are diseases that are aggravated by being overweight (e.g. spinal disorders, arthrosis).
  • The level of suffering is high.

Most of the time it is automatically assumed that Weight reduction the most pressing goal is. When faced with an overweight patient, many doctors also think of losing weight first. The fact that an obese person can only live long and healthy if he loses weight is not tenable across the board.

While it has been proven for young overweight people, for example, that losing weight can prevent future diseases (for example, the risk of developing diabetes is halved with every 4 kg loss), this is the case for older people over 65 years of age far less secure. And people who are already sick do not necessarily benefit from losing weight. B. in heart failure by losing weight alone does not improve. An exercise program, on the other hand, has a clearly positive effect. And for type 2 diabetes, which is not uncommon in overweight people, the following applies: Although weight loss itself is good (many diabetics can use it to lower their blood sugar so much that they can do without insulin), the metabolism can still be reduced a lot with exercise improve significantly.

Change lifestyle. Some people manage to lose weight, if only moderately. However, weight alone is not critical to health. The main health benefits are an increase in physical performance and a change to a better diet.

More crucial than how much we lose weight is for our health, how we lose weight.

The research results of the last few years show:

  • Just switching to a healthier diet lowers blood lipids and blood pressure - with or without weight loss.
  • Physical activity provides long-term protection against cardiovascular diseases - this protective effect is largely independent of body weight. In women in particular, the functional capacity (a measure of physical fitness) is more important for the cardiovascular risk than the BMI and even the fat distribution (or, in the words of an American doctor: "being fit is more important than being fat") ).
  • Training programs such as B. "Mobilis" of the Barmer Ersatzkasse show in comparison to more diet-oriented training programs that exercise is crucial for losing weight
  • And don't forget: For your health, avoiding additional health risks is at least as important. Quitting smoking can be more important than losing weight!
Paradoxically, the first goal in the treatment of obesity is not losing weight, but a change in lifestyle. All other treatment options can only support the change in lifestyle, but not replace it!

Medication. Drug treatment is controversial. For one thing, drugs only work when they are continuously be taken - this is not only expensive, but also represents a far-reaching intervention in the body. On the other hand, side effects are frequent, the approval of many slimming pills had to be revoked because of serious side effects.

Thirdly, drugs do change the weight somewhat, but they do not improve the metabolic situation. It is therefore questionable to what extent drugs prevent the dreaded secondary diseases of obesity at all.

Special text: Prescription drugs for weight loss

Operative treatment options come into question if all of the above treatment attempts have been unsuccessful and there is a threat of serious health risks. Any intervention is dangerous and should therefore not be misused as cosmetic surgery.

If the doctor recommends the operation, banding and surgical reduction of the stomach are possible. With a BMI of over 50, combination methods are also used to partially divert the food past the stomach.

At the Banding a small forestomach is formed by inserting a special band in order to achieve a faster feeling of satiety. An alternative could soon be one Pacemaker for the stomach be. The device, the size of a matchbox, is planted under the skin of the abdomen and stimulates the stomach wall via electrodes. These stimuli suppress the appetite. The procedures described can be carried out in a minimally invasive manner and are reversible.

In the surgical reduction of the stomach (Gastroplasty) and the combination techniques with partial bypassing of the stomach are major interventions in which parts of the stomach are irrevocably removed.

The Liposuction (Liposuction) is not a useful treatment for obesity.

Your pharmacy recommends

Self-help is the decisive lever against being overweight - no one other than you can have a positive effect! That this is possible is shown by the experiences of thousands of overweight people who have taken their weight problem into their own hands and changed their lives: through a more conscious diet and above all through more exercise. With one of these comprehensive After all, 20% of those who want to lose weight can lose more than 10% of their body weight. .

That's part of it:

Move.

Make your Habits to the test, not just what you eat.Increased fitness can extend your life by 10 years and also bring momentum into your everyday life. At the same time, exercise increases your chance of losing your weight permanent to lower.

Quality not quantity.

Instead of dieting, change your diet. And this is where everything counts: what you eat, how you eat, and what you buy too (everything you put in the shopping cart ends up in your stomach at some point).

Attitude.

Don't believe in miracles, believe in yourself. Miracle drugs don't help - if they did, there would be no more fat ones.

  • Choose achievable goals: When it comes to losing weight, many overweight people have an ideal in the back of their minds that corresponds to a movie star. That can't work. And even for the goal of "only" one pound of weight loss per week, repeatedly cited as realistic, it may be achievable - but what speaks against half a pound as long as you keep losing weight over the long term?
  • What does being slim mean for you - What exactly do you want to achieve? Are there perhaps other ways to achieve the same thing?
  • And above all: take it Farewell to the fairytale picture! You are what you are - plus or minus a little. And you can live with that.

Special text: Over-the-counter slimming pills and dietary supplements for weight loss

Complementary medicine

A word about naturopathy. Unfortunately, the majority of their approaches distract from the primacy of self-help. Of course, acupuncture and traditional Chinese medicine are also offered for weight loss, but how are they supposed to work? The laws of thermodynamics also apply to naturopathic treatments: the energy balance must become negative in the long term. The same applies to therapeutic fasting - in the long term, it is just as unsuccessful as the pineapple diet and the apple cider vinegar, which is said to stimulate fat burning.

Further information

  • www.adipositas-gesellschaft.de - The German Adipositas Society e. V. (Hamburg) is an association of scientists and therapists who focus on obesity. The website contains, inter alia. Guidelines for the treatment of obesity in adolescents and adults.
  • D. Hauner; H. Hauner: Effective help with obesity. Trias, 2001. Well-founded medical advice for overweight and obese people, presents all treatment approaches in detail.

Continue reading:

Causes of Obesity

Overweight - a balance sheet problem

Overweight and obesity in children

Authors

Dr. med. Arne Schäffler, Dr. Nicole Schaenzler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:30


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.