Obesity - obesity
Morbid obesity and an excessive increase in adipose tissue in the body is considered Obesity, Called obesity or obesity. If the Body Mass Index (BMI) rises above 30, a person is considered obese. Being overweight is a health-threatening condition that can lead to a variety of sometimes serious illnesses, such as diabetes, cardiovascular diseases and joint damage. Obesity can occur if the body is supplied with far more energy than it really needs over a longer period of time. Obesity can also occur as a result of illness and as a side effect of certain medications.
With the Body Mass Index (BMI) the body weight can be assessed more precisely. The quotient is determined from the weight and the height in square (BMI = body mass in kilograms / height in meters²). This provides an indication of whether body weight is in a healthy ratio to body size. The BMI value is divided into the following categories:
- BMI under 16: strong underweight,
- BMI 16 to 16.9: underweight,
- BMI 17 to 18.49: light underweight,
- BMI 18.5 to 24.9: normal weight,
- BMI 25 to 29.9: overweight,
- BMI 30 to 34.9: Obesity grade I,
- BMI 35 to 39.9: Obesity grade II,
- BMI over 40: Obesity grade III.
Waist circumference to hip circumference ratio
A criticism of the BMI is that it does not take into account the higher weight of muscle mass compared to fat. People who do a lot of weight training or have a lot of muscle for other reasons are quickly considered overweight. For the definition of obesity, another value is therefore used in addition to the increased body mass index, namely the waist-hip ratio (THV). For this, the circumference of the waist at the navel height and the circumference of the hip at the thickest point are measured. Waist size divided by hip size (TVH = waist size / hip size) gives a value. The larger this is, the more harmful to the health of those affected. The value is to be assessed differently for women and men.
For women, the value allows the following conclusions:
- THV below 0.8: normal weight,
- THV 0.8 to 0.84: overweight,
- THV from 0.85: obesity.
In men, the THV is classified as follows:
- THV below 0.9: normal weight,
- THV 0.9 to 0.99: overweight,
- THV from 1: obesity.
The limit for obesity is 0.85 for women and 1.0 for men. Obesity, for example, where the fatty tissue is mainly in places such as the thighs and buttocks, is usually less dangerous than obesity with a lot of belly fat, since in this case the internal organs are also more affected. The body shape of an apple type tends to have a large belly circumference, whereas in the case of a pear type the pounds are distributed over the thighs, abdomen and buttocks.
Obesity risk factors
Some people are more at risk of developing obesity than others. Favorable factors include:
- Inheritance: The genes affect the amount of body fat that is stored and the efficiency in converting food into energy. In addition, genetics are also responsible for regulating appetite and calorie consumption.
- Family influences: Family members tend to adopt past eating habits and similar exercise habits.
- nutrition: Regular high-calorie foods such as fast food, sweetened drinks and oversized portions lead to constant weight gain.
- Hidden calories: Alcohol, cola and other soft drinks, sweets and heavily sweetened meals such as breakfast cereals can contribute to a significant weight gain.
- Lack of exercise: The less exercise is integrated into everyday life, the fewer calories are burned. Today, more and more work is done in a sitting position in front of screens, which is why the general lack of movement increases more and more.
- Diseases: Certain diseases, such as Prader-Willi syndrome or Cushing's syndrome, are a medical cause of excessive weight. Illnesses with movement pain such as arthritis can also indirectly lead to weight gain.
- Medication: Some medications can cause weight gain as a side effect. These include, for example, some antidepressants, anticonvulsants, diabetes medicines, antipsychotics, steroids and beta blockers.
- Social factors: Low salary and poor education are associated with an increased risk of obesity.
- Age: Obesity can occur at any age. Nevertheless, the risk increases with age, since muscle mass regresses from 40 years and the metabolism decreases. This results in a lower calorie requirement. Those who do not adapt their diet or become more physically active gain weight faster in old age.
- pregnancy: Weight gains during pregnancy are normal. However, some women struggle to shed excess weight after pregnancy.
- Quitting smoking: People who quit smoking often gain weight. This is usually because the urge for nicotine is suppressed with food. Nevertheless, giving up smoking is always more sensible than continuing to smoke for weight reasons.
- lack of sleep: Too much sleep and too little sleep are associated with an increased body weight. This is due to changes in the hormonal balance that lead to an increased appetite for high-calorie foods.
- stress: Stressed people tend to eat more high-fat and sugared foods or snacks. For example, some eat chocolate to reduce stress or use fast food for lack of time.
- Gut microbiome: Latest studies show that an imbalance in the intestinal flora can lead to weight gain.
- Yo-yo effects: It is not uncommon for those who lose weight quickly on a diet and then quickly gain weight again and again to rock higher and higher. This so-called yo-yo effect is based on a slowdown in the metabolism, which is triggered by the strong fluctuations in weight.
Obese people are more likely to develop a number of potentially serious health problems, such as:
- Heart disease,
- High blood pressure,
- abnormal cholesterol,
- Type 2 diabetes,
- certain types of cancer, such as
- Cervical cancer,
- Ovarian cancer,
- Breast cancer,
- Colon cancer,
- Esophageal cancer,
- Liver cancer,
- Gallbladder cancer,
- Pancreatic cancer,
- Kidney cancer,
- Prostate cancer,
- Digestive problems,
- Reflux disease,
- Gallbladder disease,
- Fatty liver and other liver problems,
- Erectile dysfunction,
- Sleep apnea,
- lower resilience,
- psychological problems like
- Feelings of guilt,
The high body weight in obesity strains the metabolism and the musculoskeletal system, which can lead to various secondary diseases. These include insulin resistance, from which type II diabetes often develops, hypertension (high blood pressure), fatty liver, joint problems, breathing difficulties, arteriosclerosis (hardening of the arteries) and fat metabolism disorders. Some obese patients already suffer from several of the secondary complications mentioned. Obesity increases the risk of cardiovascular diseases, such as a heart attack or stroke, especially if the weight continues to increase.
In addition, the latest studies have identified a messenger substance in abdominal fat (wingless-type signaling pathway protein-1, in short: WISP1) that is released into the blood and favors chronic inflammation and the development of insulin resistance. The more belly fat there is, the more WISP1 is released.
Obesity and diabetes
With type II diabetes, the body is no longer able to transport the sugar produced into the cells. Insulin, which is also produced in sufficient quantities at the beginning of the disease, is required to utilize the sugar. When insulin resistance occurs, the body's cells no longer respond properly to the insulin, which means that the blood sugar level rises and the glucose does not get where it is needed. The body then produces more and more insulin, which in the long term pushes the pancreas to its limits and limits insulin production more and more. Type II diabetes develops. The cause of this disease is often an excessive body weight, i.e. obesity, together with improper nutrition and lack of exercise.
Fat metabolism disorders
Other complications include lipid metabolism disorders, also called hyperlipidemia or hyperlipoproteinemia. Years of high-fat diets can increase blood cholesterol and / or triglyceride levels. The excess can no longer be removed by the body and the fat is deposited in the vessels, which can ultimately lead to a heart attack or a stroke.
High blood pressure
Hypertension, also known as hypertension, is one of the possible consequences of obesity. Due to the strong overweight, the body has to be supplied with more blood, so the heart has to increase its performance. This increased performance also increases blood pressure over time. However, there is quite a possibility here to bring the blood pressure back to normal areas by losing weight.
Difficulty breathing in obesity
Difficulty breathing is also one of the possible consequences of massive excess weight. The fat accumulation in the area of the ribs reduces breathing flexibility. In addition, there is an increased pressure in the abdominal cavity, which can result in a raised diaphragm, which further reduces the tidal volume. Those affected become short of breath. The majority of obese patients also suffer from a so-called sleep apnea syndrome. This creates short pauses in breathing during night sleep, which leads to daytime tiredness with reduced performance and even the compulsion to fall asleep.
Damaged musculoskeletal system
The musculoskeletal system can also suffer from heavy body weight. Tendons, ligaments, muscles and joints are affected. Back pain sets in. Painful arthrosis develops, especially on the knees and hips (see knee pain and hip pain). Those affected get flat feet and / or spreading feet.
Gout can develop through predisposition, but also through obesity, purine-rich diet and increased alcohol consumption. Uric acid is the breakdown product of the purines. These substances are mainly found in animal products such as meat, sausage, but also in some legumes such as lentils, beans and also in alcohol. With a normal balanced diet, the body usually gets along with the purines and excretes them as uric acid. However, if the food is very rich in purine, this can lead to an excess of uric acid in the blood and cause a gout attack. This is an inflammatory reaction, especially in joints, which is associated with massive pain.
Female patients often complain of menstrual cramps. Fertility can also suffer from high body weight.
Usually not only one cause is the trigger, but several factors lead to the massive overweight. The predisposition to obesity can be genetic, but this should not be seen as the sole cause. Lack of exercise and poor nutrition are often added here. There is also sometimes a genetic defect that means that those affected have no feeling of satiety. Obesity can begin in childhood, when eating is used to combat stress and the rewards consist of lots of sweets. Furthermore, massive sleep problems can lead to such significant metabolic disorders that those affected are constantly hungry and cannot curb their appetite, even though the body is not deficient.
Eating disorders are just as much a cause as hormonal illnesses, for example in the form of Cushing's syndrome (hormonal illness, triggered by an excess of cortisol). Medicines such as glucocorticoids, neuroleptics, some antidepressants and antidiabetics are also held responsible for the development of obesity.
Furthermore, the foundation stone can be laid in childhood. Inherited diseases such as disorders of the pituitary gland (thyroid gland), thyroid or adrenal cortex can lead to various symptoms and increased body weight. But childhood nutrition also plays an important role. Sitting for hours in front of the computer, in front of the tablet or television, lack of movement and, in addition, wrong, too fat and too sweet food is not without consequences.
Families with obese children are often found to have at least one overweight parent. The importance of eating is an important component in a child's life. Possible reward rituals with sweets and the composition of the food in connection with a lack of exercise support the development of excessive body weight. However, stressful situations such as separation of parents or the feeling of “not being loved” can also lead to an incorrect, high-calorie diet.
Good eaters are more likely to develop obesity
Not everyone who eats too much has problems with their pounds. Good feed users, however, do. Almost every piece of cake increases the weight of these people, whereas the poor feed users consume more energy and remain rather slim. Certain enzymes also play an important role here. Researchers have found that the enzyme LPL (lipoprotein lipase) occurs to a greater extent in people who are overweight, which means that they store more fat. This enzyme is also responsible for the so-called yo-yo effect, in which the weight rises again quickly after dieting, often even higher than before the diet.
Good fat - bad fat
Fat is an important part of the diet. Fat is an energy supplier, is important for the cell membrane and is used for the production of certain hormones. Essential fatty acids in particular are vital because they cannot be produced by the body itself, but must be supplied with food. However, no more than 30 percent of your daily calorie count should be met by fat. The type of fat supplier is also important here. Fat contains twice as many calories as carbohydrates and can accumulate in the body and lead to obesity in the long term. Fats can also increase your risk of cardiovascular disease, especially if they increase blood lipid levels. Fat is not just fat - an important aspect that should be taken into account in the diet.
Saturated fatty acids, such as those found in meat, sausage, cheese, butter and cream, can increase LDL (Low Density Lipoprotein), the so-called "bad" cholesterol. These saturated fatty acids are also “hidden” in snacks such as chips or baked goods. Unsaturated fats, however, are recommended. These should primarily be consumed in the form of vegetable oils. Examples include olive oil, rapeseed oil or linseed oil. These "good" fats are also contained in avocados, nuts and seeds. The unsaturated fatty acids are able to lower the LDL, which can be harmful to the body, and at the same time raise the "good" cholesterol, the HDL (High Density Lipoprotein).
The body is able to produce fatty acids itself, with one exception - the poly-saturated fatty acids. These are vital, that is, essential and must be supplied through food. The essential fatty acids - also called omega-3 and omege-6 fatty acids - are contained in nuts, sunflower oil and high-fat fish species.
The body produces cell membranes and hormones from healthy fats. The organs are embedded in fat to protect them and the nerves are isolated by a layer of fat. The essential fatty acids are primarily responsible for this. However, animal fats contain saturated fatty acids. If too many of these are fed over a longer period of time, the excess fat can be stored in the body in the form of additional pounds. Not only is weight a health hazard, but also the fact that most overweight people overeat and the food is too fat and too sweet. Cholesterol levels rise, fats are deposited on the walls of the vessels and arteriosclerosis (hardening of the arteries) arises. As a result, the vascular volume can become narrower and the risk of a heart attack or a stroke may increase significantly.
The goal of obesity treatment is to achieve and maintain a healthy weight. Depending on the severity and condition of those affected, several treatment options are available, such as:
- Change of diet,
- regular exercise,
- Behavior changes,
- Obesity cure in a rehab clinic
- Medicines like orlistat or lorcaserin,
- Gastric balloon to reduce the size of the stomach,
- Operations such as gastric bypass, gastric reduction, gastric band.
To get the massive excess weight under control, a change in diet is essential. However, this should not happen overnight. Especially with massive overweight, medical monitoring of the diet or the change in diet is absolutely necessary. In the case of existing diseases, a precise nutritional plan is drawn up so that there are no deficiency situations. In order to lose weight in obesity, the consumption of meat and sausages should be significantly reduced. The protein required for the body can also be supplied via dairy products or fish. The amount of daily fat intake should not exceed one gram per kilogram of body weight. It is also important to take care of hidden fats, such as those found in fast food or finished products. The preparation of the dishes should be low in fat, the absorption of fat is best done in the form of mono- and polyunsaturated fatty acids. In addition, the portion sizes must change so that the energy consumption exceeds the energy supply.
There is no best weight loss diet. The key is to permanently change your diet to a healthier form. The following points should be considered when changing your diet:
- Set calorie limit: The daily calorie limit should be recognized and adhered to. It can vary from person to person. A typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 calories for men.
- Eat fillers: Desserts, cake sweets, processed foods, chips and the like contain large amounts of calories in small portions. In contrast, fruits and vegetables offer larger portion sizes with fewer calories. This way you can eat your fill without consuming too many calories.
- Exchange unhealthy foods: Animal fats can be replaced by vegetable, white bread by whole grain bread, sweets by fruit, red meat by poultry and fish, chips by potatoes or rice, etc.
- Reduce sugar: The drinking of sugared drinks should be stopped. In general, tons of sugar are hidden in many processed products. One example is breakfast cereal, which is advertised as a healthy meal in advertising.
- Replace meals: A meal can also be replaced with special diet products such as a low-calorie shake. It is best to do this as part of a monitored diet plan.
- Avoid crash diets: Losing weight should be slow and steady. Beware of diets that promise high weight loss in a short time. As a rule, all pounds and more will come back if a permanent change in diet is not achieved.
Naturopathy and holistic medicine
Naturopathy can help with obesity. For example, various herbs from phytotherapy such as dandelion, nettle and ginger are used to boost the metabolism somewhat. Bach flowers and tea blends with nerve-strengthening plants are used to stabilize the psyche. In acupuncture, points are stimulated to dampen the feeling of hunger and stimulate the metabolism.
If stress is a cause, psychosomatic counseling and care is recommended. Relaxation exercises (e.g. autogenic training) and dealing with stress can be learned.
Of course, these are only accompanying measures. A balanced, individual diet plan that contains healthy, vitamin-rich, low-fat and low-calorie and base-rich foods is essential. Regular exercise - after consultation with a doctor - is a central element in the treatment of obesity. (vb, sw)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
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ICD codes for this disease: E66ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.