World Obesity Day on March 4, 2024

What is obesity?

Obesity is a chronic disease, defined as an increase in body fat that exceeds normal levels. The basis for calculating the weight classification is the so-called "body mass index" (BMI). The BMI is defined as the quotient of body weight and height squared (kg/m2). In addition to the degree of obesity, which is measured by the BMI, the fat distribution pattern determines the metabolic and cardiovascular health risk. The risk of disease is greater with abdominal (abdominal or visceral) obesity, which is caused by fat accumulation within the abdominal cavity (so-called "apple type"). A simple measure to assess these fat deposits is to measure the waist circumference. A waist circumference of ≥ 88 cm in women or ≥ 102 cm in men indicates abdominal obesity and a significantly increased risk of secondary diseases. The waist circumference should always be measured in people with a BMI ≥ 25 kg/m2. An increase in subcutaneous fatty tissue, i.e. increased fat deposits on the buttocks and legs, is less harmful (so-called "pear type").

What are the causes of obesity and what are the consequences of the disease?

Obesity is a disease with many different causes. In principle, there is an imbalance between energy intake through diet and energy expenditure through physical activity. This results in an "energy surplus", which is stored as fat in the fat cells. Although genetic factors also play a role, they are modified to a considerable extent by environmental factors, which generally have a very pronounced influence on the development of obesity. The sharp increase in the incidence of obesity in industrialized countries is primarily attributed to so-called "fattening" environmental factors and is summarized under the term "obesogenic environment". This is characterized by malnutrition, overeating and lack of exercise. Individual aspects of the development of obesity include the constant availability of (often high-calorie or nutrient-dense) food, a predominantly sedentary and inactive lifestyle without regular physical activity, a lack of sleep and high stress levels at work. A low social status and depressive disorders are also frequently associated with the development of obesity, as are certain eating disorders (binge eating) and endocrine disorders (e.g. pituitary insufficiency, craniopharyngioma involving the eating center, hypothyroidism, Cushing's syndrome). Obesity can also be a side effect of medication (antidepressants, neuroleptics, antiepileptics, antidiabetics, glucocorticoids, some contraceptives, beta-blockers).
Adults with obesity have a lower life expectancy and an increased risk of a variety of chronic diseases. Obesity should therefore not be seen as "just" a cosmetic problem, but as a multifactorial medical problem that increases the risk of other diseases (e.g. diabetes mellitus, high blood pressure, heart attack, stroke, fatty liver, various forms of cancer, sleep apnea).

Obesity also has numerous psychosocial effects. In recent years, particular emphasis has been placed on the negative stigmatization and discrimination associated with obesity. The negative evaluation of overweight and obese people is very widespread in Western nations. A devaluation of people with obesity has also been shown in population-based studies for Germany. Convictions that people with obesity are solely responsible for their excess weight due to laziness, lack of willpower or indiscipline appear to be widespread and prevent the acceptance and consistent confrontation of obesity as a disease.

How is obesity treated in the Clinical Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology?

The basis of obesity therapy is a comprehensive analysis of the patient's nutritional status and eating habits, which includes, for example, the creation and analysis of a multi-day dietary protocol. In addition, certain diseases, especially endocrine diseases, must be excluded so that metabolic diseases leading to obesity are not "overlooked". This is combined with a comprehensive analysis of the patient's cardiovascular risk, including an examination of glucose and lipid metabolism and other cardiovascular risk factors. These examinations and analyses are essential prerequisites for the comprehensive lifestyle modification of obese patients that is usually required. In addition to these "non-drug" measures, drug therapies have recently become available that can be used here. In extreme forms of obesity, bariatric surgery can also be useful if these measures fail. These require a precise indication as well as differentiated post-operative follow-up care. All of these measures are provided and implemented by the Clinical Department's nutritional and metabolic medicine department.

In addition, there is close cooperation with the Rehabilitation Department of Rehabilitation Medicine and Sports Medicine and the Psychosomatic Clinical Department of our hospital, as well as with the reference centers for bariatric surgery in the region, in order to be able to guarantee comprehensive care for this patient group that does justice to the complexity of the clinical picture of obesity.

Important links

You can access our nutritional medicine and the "Leichter durchs Leben" program here.
Click here to go to our endocrinology outpatient clinic.
The German Obesity Society (Deutsche Adipositas-Gesellschaft e.V.) provides information about the disease.