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Obesity: Quick Reference

  • Description: pathological obesity, chronic illness, BMI of 30 and more
  • Symptoms: Unusually excessive accumulation of fat in the body, decreased performance, shortness of breath, excessive sweating
  • Consequential damage: Diabetes, cardiovascular diseases, fatty liver, joint problems, back problems, gout, kidney stones, various cancers, psychological problems
  • Causes: genetic predisposition, unhealthy eating behavior, lack of exercise, slow metabolism, various diseases
  • Treatment: Nutritional, exercise, behavioral therapy, medication, stomach reduction
  • Forecast: difficult to treat, high risk of secondary diseases, shortened life expectancy

What is Obesity?

Obesity, or obesity, is not a figure problem for people with weak character, but a recognized, chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The German Obesity Society defines obesity as an accumulation of fatty tissue in the body that exceeds the normal level.

Fat kids: That's why it pays to lose weight

  • Dangerous bacon rolls

    In Germany, more and more children are much too fat. The "cute baby fat" is anything but harmless. Overweight children often suffer from health problems that otherwise only appear much later in life. Read here what they are, whether your child is one of them and what you can do as a parent.
  • Bad blood sugar levels

    Anyone who is overweight as a child has a four times higher risk of type 2 diabetes. One of the main causes of the metabolic disease is the dangerous mix of physical inactivity and malnutrition. The problem: the disease occurs after a delay. The children do not have any complaints yet, they only come in (early) adulthood.
  • Earlier in puberty

    Fat cells produce hormones such as leptin. That kicks off puberty. From an evolutionary point of view, this makes sense. The body knows that it has enough fat reserves to start reproducing. As a result, overweight children reach puberty earlier than their peers. Boys also develop breasts, girls are more likely to menstruate.
  • Vessels in danger

    The cause of obesity in children is not infrequently a diet that is too high in fat. Burgers, pizza and the like don't just hit your hips. The blood lipid levels are also too high in overweight children. An elevated cholesterol level is a major risk factor for the heart and blood vessels. There is a risk of heart attacks and hardening of the arteries in adulthood.
  • Too high blood pressure

    Being very overweight makes the body insensitive to insulin. However, a lot of insulin in the blood can increase blood pressure. The lack of exercise is also not good for the child's blood pressure. Other values ​​also apply: a blood pressure of 120 to 80 is almost ideal for an adult, but it is far too high for a child. In the long term, this will damage the heart, kidneys and eyes. 113.5 to 72 is ideal for ten year old boys and 115 to 72 for girls.
  • Hip and knee pain

    Obesity is a risk factor for epiphyseal capitis femoris (ECF) - a hip misalignment - even in five-year-old children. This has been shown by a study by the University of Liverpool. The femoral head slides off the thigh neck, the leg rotates outwards. This leads to severe pain - especially in the hips and knees. The following applies: the higher the child's BMI, the greater the risk of the misalignment.
  • Low resilience

    Overweight children are less physically resilient than their normal-weight friends. This quickly creates a vicious circle: if you find it difficult to move, you don't like moving and your fitness continues to decline. Just a few steps or the way to school become a challenge. Exercise is important in order to reduce excess weight and get through everyday life more easily.
  • Mental health problems from teasing

    Fat children are often exposed to teasing and bullying from their peers. This leaves emotional traces behind: Overweight children have a one and a half times higher risk of psychological abnormalities, while obese children have a three times higher risk. In addition, there is a risk that frustration over social exclusion will be compensated for with food - this is also a vicious circle.
  • When is my child too fat?

    In Germany, 15 percent of children are overweight and 5 percent are even obese. The body mass index reveals whether your child is one of them. It is calculated from the height squared divided by the weight. For five-year-old boys and girls, values ​​over 17 are questionable. For ten-year-olds, a BMI of more than 19 is considered too high. The pediatrician can determine the BMI precisely. If he sounds the alarm, you should take countermeasures. What can parents do about it?
  • Cooking on my own

    Too Much Fat and Sugar Every Day? No wonder the bacon pads are growing and thriving! No more sugary drinks. Instead, serve water and unsweetened teas. Ready meals and snacks are often real calorie bombs. Cook fresh and healthy meals with your children. The youngsters learn healthy eating habits and you know exactly what ends up on the plate. Your pediatrician will give you further tips and support.

Guide value body mass index (BMI)

A body mass index of 25 or more is considered overweight according to the guidelines of the World Health Organization, and obese from a BMI of 30. The BMI is calculated from the weight (in kg) divided by the height squared (m2). Thus, for example, a person 180 cm tall would be overweight with 81 kilograms and obese with 98 kilograms.

A person becomes overweight or obese if he supplies his body with more energy than he consumes in the long term (positive energy balance). Food intake and exercise are two parameters that can be used to influence weight.

Individual factors influence weight

However, there are numerous factors that significantly influence the metabolism and thus the individual energy balance. This includes the genetic makeup, the mother's diet during pregnancy or the hormones. Therefore, someone who is overweight does not necessarily have to eat more or exercise less than a lean person.

Stress on the whole body

Obesity, also known as obesity, puts a strain on the whole body and therefore carries a high risk of secondary diseases - from heart attacks to diabetes to various types of cancer. The fact that a quarter of adults in Germany are now obese is therefore a major social problem.

Obesity permagna

From a BMI of 40, doctors also speak of adiposity permagna or obesity grade 3. The affected persons are very obese and therefore mostly severely restricted in their quality of life. They even find it difficult to walk or sit slowly.

They are particularly likely to suffer from secondary diseases such as diabetes and high blood pressure, and their life expectancy is reduced. Most of the time, self-confidence suffers from being overweight and those affected are stigmatized by their environment.

Losing weight significantly is crucial for very obese people in order to become healthier again. You can read more about grade III obesity in the article Obesity permagna.

Obesity: symptoms

The more pronounced the excess weight is and the longer it has existed, the greater the physical complaints. The risk of secondary diseases also increases. The messenger substances that are formed in adipose tissue also contribute to this. They are called adipokines. While there are quite a few in the overweight sector who are physically fit and healthy, obese people are unlikely to be.

Main symptom of abnormal fat accumulation

The main symptom of obesity is the excessive accumulation of fat in the body. They put a strain on the body through the sheer burden that it has to bear and that has to be supplied with oxygen and nutrients.

The fat deposits are also not just fat stores. They produce messenger substances that negatively affect metabolism and many other bodily functions.

Fat distribution: apple type and pear type

How dangerous the fat is depends not only on the amount, but also on where it accumulates. Fat stores in the abdominal region are considered to be particularly unfavorable in terms of health. The so-called visceral fat collects not only under the skin, but also around the organs. The body silhouette with this fat distribution is also known as the "apple type". It is especially typical for men.

In women, on the other hand, fat accumulates mainly on the hips and thighs. This is why this shape is known as the “pear type”. These deposits are less harmful to health than those of the apple type.

Abdominal circumference risk factor

As a rule of thumb, a waist circumference of over 80 cm is considered risky for women and over 94 cm for men. This increases the risk of stroke and type 2 diabetes, among other things. With a waist circumference of over 88 cm in women and 102 cm in men, the risk is even significantly higher.

Reduced physical performance

The heart and circulation are particularly stressed by being overweight. Even minor physical exertion becomes a strenuous undertaking. On the one hand, this is due to the weight load, but also to the fact that more tissue has to be supplied with blood.

The limited physical performance is primarily noticeable through shortness of breath or shortness of breath. This occurs when the heart and lungs cannot compensate for the increased need for oxygen and there is therefore a lack of oxygen in the blood and tissue.

Since any physical activity is very strenuous due to the weight and uncomfortable due to the shortness of breath, many people with obesity shy away from physical exertion. But it is precisely the lack of exercise that can be a major cause of obesity. Those affected can get caught in a vicious circle of lack of exercise and weight gain, which pushes their weight higher and higher.

Joint wear

In addition to the cardiovascular system, the musculoskeletal system in particular suffers from obesity. Due to the high stress on the joints, they wear out prematurely. The fine layer of cartilage in various joints is gradually irreparably destroyed (osteoarthritis). The knees, hip joints and ankles are particularly often affected. Obesity can also lead to premature wear of the intervertebral discs between the vertebral bodies and thus also cause a herniated disc (disc prolapse).

Increased sweating (hyperhidrosis)

People with obesity often sweat excessively. One reason for this is the weight-related increased physical strain, another is the poorer heat dissipation via the fatty tissue. Many obese people feel uncomfortable with excessive sweating.

Reflux (heartburn)

The fat stores in the abdomen can continuously press on the digestive organs, for example on the stomach. Then acidic gastric juice is forced back into the esophagus, causing heartburn. In the long term, the acid attacks change the cells of the esophagus: a so-called Barrett's esophagus develops, which can degenerate into cancer.

Sleep apnea

People with sleep apnea syndrome (SAS) experience paused breathing during sleep. The most common form of this condition is what is known as obstructive sleep apnea syndrome (OSAS). The muscles of the upper respiratory tract relax during sleep. This obstructs the airflow for normal breathing and sleep quality is poor. This is often the case with very overweight people.

People with sleep apnea are often very tired and unable to concentrate. The psyche is also burdened by the lack of recovery during sleep.

Varicose veins (varicosis) and thrombosis

Varicose veins are more common in obese people. This is understood to mean an expansion of the superficial veins on the legs. Pronounced varicose veins carry an increased risk of blood clots (thrombosis) in the leg veins.

It has not yet been clearly clarified why people with obesity are more prone to varicose veins. Possibly the comparatively weaker connective tissue of obese people is the reason. Researchers also suspect that the fat cells release a number of messenger substances that weaken the vessel walls of the veins.

Gallstones (cholecystolithiasis)

Obesity is one of the major risk factors for gallstones. People who are obese often have high levels of cholesterol. When the cholesterol crystallizes, gallstones form. Cholesterol stones are the most common type of gallstone in developed countries.

Gout (hyperuricemia)

With obesity, the uric acid level in the blood often rises too. If the uric acid in the blood has exceeded a critical concentration threshold, it can crystallize out. The uric acid crystals are then deposited in joints, where inflammation can cause a gout attack with great pain.

Fatty liver

If a person eats too much and too fat, it also puts a strain on the liver. It stores ever larger amounts of fat - a so-called fatty liver develops, which usually does not cause any symptoms for a long time. It becomes really problematic when the liver begins to scar and rebuild: a shrunken liver (liver cirrhosis) forms.

Mental problems

People with obesity are often stigmatized because of their weight. Surveys show that two thirds of Germans suspect the reasons for obesity to be laziness and overeating. Most respondents assumed that obesity was self-inflicted. Those affected are often confronted with these blanket assessments in everyday life. Social withdrawal and possibly increased comfort food can be the consequences.

Stigmatization can trigger numerous mental illnesses: For example, people with obesity suffer more from depression and anxiety disorders. Children and adolescents are particularly hard hit by social isolation and rejection from their peers. Negative formative experiences at this age can massively damage the psychological stability of adolescents and cause lasting psychological disorders.

Obesity: causes and risk factors

The causes of obesity go far beyond eating too much and too little exercise. A number of factors seem to influence and reinforce one another. The exact mechanisms have not yet been fully clarified. It is becoming apparent, however, that the disease tends to take on a life of its own: the more overweight, the more stubbornly the body defends the extra pounds.

Eating behavior (alimentary obesity)

One thing is clear, if you eat too much and also very high in calories, you are very likely to gain weight. But which amount is too much depends on many factors and is individually different.

Some researchers also take the view that it is not the total amount of calories that is decisive for the development of obesity, but the composition of the diet. For example, that oils with polyunsaturated fatty acids are less potent than saturated fat. Or that sweets make you thicker than vegetables with the same amount of calories.

Still other hypotheses suggest that longer breaks, during which the body has time to break down food deposits, help to become or stay slim. If you often eat something in between, you might be more likely to gain weight with the same calorie intake. A minimum of four calorie-free hours between meals is recommended.

Sedentary lifestyle

If the daily calorie balance is "positive", ie more calories are consumed than are consumed, you gain weight. So if you don't like exercise, you can eat less without getting fat. On the one hand, of course, more energy is used during the movement itself. But there is also an afterburn effect: Even after the activity has ended, the body consumes more energy for a while than usual.

It is not just the current amount of exercise that is decisive: if you exercise little, you have less muscle mass. But muscles also consume more energy at rest than fat tissue, for example. If the muscle mass decreases, the so-called basal metabolic rate also decreases, that is the energy requirement of the body at rest.

The problem is that social networks entice young people in particular to spend the day sitting with virtual friends rather than actually exerting themselves physically or being active in sports.

More and more adults also have a lifestyle that makes them prone to obesity: Many employees spend a large part of their time at the PC. Cycling and running have been replaced by driving a car or public transport, and in many places there is no need to climb stairs with escalators and elevators.


The basal metabolic rate also depends on other factors.So there are actually people who eat normally and still get fat. They are called good feed converters. That sounds good at first, but is problematic in times of oversized food supply. This is partly predisposition, but it can also be caused or exacerbated by dieting. Then the metabolism slows down. Conversely, there are also very slim people who eat well enough - without moving too much to compensate.

Obese people also lose less heat energy due to the insulating layer of fat under the skin. Therefore, they have to convert comparatively less energy into heat, i.e. burn fewer calories.

Environment shapes eating behavior

Eating habits are significantly shaped in childhood and adolescence. However, an increasing number of children do not learn how to handle food properly either at home or at school. For example, uncontrolled access to sweets disrupts the natural rhythm of hunger and food intake: people eat constantly and constantly.

There is often not enough time in the family for cooking and meals together. The void is filled by fast food offerings. This means that some people consume high-calorie ready-made foods practically around the clock. Sugary, fatty foods are also often significantly cheaper than high-quality foods.

Genetic causes

Genes play a major role in the development of obesity: The results of twin studies suggest that about 40 to 70 percent of obesity is due to genetic causes.

However, it is currently still unclear how many genes are actually involved in the development of obesity and in what way. About 100 genes are known to be associated with overweight and obesity.

The “FTO gene” in particular is the focus of obesity research. The gene appears to be involved in controlling appetite. People with a mutation in this gene may have a delayed feeling full and therefore gain weight more easily.

An “individual target weight” could also be genetically determined. The underlying mechanisms are so far completely unclear. However, studies with adoptive children speak in favor of such a genetically programmed target weight: In these studies, the weight of the adoptive children in adulthood was less likely to be that of the adoptive parents, but more often to the weight of the biological parents and siblings.

Epigenetic Programming

Not only do the genes themselves have a huge impact on weight, but also how active they are in the body. What many do not know: A large part of the genes is even completely muted and is not used at all.

Which these are is influenced, among other things, in the womb. If the mother is overweight or develops what is known as gestational diabetes, the children are often too big and too heavy to be born. Your risk of obesity is then high because the body is used to an oversupply of food. The child has a lifelong tendency to overeat. In addition, his body tolerates higher blood sugar levels.

Before birth and in childhood, the so-called epigenetic imprint is particularly strong. But also in the further life the living conditions are decisive. Exercise, stress, hunger or constant overeating - cells can all change the way cells function. The good news is: through a healthier lifestyle, even in adulthood, it is possible to turn many negative genes off and on positive ones.

Diseases as a cause of obesity

Some diseases and medications can also promote weight gain and thus obesity. Then experts speak of secondary obesity.

  • Polycystic Ovary Syndrome (PCOS): Around four to twelve percent of women of childbearing age suffer from this cyst disease of the ovaries. Menstrual cycle disorders and obesity are characteristic of the disease.
  • Cushing's disease (hypercortisolism): In this condition, the adrenal glands release an unnatural amount of cortisone into the blood. When the blood level is permanently elevated, the hormone cortisone causes a strong increase in weight, especially on the trunk of the body ("trunk obesity").
  • Underactive thyroid (hypothyroidism): In the case of hypothyroidism, the thyroid hormones T3 and T4 are not produced in sufficient quantities. The energy expenditure is then lower than normal.
  • Testosterone deficiency in men (hypogonadotrophic hypogonadism): Because of insufficient hormone production in the pituitary gland (pituitary gland) or the diencephalon (hypothalamus), men produce less testosterone in this condition. This also promotes fat deposits.
  • Genetic Syndromes: People with Prader-Willi Syndrome (PWS) or Laurence-Moon-Biedl-Bardet Syndrome (LMBBS) are often extremely obese.
  • Mental illness: People with depression or anxiety disorders often also suffer from obesity. Eating serves as a short-term relief for the psyche. The psychological strain, in turn, can increase due to the increasing body weight, which means that those affected eat more in order to feel better again.
  • Binge eating disorder: A binge eating disorder, in which those affected repeatedly have binge eating, can also cause severe weight gain.


Some drugs have the undesirable side effects of stimulating the appetite or retaining more water. These drugs include:

  • Antihistamines (medicines for allergies)