Obesity (severe overweight)

A person is considered to be severely overweight (obese) if the percentage of fat in their body is excessively high. This is the case if their body mass index (BMI) is over 30.

Obesity increases the risk of developing various chronic illnesses, such as diabetes, osteoarthritis and cardiovascular diseases.

It is therefore advisable for people who are obese and, in particular, very obese, to lose weight.

However, this is not easy for most. They need to be very committed, have plenty of perseverance and adequate support.

However, losing just a few pounds of weight can lead to improved health.

Is obesity a health condition in its own right?

Opinions differ as to whether obesity should be regarded as a health condition in its own right. For example, it is classified as an illness by the German Association for the Study of Obesity (Deutsche Adipositas-Gesellschaft) and the World Health Organization (WHO) but not by the German College of General Practitioners (Deutsche Gesellschaft für Allgemeinmedizin, DEGAM).

From the perspective of DEGAM, obesity is a risk factor that should always be examined in connection with the other risk factors that apply to an individual patient in order to assess their health.

People with class 1 obesity in particular often do not feel less healthy or well than slimmer individuals. They may also be physically fit and heave a healthy metabolism.

In most cases, people become severely overweight (obese) as a result of an energy imbalance. If more calories are consumed than are used up, the body stores the excess energy as fat.

Various factors can contribute to weight gain, for example:

• diet and lifestyle
• Genetic predisposition
• certain illnesses
• psychological and social factors
• certain drugs, such as some psychotropic drugs and diabetes medication

Societal developments have also led to an increase in obesity rates. These days, fewer and fewer people are employed in jobs that require physical work, for example. This makes it more difficult for people to use up as many calories as they consume on a daily basis.

At the same time, people in developed countries are surrounded on all sides by a large supply of food of all kinds. Many people regularly eat snacks such as sweets, potato chips (crisps) and nuts between meals, for example.

A huge range of sugary drinks is also available. Alcohol, which contains even more calories than sugar, can also encourage weight gain.

For more detailed information, for example about the causes of obesity, visit gesundheitsinformation.de.

According to figures reported by the Robert Koch Institute, about 24 percent of all men and women in Germany are obese.

Of these, around:

• 17 percent have class 1 obesity with a BMI between 30 and 35
• 5 percent have class 2 obesity with a BMI between 35 and 40
• 2 percent have class 3 obesity with a BMI over 40

Around 6 percent of children and adolescents are obese. 

In the past few decades, the proportion of people who are very overweight has risen in all age groups.

People do not suddenly become severely overweight (obese). Usually, obesity develops over years and decades. In most cases, obesity doesn’t occur until adulthood, often between the ages of 30 and 60.

Many people do not move enough in their everyday lives and have less time for exercise once they start working or having a family.

Over the course of their lives, other factors such as certain diseases can further encourage weight gain. 

For women, pregnancy or menopause can trigger permanent weight gain.

• Although most mothers return to their pre-pregnancy weight after the birth, some women are unable to shift the weight they gained.
• It is not entirely clear why many women gain weight during menopause. Possible reasons include changes in hormonal balance and metabolism.

It is particularly difficult for people who have been obese since they were children or adolescents to lose weight later in life.

What are the potential long-term effects of obesity?

Obesity can lead to various other health conditions. These include:

• type 2 diabetes (adult-onset diabetes)
• cardiovascular diseases, such as heart attack or stroke
• osteoarthritis
• sleep apnea
• non-alcoholic fatty liver disease (NAFLD)
• gallstones
• certain types of cancer

Severe overweight can also raise blood pressure and cause unhealthy cholesterol levels. This in turn increases the risk of vascular diseases.

The more obese a person is and the longer they continue to carry this weight, the higher their risk of developing secondary diseases.

Doctors consider someone with a body mass index (BMI) of at least 30 to be severely overweight (obese).

BMI is a measure of a person’s weight compared to their height. However, BMI provides no indication of how body fat is distributed.

This is why waist circumference is also measured, roughly between the costal arches (bottom edges of the rib cage) and the iliac crests (curved areas on the sides of the hip bones). This is because fat on the abdomen (belly) poses a greater health risk than fat on other parts of the body.

If the circumference is greater than 102 cm for a man or 88 cm for a woman, this indicates excessive abdominal (belly) fat.

However, these measuring methods fail to take account of individual body shape or age.

Further tests

In order to better judge the risk of complications, doctors should consider weight together with other factors, such as blood pressure, blood sugar, cholesterol and kidney values.

Since conditions such as underactive thyroid can make obesity more likely, possible causes should also be determined. It can therefore be a good idea to determine thyroid levels.

Otherwise, obesity can sometimes be too hastily attributed to poor diet or too little exercise alone.

People with obesity do not necessarily have to reach a specific BMI to improve their health.

Losing just a few pounds of weight can have a positive effect on health.

Depending on their starting weight, medical associations recommend losing 5 to 10 percent within 6 to 12 months.

Weight loss tips

Those who want to lose weight should make sure they establish a realistic plan to suit their needs. For some people, physical fitness and performance is their top priority, while others prioritize health reasons or the desire to feel better in their own skin.

To lose weight, the usual recommendation is a combination of more exercise and a change of diet.

This can be supported by various weight loss programs, some scientifically proven and recommended by medical associations.

However, they often have to be paid for by individuals themselves because they are considered more of a “lifestyle change” rather than treatment.

These programs often also include elements of behavioral therapy. For example, they explain how:

• changes to diet can be made flexible enough to maintain on a daily basis
• more movement and exercise can be incorporated into daily life
• to cope with circumstances that are outside of the individual’s direct control (e.g., at work)

If a diet and exercise program is not enough, drugs can also help people to lose weight.

How to keep the weight off

Keeping weight off in the long term is often more difficult than losing weight in the first place. This is due to processes involved in metabolism, hormonal balance and the central nervous system that keep body weight in balance.

For example, losing weight reduces muscle mass and, as a result, the body’s energy requirement. This means that the more weight a person loses, the more difficult it is to maintain the new weight or lose more.

Many people also find it difficult to permanently change habits and behaviors developed over many years.

Those who manage to successfully maintain a balanced diet and get enough exercise in the long term are most likely to avoid gaining weight again or to gain only a little.

The most important principle to follow is that the number of calories consumed must not exceed the number that the body consumes.

Gastric surgery may also be an option for people who are very obese. As this type of procedure can be completely life-changing, it is important to carefully weigh up the pros and cons.

More information about surgical treatment of obesity can be found at gesundheitsinformation.de.

Often, people who are severely overweight (obese) cannot get around very easily and are physically less resilient than others. In addition, being very overweight is at odds with the current ideal of beauty that is commonly portrayed on TV, in other media or in advertising, for example.

This can have a negative effect on a person’s self-esteem and can inhibit them from appearing in public, playing sports or going to the swimming pool, for example.

Some people therefore find it helpful to make a point of meeting other people in a similar position to exercise or play sports or to share their experiences in a support group.

Obesity may also be related to depression, eating disorders and other mental illnesses. In these cases, the problems should be examined together, rather than in isolation.

You can read real-life stories by people with obesity at gesundheitsinformation.de.

You will find information about self-help groups via a database on the website of the National Contact and Information Point For Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen – NAKOS).