Overweight (Obesity)

Overweight Definition

Obesity is the deviation from healthy weight due to the augmentation in body mass or its fat portion. If the body mass exceeds a certain level, the risk of getting specific diseases increases. Beyond that, life expectancy and quality of life decrease with rising body weight. The body mass index (BMI) describes the ideal weight to a person's height.

Calculating the BMI: BMI = (body weight:height²)

It is calculated by the kilograms of the body weight divided by the height squared. The BMI corresponds best to the body's fat tissue mass determined by direct measurement. For this reason, the BMI is particularly well suitable to evaluate the risk of disease arising from being overweight.

• BMI as of 25 – overweight
• BMI 30-34.5 – obesity grade I
• BMI 35-39,5 – obesity grade II
• As of <40 – obesity grade III

A fat portion above 30% of the body weight in women and 20% in men is another definition to diagnose obesity. Obesity is a chronic disease that occurs mainly in industrialized countries. About 1/3 of adults and 1/4 of school-age children are obese or overweight in Europe.

Causes for Overweight

A distinction is made between primary and secondary obesity regarding the cause.

Primary obesity focuses on genetic causes, over- and malnutrition, the individual's lifestyle and psychological factors such as stress, frustration, and loneliness.

Secondary obesity includes endocrinological diseases (diseases of the hormone system), centrally related diseases like brain tumors or drug-related diseases such as after taking antidepressants, hormone products, beta-blockers, or lithium.

The underlying problem with obesity is the imbalance between energy intake and energy consumption. A distinction is made between the augmentation of fat cells (hyperplasia, in about 25% of obese patients), which occurs mainly in early childhood, and the enlargement of individual fat cells (hypertrophy, in about 75% of obese patients). If, for example, one has a genetic susceptibility to obesity, this is caused by overeating and exercising too little.

The unfavorable genetic characteristics of the individual can, therefore, lead more quickly to obesity if the imbalance between energy supply and consumption determines everyday life. On the other hand, people with hormonal imbalance are also more likely to be affected by obesity. After food has been eaten, the body signals typically, via the hormone leptin, that it is satisfied, and a feeling of fullness sets in. In some patients with obesity, hunger persists despite the hormone leptin, which is also known as leptin resistance.

What Effects and Diseases Can Overweight Cause?

Reduced performance and shortness of breath, increased tendency to sweat, psychological impairments, and mechanical overstraining of the joints and spine are in the foreground.

Secondary diseases caused by obesity can be:

• Heart diseases
• Vascular diseases
• Hypertension
• Lipometabolic disorder
• Diabetes
• Osteoarthritis

It can also come to reluctance in men and women, increased cancer risk, sleep apnea, gallstones, elevated uric acid level, and consequences in social life such as reactive depression. The mortality risk due to the result of overweigh already increased as of a BMI of 27.

Which Doctor Helps With Overweight?

If patients want to do something about their overweight, the first choice is usually seeing the family doctor. Diagnosing and treating obesity is generally carried out by an internist. There are also additional qualifications for nutrition specialists and counselors. The diagnosis is made by calculating and estimating the overweight patient according to the BMI. Besides, the patient is graded to a particular fat distribution type, the cardiovascular risk factors are analyzed, the exercise and activity habits are determined, and possible hormonal causes are clarified. For this clarification, the level of the thyroid hormones is specified (TSH), and tests are carried out to control the blood sugar level (fasting plasma glucose, HbA1c) and the hormone cortisone (dexamethasone inhibition test).

Obesity Therapy

Therapy is recommended if the BMI is higher than 30. For other diseases (concomitant diseases) such as high blood pressure, diabetes, or fat metabolism disorders, it is advisable to start therapy early.

Modules of obesity therapy:

• Change of diet
• Physical exercising
• Behavior therapy

A primary therapy should initially help to regulate the disturbed energy balance. For this purpose, the diet is adjusted, a plan for physical training is created (especially endurance training), and behavioral therapy or dynamic group therapy is started. The aim is not to achieve the fastest possible weight reduction without having a long-term effect.

This is why a therapy that includes parts of all three therapy principles (multimodal therapy) should be started. Through group therapy, patients develop a different attitude towards their illness and realize that they are suffering from obesity. This has a positive effect on the long-term results of the therapy. A flexible therapy plan has a better result than fixed nutritional programs. In the long term, it is very important to maintain this weight after the target weight has been reached. This is usually more difficult than the initial weight reduction.

Surgical Weight Loss as the Last Option in Severe Cases of Overweight

If all therapeutic options for weight reduction have been exhausted, but the result does not represent a sufficient reduction, obesity surgery can help.. Different options for stomach reduction are available. Affected patients will be appropriately advised by qualified specialists in clinics for obesity surgeryto determine the suitable individual procedure and to apply for health insurance coverage.

Sources:

• www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742
• Practical Guide to Obesity Medicine