Obesity:
Explanation of terms, types and therapy
Obesity is a state of being severely overweight that poses a danger to the body. In 2017, about 39% of men and 23% of women in Switzerland were overweight, with 12% of men and 10% of women being obese. These figures have doubled since 1992. The disease manifests itself in various forms. In the following you can learn about which forms there are and how to treat obesity.
Obesity is a chronic disease involving a pathological increase in body fat. It is one of the metabolic diseases. Obesity increases the risk of secondary diseases such as cardiovascular problems, diabetes or cancer. Many of those affected also suffer from societal stigmatisation. There are many reasons for weight gain, but unhealthy eating habits are often the root cause. A formula known as the body mass index (BMI) can be used to determine whether obesity is present – based on height and weight.
Depending on the level of BMI, obesity can be categorized in classes 1 to 3. By definition, obesity starts at a BMI of 30. A value between 25 and 29.9 is referred to as overweight (pre-obesity), in which the risk of secondary diseases is already slightly increased.
| Category | BMI | Risk of secondary illness |
|---|---|---|
|
Overweight | 25 - 29.9 | Slightly elevated |
|
Obesity class I | 30 - 34.9 | Elevated |
|
Obesity class II | 35 - 39.9 | High |
|
Obesity class III | 40 and above | Very high |
Source: World Health Organization (WHO), year: 2000
In people with obesity, fat usually is not evenly distributed throughout the body. Particularly stubborn fat reserves often accumulate on the abdomen or around the internal organs, as is typically the case in men. People with this problem are also referred to as having an apple body shape or android fat distribution. In women, excess body fat is more likely to form on the thighs and hips. This known as the pear body shape or gynoid fat distribution.
Nutritional therapy can change eating habits and help people to develop a more mindful approach to food. After successful weight loss, it is also important to learn to maintain the new body weight through a balanced calorie intake. Movement therapy also supports effective weight loss, e.g. through endurance sports that do not put a strain on the joints.
In patients with class 2 and 3 obesity, surgery may also be considered. Common operations involve reducing the size of the stomach using a gastric band or a balloon. Afterwards, only small amounts of food can be consumed. Gastric bypass is also a common method in which the stomach is reduced in size while the small intestine is shortened, so that the body can eat less food.
Many over-the-counter medications that promise rapid weight loss, such as appetite suppressants or metabolism stimulants, are not very effective. However, there are also prescription medicines whose efficacy has been proven by studies. Orlistat, for example, reduces fat intake by eliminating some of the fat in undigested form. Liraglutide increases insulin production, delays the emptying of the stomach and reduces the appetite. Ask a doctor for advice on which medication can help you to lose weight.
BMI can be calculated using the following formula:
Body weight (in kilograms) / (Height in metres)²
Abdominal circumference can also be an indication of obesity, which is why it should also be measured in addition to BMI. An abdominal circumference (measured at navel height) of more than 102 centimetres in men and 88 centimetres in women is an indicator of obesity.
Other diagnostic methods include:
- Blood tests for elevated blood lipid levels, checks of liver values, cholesterol levels, hormones in the blood
- Echocardiography: ultrasound scan of the heart
- Electrocardiogram (ECG) at rest and under exertion
- Cardiac catheter examination if a disease of the heart, heart valves or coronary vessels is suspected
Children and adolescents can also develop obesity. If abnormal excess weight is suspected, a paediatrician should be consulted.
In children and adolescents, the BMI score alone is not meaningful, as it does not take into account age or gender. Growth curves (percentiles) are used to determine whether the weight is normal or too high for the child’s age and gender.
- Biological factors: age and gender
- Genetic factors
- Hormonal factors
- Social or socio-economic status, i.e. the environment in which those with obesity grew up, etc.
- Dietary factors, e.g. an increased intake of highly processed, high-fat and sugary foods over an extended period of time
- Lack of exercise
- Stress and lack of sleep
- Psychological problems that lead to certain behavioural patterns such as emotional eating
- Other diseases such as insulin resistance or thyroid dysfunction
- Medicines with weight gain as a side effect, e.g. antidepressants and neuroleptics
This is due to the messenger substances contained in adipose tissue, which can cause inflammation in the body. Common diseases that occur in obese people include type 2 diabetes, atherosclerosis, heart attack, stroke and some cancers (especially breast, colon and oesophageal cancer). As a result, life expectancy is significantly reduced from a BMI of 40 (class 3), and the risk of secondary diseases is already elevated from a BMI of 30.
Self-help groups also offer help in dealing with discrimination, as can forums for dialogue with other obese people. It also makes sense to seek nutritional advice to get information on healthy foods and tips on weight loss. Exercise programmes and suitable sporting activities can also provide support.
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