Obesity: When Overweight Becomes Dangerous

Adiposity, also known as obesity, is the technical term for extreme overweight. But when do I start to be considered obese and what helps against it?

What is obesity?

Adiposity (also known as obesity) is the technical term for extreme overweight. Whether a person deviates from normal weight can be determined by the so-called Body Mass Index (BMI). Overweight starts with a BMI of 25, obesity is considered to be a BMI of 30. In many cases, obesity can be attributed to incorrect nutritional habits – but various diseases also promote overweight.

Three stages of obesity obesity is divided into three stages:

• Obesity Grade 1: BMI from 30
• Obesity Grade 2: BMI from 35
• Obesity Grade 3: BMI over 40

What is meant by Adipositas permagna?

Adipositas permagna is the highest degree of extreme overweight, i.e. grade III obesity, but it is also known as morbid obesity. The reason: Such extreme overweight not only almost always leads to secondary diseases such as joint wear or even cancer, but in many cases it also significantly reduces life expectancy.

Adipositas permagna considerably restricts the quality of life of those affected: For example, it is often no longer possible to pursue one’s profession because long periods of sitting or walking are impossible due to painful joints. In addition, those affected are often ashamed of being so obese and experience contempt in their environment. The consequence: they take refuge in their own homes. The isolation and the associated psychological stress often make the complaints even worse.

Severe overweight is a growing problem, particularly in the industrialized nations: over the last 40 years, the proportion of people suffering from obesity has risen significantly. Almost a quarter of all adults in Germany and around 15 percent of children and young people suffer from obesity (in other nations, underweight is more of a problem). By the way, obesity is not really considered a disease but a health disorder. It often leads to both physical and psychological secondary diseases and can considerably reduce the quality of life of those affected.

You should know these secondary diseases

The possible consequences of a greatly increased body weight are often more dramatic than obesity itself. In most cases, the risk of these diseases is increased by severe overweight:

• Diabetes type 2
• High blood pressure
• Cardiovascular diseases
• Fat metabolism disorders
• Joint diseases
• Various cancers
• Fatty liver
• Dementia

What my fat distribution tells me about my health

In addition to the BMI, the distribution of fat plays a major role in obesity in terms of the risk of developing secondary diseases. Studies show that a high proportion of abdominal fat in particular increases the probability of developing secondary diseases. Whether you have too much abdominal fat can be determined by measuring your waist: For women, the waist should not be more than 88 centimetres in circumference, for men not more than 102 centimetres.

Apple or pear?

One also speaks of a fat distribution pattern. This determines where in the body fat accumulates most.

• In the android fat distribution type, also known as apple type, the fat tends to accumulate on the abdomen – mostly men are affected. This pattern of fat distribution with a high percentage of abdominal fat is the most favourable for secondary diseases of obesity.
• The second form is the gynaecoid type, also known as the pear type, in which the fat cells settle mainly on the hips and thighs – this mostly affects women. The risk of typical secondary diseases of obesity is significantly lower with this fat distribution pattern.

What helps with obesity?

In order to get rid of obesity in the long term, living habits must be changed – even if it is difficult.

• The most important thing is a corresponding change in diet: instead of ready-made products, sweet lemonades and snacks, fruit and vegetables, milk and wholemeal products as well as water should be on the menu.
• Also incorporate exercise into your everyday life. You don’t have to go to the gym three times a week – especially if you have a high body weight, it is important not to put too much strain on your joints, especially your knees. To get started, for example, you can walk or swim for half an hour three times a week. Additional motivational help for weight loss can be provided by professional support, for example through behavioural therapy.

If a disease is the cause of obesity, it often has to be treated first before the body weight can be reduced. For example, hypothyroidism often causes a drop in the basal metabolic rate – the energy we need every day for the most important bodily functions such as breathing and blood circulation. Anyone who continues to eat normally now usually exceeds this basal metabolic rate. The consequence: you gain weight continuously. Often it is only possible to reduce the excess weight again by hormonal adjustment of the thyroid gland, which compensates for the underfunction.

Obesity surgery: Does a stomach reduction relieve me of my obesity?

It sounds like the simplest solution: By reducing the size of your stomach, for example with a gastric band or a gastric bypass, less food will fit in your stomach, which means that you automatically eat less – and the pounds are already dropping. In fact, so-called obesity surgery is usually the last resort in medicine for weight loss.

Patients often have a BMI of over 40, but an operation can also be carried out if the BMI is over 35, provided that the person concerned is already suffering from the pathological consequences of obesity. The physician decides whether obesity surgery is a suitable treatment method based on the patient’s medical history. Not everyone who is severely obese is also suitable for a stomach reduction.

The most important rule is that all other common methods of weight reduction, such as medically controlled diets, have already been exhausted without success. In addition, the affected person must be of age and emotionally stable. Addictions or depression must not be present if the patient wants to have a gastric band or a gastric bypass.

As with any operation, a stomach reduction is also associated with risks. In addition to general pain, infections and bleeding, complications can arise during anaesthesia due to the excess weight. For this reason, the doctor first assesses the patient’s personal risk and decides for himself whether a gastric banding or gastric bypass is an option for treating obesity.

Who pays for my operation?

Surgical interventions for weight loss are usually not part of the standard services of health insurance companies. Nevertheless, it can be worthwhile to apply for reimbursement of costs – positive decisions in individual cases are quite possible. A prerequisite for this is that many health insurance companies offer interdisciplinary treatment approaches, such as those offered by many certified centres. Various experts, such as psychologists, nutritionists, internists and movement therapists, are involved in the treatment of obesity.

Stomach balloon – finally filled up faster?

Another method against obesity is the use of a so-called stomach balloon. This is usually made of silicone or plastic and is inserted into the stomach either by gastroscopy or by swallowing. Due to its volume, it creates a feeling of satiety, which should encourage the person concerned to eat less. It is not considered a surgical measure to reduce body weight and is therefore not part of the surgical treatment options.

You can’t do it without discipline

No matter whether you have decided to have a stomach reduction or a stomach balloon to fight obesity: It depends above all on the patient himself whether weight loss is successful or not. Following the respective procedure, those affected receive psychological and nutritional advice. It is most important to stick to the given life and nutrition plan. Then a reduction of up to 70 percent of excess weight is possible within two years. Patients should also be prepared for possible follow-up operations – for example, to have superfluous skin removed after weight loss.