Obesity ( obesity , from Latin adeps "fat"), obesity or obesity (rare obesity ) is a nutritional and metabolic disease with severe obesity and positive energy balance , by going beyond the normal scope increase of body fat frequently morbid marked impact. According to the WHO definition, obesity is present in people with a body mass index (BMI) of 30 kg / m². A distinction is made between three degrees of severity, separated from one another by the BMI. Indicators for the percentage of body fat and its distribution are the waist circumference and the waist-to-hip ratio .
Degrees of severity
|Category (according to WHO)||BMI (kg / m²)|
|Grade I obesity||30-34.9|
|Obesity grade II||35-39.9|
|Obesity grade III
(Obesity permagna or morbid obesity)
The decisive factor for the risk of cardiovascular disease is not the BMI, but the fat distribution pattern . Fat deposits in the abdomen and on the internal organs (so-called apple type) have a particularly disadvantageous effect . This inner belly fat (“intra-abdominal fat”, “ visceral fat tissue ”) has a particularly unfavorable effect on fat and carbohydrate metabolism (sugar metabolism) and is an essential indicator of the metabolic syndrome and thus leads to lipid metabolism disorders and diabetes . The more hip and thigh-accentuated fat distribution (so-called pear type) is considered to be less risky.
The waist circumference at the waist (waist circumference) is easy to measure as a measure of the fat distribution. Depending on the source, there is an increased risk for women from 80 cm or 88 cm, for men from 94 cm or 102 cm.
Obesity in children is determined taking into account the level of development, age and height (so-called percentiles ). On obesity in children and adolescents, see also the Idefics study , a European intervention study that investigates “[…] the effects of diet, lifestyle and social environment on the health of European children aged two to ten years […]” .
Obesity occurs more frequently in industrialized countries, especially in living conditions characterized by little physical work and an abundance of food . In recent years, however, emerging countries have also been increasingly affected.
Numerous studies have examined the relationship between BMI and food intake. The result of the VERA study from 1985 to 89 was surprising: at the time there was no connection between the physiological calorific value consumed with food and the observed BMI. However, there were clear indications that the people examined mostly consumed too much fat - especially too many saturated fatty acids - and too few vitamins and minerals.
The main causes are:
Overeating and lack of exercise
Too much and wrong nutrition on the one hand - too little exercise (energy consumption) on the other hand - lead to an excess in a person's individual energy balance . Energy that is supplied and not used by food is ultimately stored in fat deposits.
In the diet, sugary drinks seem to play an important role. Although some reviews come to the conclusion that no connection could be proven, a new article shows that this is mainly the case in papers with a financial conflict of interest. Studies without a financial conflict of interest show a connection between regular and high consumption of sugary drinks and obesity in over 80 percent of cases.
- Sedentary activity
- Little movement thanks to the car, elevator and escalator
- Passive leisure time (television, computer)
- Oversupply of goods
- Eating as a substitute and act of skipping over emotional and personal affection
- Education: "The plate is eaten empty", "Eat something, then you will become something!"
- No regular meals
- Fast food : portion size, eating speed, too high fat, salt and sugar content, not filling enough
- Flavor enhancer glutamate (can stimulate appetite)
- Colors and fragrances that make the food appear more appetizing
- Advertising for sugary and fatty foods
- Flavor imprinting through added sugar (soft drinks, baby food , sweetened tea, sweetened meat products)
- Yo-yo effect after a diet
- Overweight as an ideal of beauty or a sign of prosperity in some cultures
- Sports where obesity is beneficial ( sumo wrestling)
The lower the social status (determined by the three factors of education, household income and professional position), the more often one encounters the problem of obesity: the higher the school leaving certificate, the lower - and therefore cheaper - the body mass index . Around a quarter of men in the lower classes suffer from obesity in Germany - in the upper class it is only around 15%. For women, the difference is even more pronounced, at around 35% to 10%.
Genetic factors ( hereditary disposition ) shape the basal metabolic rate, food utilization and the fat distribution pattern. In the times of the “hunter-gatherers”, food utilization was an important survival feature : those who could store the surplus in fat cells could live off it in times of shortage.
"Since the genetic makeup of humans has practically not changed in the last few decades, the sharp increase in obesity is primarily the result of changed living conditions."
Twin studies suggest that being overweight also has a genetic component. In this analysis it is given as 70%. In addition, a strong correlation was found between their BMI and that of their birth parents in adoptive children , but no correlation between their weight and that of their adoptive parents.
Obesity as a direct and indirect consequence of diseases and living conditions
Metabolic diseases occur in around 2% of the total population. The proportion of cases in which metabolic diseases are the cause of obesity has not yet been proven. Typical metabolic diseases that can directly cause obesity are
- Hypothyroidism (e.g. Hashimoto's thyroiditis )
- Disturbances of the cortisol balance ( Cushing's syndrome ) or
- Glucose metabolism disorders with hyperinsulinism .
Physical (life) circumstances and illnesses that can indirectly cause obesity do not always have a direct impact on nutrition and its metabolism, but are often associated with obesity if they are accompanied by a sometimes considerable lack of exercise:
- Pregnancy and breastfeeding
- high age
- Autoimmune diseases such as multiple sclerosis , rheumatism , etc. related diseases that affect the musculoskeletal system
- Back disorders such as a herniated disc
- Anxiety disorders such as sociophobia
- mental illnesses with altered experience of reality such as schizophrenia and psychoses
- Disability following accidents or due to congenital disabilities
- Coma and persistent vegetative state
- Dementia and other age-related diseases
A connection with an infection by the Ad-36 adenovirus is suspected . Some forms of obesity, especially if this goes hand in hand with the lipid metabolism disorders that are usually also present, could be due to an infection with this virus. This virus is able to transform stem cells into fat cells . However, it is unclear exactly how this virus leads to obesity, which additional factors have an influence and which therapeutic consequences could result from it. It is also still unclear whether this virus only leads to infections more frequently in obese people, but is not itself involved in the development of obesity.
Medication side effects
While some drugs without doubt the side effect have 'weight gain', such as insulin , drug contraceptives , antidepressants , antipsychotics , corticosteroids and beta-blockers , other causes at weaning the effect of weight loss; these include, for example, sympathomimetics or NO donors such as Viagra .
Certain maternal diseases (e.g. type 2 diabetes mellitus ) as well as drugs and certain chemicals that can influence the development of the fetus during pregnancy are suspected, the development of metabolic diseases and diabetes, but also human consumption of food and thus to influence the tendency to obesity (e.g. bisphenol A ).
The utilization of food requires work. Digesting easily digestible (cooked) food requires less energy. The digestion of fiber-rich and protein-rich foods, on the other hand, uses more energy.
The quality of the fats also plays a role. Certain fats ( cholesterol , trans fatty acids ) can be easily stored by the body to a certain extent (which not only promotes the formation of visceral adipose tissue, but also arteriosclerosis ). The feeling of satiety is primarily determined by the volume of food. Eating with a low energy density also makes you feel full, but provides fewer calories. This can be achieved with wholesome foods that contain large amounts of fiber in addition to carbohydrates, proteins and fat. There are also various types of vegetables that contain hardly any carbohydrates and therefore few calories. Since fat has the highest energy density, you should save on it, which leads to low-fat diets. According to a fat study by the DGE, a reduction in fat consumption leads to lower blood levels of cholesterol. However, you can also lose weight with low carb diets.
Certain foods are artificially fortified with phytosterols , which are supposed to reduce the transport of cholesterol in the blood. The side effects (e.g. on the hormone level) have not yet been adequately researched.
A link between poor sleep and obesity was shown as early as 2007. Again and again researchers are looking for connections between sleeping habits and obesity. Studies repeatedly show that getting enough good quality sleep is important in order to avoid obesity.
A 2013 study of school children between the ages of 8 and 11 showed that more sleep leads to less food consumption, lower fasting leptin concentrations and lower weight.
Many diseases of civilization are directly related to being overweight. Obesity is a high risk factor for developing cardiovascular disease . If there are other diseases such as diabetes mellitus (diabetes), lipid metabolism disorders ( high cholesterol or LDL) or high blood pressure , the risk of cardiovascular disease ( metabolic syndrome ) is significantly increased, as is the risk of premature death.
Obesity increases the risk of arterial hypertension (high blood pressure), diabetes mellitus type 2 (adult onset diabetes, diabetes), reflux , heart attacks , atherosclerosis , stroke , breast and other types of cancer , osteoarthritis , degenerative spine disease, gallbladder disease , gout , restrictive ventilatory disorder and obstructive sleep apnea Syndrome . From a BMI of 30, the risk of illness is significantly higher.
Obesity is also a risk factor for impaired cognitive performance and for dementias , including Alzheimer's disease . This could be at least partly related to diabetes mellitus, which is now known to be associated with an increased risk of Alzheimer's disease. Defects in the vascular system , impaired insulin metabolism and signaling pathways and a defect in the glucose transport mechanism in the brain play a role here . More recent studies show that the higher the BMI, the higher the risk of atrophy (tissue loss) in certain areas of the brain and consequently the risk of dementia. The frontal lobes , parts of the parietal lobe and the hippocampus are particularly affected by the shrinkage of the brain tissue . However, it has not yet been conclusively clarified whether the brain tissue atrophy occurs first and whether obesity is only triggered by this, since the affected regions also have brain centers that influence food intake and metabolism .
The emotional consequences of obesity are also serious. Those affected often feel like failures and outsiders. Psychological and even economic damage often occurs for those affected because obesity is not socially tolerated and those affected are often socially and professionally marginalized. Obesity can, for example, prevent employment in the public service or civil service.
The financial and socio-economic consequences of being overweight are enormous. The damage to the musculoskeletal system alone leads to a variety of therapies, including surgical interventions (e.g. knee surgery, hip surgery), which in turn lead to complications such as wound healing disorders and delayed recovery , especially in the case of pronounced obesity .
On the other hand, epidemiological studies have shown that obese patients have better chances of survival than normal-weight patients in certain diseases, such as heart failure , type 2 diabetes mellitus and chronic kidney failure . This phenomenon is known as the obesity paradox . It could also be shown that obese patients in the intensive care unit are not less likely to survive, even though they have to be ventilated more frequently after an operation, for example.
Obesity in childhood and adolescence
Childhood obesity is also associated with higher health risks. This applies not only to physical, but also to mental illnesses. There is a positive correlation between obesity and emotional disorders, behavior disorders, school problems, ADHD, depression, learning disorders, developmental disorders of bones, muscles and joints, asthma, allergies, headaches and ear infections. While the incidence of developmental disorders and other dysfunctions is increased by a factor of 1.3 in the case of overweight, it is twice as high in obesity as in normal-weight peers.
Obesity During Pregnancy
The analysis of Scottish data on 28,540 pregnant women in the Aberdeen Maternity and Neonatal database, in conjunction with hospital statistics and local death records, showed that children whose mothers had a pregnancy BMI of 30 or higher were at increased risk of inpatient treatment for heart Circulatory diseases and a mortality rate that was around a third higher. However, the cohort study cannot prove a causal relationship. Genetic, familial and social factors could also play a role.
The risk of developing gestational diabetes , also known as gestational diabetes, is also increased by obesity. If gestational diabetes is undetected, the unborn child can develop what is known as fetal macrosomia . The child's birth weight in this case is significantly higher than that of other babies. This can lead to complications during childbirth.
Neurobiological control of appetite, energy expenditure, hormone levels and growth
With advances in molecular and neurobiology, we are beginning to understand how the complex control loop for controlling food intake and energy balance could work. It is not clear whether the findings, which were mostly obtained from animal experiments, can be transferred to humans.
A set point model is also being discussed , according to which the weight should return to a basic value in the event of deviations up or down.
Some results about the very complicated control mechanisms:
- Leptin is a long-term hormone that is produced in fat cells. The more fat there is in the fat cells, the higher the leptin concentration. It primarily informs the central nervous system (CNS) whether the body is starving. It also inhibits the feeling of hunger. Most overweight people seem to have leptin resistance. Today there are two explanations for this: a defect in the leptin transport across the blood-brain barrier and a defective leptin receptor that is not sufficiently sensitive to the amount of leptin present.
- Insulin is made in the pancreas . It regulates the concentration of glucose in the blood. Mice whose neurons do not have insulin receptors are mildly overweight.
- Peptide YY , GLP-1 , oxyntomodulin and cholecystokinin are produced in the intestine and reduce the feeling of hunger for a short time.
- Ghrelin is a peptide that u. a. is formed in the stomach. It stimulates the appetite.
All of this information is processed in the CNS and regulates appetite, energy consumption, hormone levels and growth.
Selfish brain theory
Recent neurobiological research approaches attribute the development of obesity to a malfunction in the energy supply to the brain. In this system of theory, the brain is viewed as naturally selfish because, despite its small volume in relation to the body, it consumes half of a person's daily glucose requirement. This high consumption is maintained in situations of heavy physical stress or emaciation, as experimental observations on humans show. The high energy requirement of the brain is ensured in healthy people by hormonally controlled allocation, i. That is, glucose is withdrawn from the body and sent to the brain. Obesity now presents itself as the result of allocation failure: Due to defects in brain regions that control the blood sugar and fat regulation cycle, energy is not requested from the body, but supplied through additional food intake, although the organs are actually saturated. The result is an energetic backlog in the supply chain. The selfish brain theory as the basis of the neurobiological explanation of the development of obesity was founded by Achim Peters and is under his leadership with scientists from various disciplines in the research group funded by the DFG : "Selfish Brain: Brain Glucose and Metabolic Syndrome" at the university Lübeck further developed.
Different therapies are indicated depending on the cause. The goal is always weight loss .
According to the official guidelines for obesity 050/001 of the AWMF, the following preliminary examinations must be carried out prior to treatment :
- Height and weight, waist circumference
- Clinical examination
- Fasting blood sugar
- Cholesterol, triglycerides
- uric acid
- TSH, optionally also other endocrinological parameters (e.g. dexamethasone inhibition test to rule out Cushing's syndrome)
- Albumin / creatinine ratio
In addition, the following things should be clarified with a detailed anamnesis :
- Eating habits, exercise habits (using eating and exercise diaries)
- Medical history (relevant diseases as the cause of obesity)
- mental state (self-esteem, importance of weight for the patient)
- Grade I obesity: 5-10% weight loss
- Grade II obesity: 10-20% weight loss
- Grade III obesity: 10-30% weight loss
Therapeutic tasks are:
- Change eating behavior sustainably
- Sustainable change in exercise behavior
- Involving the partner, the family
A positive motivation is decisive: anticipation of a healthy life with more well-being, desire for exercise, a better lifestyle, enjoyable food, insight, knowledge, purposefulness, independence, maturity, freedom, social contacts: not "away from being overweight" but "towards it" to live".
Action for healthy eating and exercise
In 2007, the federal government started the campaign for healthy eating and exercise . The aim is to encourage the 37 million overweight or obese adults and 2 million children to adopt a healthier diet and exercise behavior, thereby reducing the prevalence of obesity in the long term. It is hoped that the success will be similar to that of the fitness movement in the 1970s. The campaign was replaced in 2008 by the IN FORM action plan - Germany's initiative for healthy eating and more exercise . It is an action plan of the federal government (BMELV, BMG), the federal states, the municipalities and important actors from civil society. The action plan aims to significantly reduce the number of overweight people by 2020 and thus contribute to lowering costs in the health system.
Diet and exercise
The human nutrition and its motions are a matter of habit to a great extent. For patients without mental illnesses or eating disorders, detailed advice on healthy eating and how to exercise more, as well as support in changing their diet, can be successful.
It has not been scientifically proven which type of diet is most likely to provide relief. Usually it is advisable to have more fiber (see also whole foods ) and to avoid fats; Foods with a high proportion of saturated fats should be replaced by foods with more essential fatty acids , or fat consumption should be drastically reduced overall. However, there are also schools that recommend switching to healthy fats and lots of protein and instead reducing carbohydrates (e.g. the LOGI method or the Atkins diet ).
The European Diogenes study published in 2010, in which 772 families with 938 overweight adults and 827 children took part, showed that a high-protein diet with a low-carbohydrate content prevents obesity or makes it easier to lose weight, prevents the yo-yo effect and am can easily be implemented permanently in everyday life. The study group with a diet with an increased protein content (25% protein content) and a low glycemic index had the best results of all five study groups.
Increasing physical activity is an important item in the energy balance . In particular, endurance sports such as cycling , swimming , hiking and jogging - carried out consistently over months and years - serve to reduce weight. Jogging for 15 minutes or cycling at moderate speeds corresponds to an energy expenditure of around 600 kJ (= 150 kcal ). In order to break down 1 kilogram of fat tissue (corresponds to approx. 28,000 kJ or 7,000 kcal), you would have to jog for 15 minutes a day for about 7 weeks. This explains why it is so difficult to reduce weight through increased exercise alone, and why short-term exercise programs have to fail.
An analysis of several studies on the effect of exercise and diet on obesity showed that only a small amount of weight loss could be achieved through exercise alone. The weight loss was more pronounced when the study participants also followed a diet or intensified physical activity. In addition to the weight loss, the study participants also showed a decrease in blood pressure, blood lipids and fasting blood sugar.
There are numerous weight loss programs aimed at changing eating habits. The Weight Watchers program enables moderately obese people to achieve a mean weight reduction of 3 to 4.5 kg. The DGE program I'm losing weight ... after one year resulted in a mean weight loss of 2.3 kg for women and 4.1 kg for men.
An eating disorder usually requires several weeks of therapy in a special clinic (see Psychosomatic Clinic ) , supplemented by regular long-term work in a self-help group (e.g. Overeaters Anonymous ).
Psychotherapy, family therapy, addiction therapy
The aim of psychotherapy is to identify the individual causes of the eating disorder and to learn alternative behaviors. Therapy in a group has also proven itself. For long-term success, it is important that family members are involved. At the same time, the person affected works regularly in a self-help group with those who are also affected.
Outpatient or inpatient therapy in a specialist clinic for eating disorders or a psychosomatic clinic is a possible start on the way to changing behavior and lifestyle. It is usually financed by health or pension insurance. The reasoned application must be submitted to the social insurance company through a resident doctor. In the event of rejection, the patient also has the right to object, in the event of acceptance according to Section 9 of the Social Code (SGB 9), a free right of choice and choice, namely which specialist clinic they prefer. The aim of rehab is participation in professional and social life; the decisive factor is the change in lifestyle and behavior during the usually four-week stay, as well as competent follow-up care.
Helpful for success is:
- Eat at least 500 kcal less than you consume
- a minimum drinking amount
- 30 to 60 minutes of exercise three to five times a week
An increased BMI increases the risk of mortality. Weight reduction is always a good idea if you have diabetes or high blood pressure.
Success is strongly related to personality structure and motivation. The following are favorable: higher intelligence, higher social status, later onset of obesity, strong subjective complaints, measurable health disorders, strong personality. An eating disorder is a major hindrance.
Treatment is particularly difficult if you are very overweight. Setbacks or a lack of success often cause the patient (but also the practitioner and relatives) to give up the project entirely. The success of the treatment is determined in the long term for 10 to 20% of the patients (stabilization to 50% of the originally achieved weight loss).
It makes more sense to practice a healthy lifestyle early on in order to avoid weight gain.
In view of the multiple causes for the development of overweight and obesity, there is no diet that alone puts an end to the derailment of weight. As an introduction to a new way of eating and living, all diets are suitable that lead to a better choice of food, to its professional preparation and intelligent division of food intake during the day. Getting used to other taste preferences than eating sweet, fatty and high-calorie foods or controlling the feeling of hunger by stimulating the eating hormone serotonin with medication can only help. Without extensive changes in eating and exercise habits, diets usually only lead to short-term weight loss.
The frequent recommendation to eat five times a day can make weight loss more difficult, especially for insulin-resistant overweight people, as the many meals stimulate insulin secretion, which in turn inhibits fat breakdown ( lipolysis ).
If the change in eating and exercise behavior is difficult, the cause must be found and remedied. Medicinal forms of treatment can also be used for weight loss. In the USA, 5-Hydroxytryptophan (5-HTP), which is freely available there, is taken permanently not only to improve waking and sleeping behavior but also to reduce body weight. Adequate studies on this are not yet available; minor side effects have been reported. The constant intake of the pre-hormone 5-HTP, however, requires medical supervision, because on the one hand it passes into the bloodstream through systemic absorption , on the other hand it can cross the blood-brain barrier and thus also arrive in the cerebrospinal fluid . Long-term use of 5-HTP must therefore be viewed critically.
Rimonabant , a cannabinoid receptor antagonist, was withdrawn from the market in 2008, just two years after its approval, after the risk of depression, anxiety, sleep disorders and aggression increased significantly and five suicides were observed in connection with its use were.
In the hunger control with serotonin reuptake inhibitors, as in the case of the drug Sibutramine (trade name: Reductil ), which was wrongly named " appetite suppressant " in Germany until 2010 , there had been indications of significant side effects since approval. In a study (long-term intervention study SCOUT - not yet fully published in 2010), sibutramine users suffered significantly more often severe cardiovascular complications (heart attack, stroke, cardiac arrest or cardiovascular-related death) than placebo users, whereupon the drug was withdrawn from the market in Germany, among others.
The only drug approved in Germany is still the lipase inhibitor orlistat (trade name: Xenical ), which has also been available in an over-the-counter version since 2010. The cost of this drug, when used twice a day, is around 60 euros / month (as of May 2010). The effect is based on a disturbance of the fat absorption of the eaten - i. This means that the fat content is excreted in the form of fat diarrhea. The effect is largely limited to the meal after taking the medication. Disadvantage: With the lack of fat absorption, fat-soluble vitamins are also excreted in the stool. The use of Orlistat in the context of supervised weight loss can be useful if other measures show little or no success.
A more recent approach to weight reduction in type 2 diabetes consists in the administration of incretin mimetics .
If all conservative treatments fail, which can bariatric surgery are used. In overweight people with a BMI well over 40, it can be assumed that non-surgical measures can only achieve significant, sustainable weight reduction in exceptional cases.
Obesity as a complex clinical picture affects all sections of the population and age groups (but not to the same extent in each case) and is by no means limited to the industrialized countries. In 1995 there were 200 million adults worldwide who were obese, in 2000 the number had risen to 300 million, 115 million of them in developing countries. Since 1975, the number of obese people has tripled worldwide by 2018. According to the WHO, over 300 million people worldwide live with obesity. After the problem was confined to the affluent industrialized countries for decades, an increase in diet-related diseases has recently been observed in emerging countries such as India and China. The WHO speaks of a pandemic .
In Germany , an increase in obesity prevalence has been observed for decades . Surveys give lower values than surveys that measure height and weight. An increase over the years can be seen in both types of survey.
According to the additional microcensus survey from 2003, 13.6% of men and 12.3% of women aged 18 and over were obese (i.e. BMI 30 or higher). In the follow-up survey in 2009 it was 15.7% of men and 13.8% of women. According to the data from the telephone surveys by the Robert Koch Institute ( GEDA 2009), the proportion of adults with a BMI of 30 kg / m² or more is in a similar range. Here, 16.3% of men and 15.7% of women give corresponding body measurements.
The two major research surveys for Germany show the same trend, only at a higher level: In the 1998 Federal Health Survey, obesity (BMI> = 30) was measured in 18.9% of men and 22.5% of women. In the DEGS 2008/11 follow -up study , it was 23.3% of the men and 23.9% of the women.
The proportion of obese people increases with age. Obesity is most common among men in the 60 to 69 age group, and among women in the 70 to 79 age group. In addition, the prevalence of obesity correlates with socio-economic status : people with a high status are significantly less likely to be obese (BMI> = 30). This effect is particularly pronounced in women.
The health insurance company DAK-Gesundheit published a study in November 2016, with the result that one in four Germans is already severely overweight. In order to reduce this number again, the health insurance fund demands earlier advice and better support from those affected.
Under German law, discrimination against people based on their weight is not a criminal offense, which is why it is permissible for hotels to refuse to rent rooms to people with obesity.
In 1991 8.5% of adults in Austria were obese, in 2000 it was 11%. Across Europe, 10–20% of men and 15–25% of women are obese, with an increase in obesity prevalence towards the south and east. This also applies to Austria - with the highest percentage of overweight people in the east of the country and the lowest percentage in Tyrol and Vorarlberg.
According to estimates by the CDC in the USA , between 2017 and 2018, 42.4% of adults aged 20 and over were obese (BMI ≥ 30) and 9.2% were morbidly obese (BMI ≥ 40). Socially disadvantaged people and members of minorities ( Indians , blacks ) are much more often or more overweight than other population groups and have a lower life expectancy .
According to a May 2012 study by Duke University , around 36% of Americans were obese at the time. The scientists expect the number to increase to 42% by 2030.
The European IDEFICS study , which "[...] examines the effects of diet, lifestyle and social environment on the health of European children aged two to ten years [...]" shows a prevalence of 42% for overweight or in Italy Obesity in the age groups studied. In all the countries studied, one in five children is overweight or obese. The proportion of obese children in the southern European countries studied is up to 20%, while that in the northern regions is less than 5%.
Obesity in animals
Obesity plays a bigger role , especially in domestic dogs and house cats . In industrialized countries, an average of 40% of dogs and cats are obese, with an increase of around 10% over the past 40 years. In dogs, some breeds ( Labrador Retrievers , Cocker Spaniels ) tend to be more overweight, in cats no racial connection can be proven. Family and lap dogs are more likely to become overweight than working dogs. While females tend to be overweight in dogs, males are more likely to be overweight in cats. A castration is a major risk factor: Castrated animals tend to increased food intake and decreased movement. Reduced estrogen levels and increased IGF-1 levels are suspected to be the cause of this phenomenon . A change in the gene expression of leptin and lipoprotein lipases by castration is also discussed. Age is another risk factor; obesity occurs especially in middle age. Feeding plays a decisive role, especially the feeding of extra bites and table waste seems to play a decisive role, as they are usually not included in the daily ration. Lack of exercise also leads to greater weight gain. Outdoor cats are much less obese than pure indoor cats. In dogs, dogs kept individually tend to be more overweight than those who live with other dogs. Overweight and older dog owners often own overweight dogs.
The main consequences of obesity are osteoarthritis , torn cruciate ligament , skin diseases, urinary stones , high blood pressure, lung dysfunction, feline or canine diabetes mellitus , in dogs also pancreatitis , tumor diseases and reduced life expectancy and quality of life.
- Determination of the muscle mass / fat ratio: bioelectrical impedance analysis
- Fructose # Metabolic syndrome with excessive consumption
- List of countries by proportion of obese people
- P. Schauder, G. Ollenschläger : Nutritional medicine. Prevention and therapy. 2006, ISBN 3-437-22921-4 .
- H. Biesalski, P. Fürst, H. Kasper: Nutritional medicine. 2004, ISBN 3-13-100293-X .
- G. Reich, M. Cierpka: Psychotherapy of eating disorders. 2001, ISBN 3-13-108782-X .
- Rachel Schemmel (Editor): Nutrition, Physiology and Obesity. CRC Press, Boca Raton FL 1980, ISBN 0-8493-5471-4 .
- S3 guideline : Therapy of obesity in children and adolescents. AWMF register number 050/002, long version, short version, guideline report , status 01/2009.
- S2 guideline : Obesity of the German Society for Pediatric Rehabilitation and Prevention, AWMF register number 070/001 ( full text ), status 10/2007
- S3 guideline : Prevention and therapy of obesity of the German Obesity Society, German Diabetes Society, German Society for Nutrition and German Society for Nutritional Medicine , AWMF register number 050/001 ( full text ), as of 04/2011
- Georges Vigarello: Les métamorphoses du Gras: Histoire de l'obésité du Moyen Age au XXe siècle. Ed. Seuil, Paris 2010, ISBN 978-2-02-089893-5 .
- Werner Walisch: Obesity from a Multi-Perspective View - Considerations on Social Discourses on the Development and Treatment of Obesity. (PDF; 3.88 MB) In: Systems 23, 2009, pp. 194–220
- Standard values of the German Society for Nutrition : for men 20 to 25, for women 19 to 24 kg / m²
- Obesity: preventing and managing the global epidemic. Report of a WHO Consultation . In: WHO (Ed.): WHO Technical Report Series . tape 894 , 2000.
- Gerd Herold : Internal Medicine 2016 . P. 722
- Interdisciplinary guideline of quality S3 for "Prevention and Therapy of Obesity" . S3 guideline of the German Obesity Society , as of April 30, 2014, valid until April 30, 2019, AWMF register no. 050-001 , p. 15, accessed on October 5, 2016 (PDF).
- Working Group on Obesity in Children and Adolescents (AGA) .
- idefics.eu ( Memento from April 29, 2014 in the Internet Archive )
- Food and nutrient intake in the FRG (1985–1989) . VERA series, Volume XII. Scientific specialist publisher, Niederkleen 1994.
- Sarah C. Bundrick, Marie S. Thearle, Colleen A. Venti, Jonathan Krakoff, Susanne B. Votruba: Soda Consumption During Ad Libitum Food Intake Predicts Weight Change. In: Journal of the Academy of Nutrition and Dietetics. 2013, S., doi: 10.1016 / j.jand.2013.09.016 .
- Lynne Millar, Bosco Rowland, Melanie Nichols, Boyd Swinburn, Catherine Bennett, Helen Skouteris, Steven Allender: Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children. In: Obesity. 2013, pp. N / a – n / a, doi: 10.1002 / oby.20665 .
- M. Zheng, A. Rangan, NJ Olsen, L. Bo Andersen, N. Wedderkopp, P. Kristensen, A. Gr ntved, M. Ried-Larsen, SM Lempert, M. Allman-Farinelli, BL Heitmann: Sugar- sweetened beverages consumption in relation to changes in body fatness over 6 and 12 years among 9-year-old children: the European Youth Heart Study. In: European Journal of Clinical Nutrition. 2013, S., doi: 10.1038 / ejcn.2013.243 .
- Cara B. Ebbeling: Sugar-sweetened beverages and body weight. In: Current Opinion in Lipidology . 2013, p. 1, doi: 10.1097 / MOL.0000000000000035 .
- Maira Bes-Rastrollo, Matthias B. Schulze, Miguel Ruiz-Canela, Miguel A. Martinez-Gonzalez, David Stuckler: Financial Conflicts of Interest and Reporting Bias Regarding the Association between Sugar-Sweetened Beverages and Weight Gain: A Systematic Review of Systematic Reviews. In: PLoS Medicine . 10, 2013, p. E1001578, doi: 10.1371 / journal.pmed.1001578 .
- Overweight and obesity in Germany: Are we getting fatter? Slide 8-9. Robert Koch Institute, DEGS symposium "Measured and asked - the health of Germans under the microscope", accessed on February 12, 2016.
- Seehofer's national consumption study: The thick lower class . taz.de , accessed February 19, 2011.
- AJ Stunkard, JR Harris et al. a .: The body-mass index of twins who have been reared apart. In: The New England Journal of Medicine . Volume 322, Number 21, May 1990, , pp. 1483-1487, doi: 10.1056 / NEJM199005243222102 , PMID 2336075 .
- AJ Stunkard, TI Sørensen u. a .: An adoption study of human obesity. In: The New England Journal of Medicine . Volume 314, Number 4, January 1986, , pp. 193-198, doi: 10.1056 / NEJM198601233140401 , PMID 3941707 .
- RL Atkinson: Viruses as an etiology of obesity . In: Mayo Clin Proc . tape 82 , no. 10 , 2007, p. 1192-1198 , PMID 17908526 .
- AK Mitra, K. Clarke: Viral obesity: fact or fiction? In: Obes Rev . tape 11 , no. 4 , 2010, p. 289-296 , PMID 19874530 .
- C. Gabbert et al. a .: Adenovirus 36 and Obesity in Children and Adolescents . In: Pediatrics . tape 11 , no. 4 , 2010, p. 289-296 , doi : 10.1542 / peds.2009-3362 .
- HN Na, H. Kim, JH Nam: Prophylactic and therapeutic vaccines for obesity. In: Clinical and experimental vaccine research. Volume 3, number 1, January 2014, doi: 10.7774 / cevr.2014.3.1.37 , PMID 24427761 , PMC 3890448 (free full text) (review). , pp. 37-41,
- SCIENCE 2.0: American Chemical Society, Symposium: Genomics of Obesity - August 20, 2010 .
- LD Whigham, BA Israel, RL Atkinson: Adipogenic potential of multiple human adenoviruses in vivo and in vitro in animals. In: Am J Physiol Regul Integr Comp Physiol. 2006 Jan; 290 (1), pp. R190-R194. Epub 2005 Sep 15. PMID 16166204
- SD Vangipuram, M. Yu, J. Tian, KL Stanhope, M. Pasarica, PJ Havel, AR Heydari, NV Dhurandhar: Adipogenic human adenovirus-36 reduces leptin expression and secretion and increases glucose uptake by fat cells. In: Int J Obes . 2007; 31: pp. 87-96. Epub 2006 May 16. PMID 16703005 .
- RJ Stubbs, CG Harbron, PR Murgatroyd, AM Prentice: Covert manipulation of dietary fat and energy density: effect on substrate flux and food intake in men eating ad libitum . In: The American Journal of Clinical Nutrition . tape 62 , no. 2 , August 1, 1995, ISSN 0002-9165 , p. 316–329 , doi : 10.1093 / ajcn / 62.2.316 ( oup.com [accessed February 25, 2020]).
- AM Prentice: Manipulation of dietary fat and energy density and subsequent effects on substrate flux and food intake . In: The American Journal of Clinical Nutrition . tape 67 , no. 3 , March 1, 1998, ISSN 0002-9165 , p. 535S – 541S , doi : 10.1093 / ajcn / 67.3.535S ( oup.com [accessed February 25, 2020]).
- Günther Wolfram et al .: Fat intake and prevention of selected diet-related diseases. German Nutrition Society V., Bonn, accessed on February 25, 2020 .
- Dolores Buscemi, Ashwani Kumar, Rebecca Nugent, Kenneth Nugent: Short sleep times predict obesity in internal medicine clinic patients. In: Journal of Clinical Sleep Medicine. 2007, No. 3, pp. 681-688.
- Virginia Quick, Carol Byrd-Bredbenner, Adrienne A. White, Onikia Brown, Sarah Colby, Suzanne Shoff, Barbara Lohse, Tanya Horacek, Tanda Kidd, Geoffrey Greene: Eat, Sleep, Work, Play: Associations of Weight Status and Health- Related Behaviors Among Young Adult College Students. In: American Journal of Health Promotion. 2013, p. 131220084321009, doi: 10.4278 / ajhp.130327-QUAN-130 .
- Min-Ju Kim, Kuk-Hui Son, Hyun-Young Park, Dong-Ju Choi, Chang-Hwan Yoon, Hea-Young Lee, Eun-Young Cho, Myeong-Chan Cho: Association between shift work and obesity among female nurses : Korean Nurses' Survey. In: BMC Public Health. 13, 2013, p. 1204, doi: 10.1186 / 1471-2458-13-1204 .
- Jennifer H. Stern, Andriene S. Grant, Cynthia A. Thomson, Lesley Tinker, Lauren Hale, Kathleen M. Brennan, Nancy F. Woods, Zhao Chen: Short sleep duration is associated with decreased serum leptin, increased energy intake, and decreased diet quality in postmenopausal women. In: Obesity. 2013, doi: 10.1002 / oby.20683 .
- Suzanna M. Martinez, Louise C. Greenspan, Nancy F. Butte, Steven E. Gregorich, Cynthia L. De Groat, Julianna Deardorff, Carlos Penilla, Lauri A. Pasch, Elena Flores, Jeanne M. Tschann: Mother-reported sleep , accelerometer-estimated sleep and weight status in Mexican American children: sleep duration is associated with increased adiposity and risk for overweight / obese status. In: Journal of Sleep Research. 2013, pp. N / a – n / a, doi: 10.1111 / jsr.12114 .
- CN Hart, MA Carskadon, RV Considine, JL Fava, J. .. Lawton, HA Raynor, E. .. Jelalian, J. .. Owens, R. .. Wing: Changes in Children's Sleep Duration on Food Intake, Weight , and leptin. In: PEDIATRICS. 132, 2013, pp. E1473 – e1480, doi: 10.1542 / peds.2013-1274 .
- Barry I. Graubard, Heather Orpana, Brian K. Kit, Katherine M. Flegal: Association of All-Cause Mortality With Overweight and Obesity Using standard Body Mass Index Categories: A Systematic Review and Meta-analysis . In: JAMA . tape 309 , no. 1 , January 2, 2013, ISSN 0098-7484 , p. 71–82 , doi : 10.1001 / jama.2012.113905 , PMID 23280227 , PMC 4855514 (free full text) - ( jamanetwork.com [accessed January 7, 2019]).
- Xavier Michelet, Lydia Dyck et al. a .: Metabolic reprogramming of natural killer cells in obesity limits antitumor responses. In: Nature Immunology. 19, 2018, p. 1330, doi: 10.1038 / s41590-018-0251-7 .
- Hilmar Burchardi: Etiology and pathophysiology of acute respiratory failure (ARI). In: J. Kilian, H. Benzer, FW Ahnefeld (ed.): Basic principles of ventilation. Springer, Berlin a. a. 1991, ISBN 3-540-53078-9 , 2nd, unchanged edition, ibid. 1994, ISBN 3-540-57904-4 , pp. 47-91; here: p. 87 f.
- Matthias Lenz u. A .: morbidity and mortality in overweight and obesity in adulthood: A Systematic Review . In: Deutsches Ärzteblatt. Volume 106, issue 40.
- MF Elias et al. a .: Obesity, diabetes and cognitive deficit: The Framingham Heart Study . In: Neurobiol Aging . tape 26 , no. 1 , 2005, p. 11-16 , PMID 16223549 .
- PA Wolf u. a .: Relation of obesity to cognitive function: importance of central obesity and synergistic influence of concomitant hypertension. The Framingham Heart Study . In: Curr Alzheimer Res . tape 4 , no. 2 , 2007, p. 111-116 , PMID 17430232 .
- F. Irie u. a .: Enhanced risk for Alzheimer disease in persons with type 2 diabetes and APOE epsilon4: the Cardiovascular Health Study Cognition Study . In: Arch Neurol . tape 65 , no. 1 , 2008, p. 83-89 , PMID 18195144 .
- WL Xu et al .: Uncontrolled diabetes increases the risk of Alzheimer's disease: a population-based cohort study . In: Diabetologia . tape 52 , no. 6 , 2009, p. 1031-1039 , PMID 19280172 .
- EK Naderali u. a .: Obesity and Alzheimer's Disease: A Link Between Body Weight and Cognitive Function in Old Age . In: Am J Alzheimers Dis Other Demen . Epub ahead of print, 2009, PMID 19801534 .
- AR Cyrus et al. a .: Brain Structure and Obesity . In: Human Brain Mapping , 2009, Epub ahead of print.
- Obesity causes the brain to age faster. ( Memento from March 30, 2012 in the Internet Archive ) In: Deutsches Ärzteblatt . August 24, 2009.
- Society against Weight Discrimination, April 15, 2008: Civil service despite obesity ( Memento of December 22, 2012 in the Internet Archive )
- Ekkehard Müller-Jentsch: Process to make a teacher into civil service: Good teaching - but the teacher was too difficult. In: Süddeutsche Zeitung . April 14, 2011, accessed February 9, 2014 .
- R. Arena, CJ Lavie: The obesity paradox and outcome in heart failure: is excess bodyweight truly protective? In: Future cardiology. Volume 6, Number 1, January 2010, pp. 1-6. doi: 10.2217 / fca.09.158 . PMID 20014982 . (Review).
- S. Tafelski, H. Yi, F. Ismaeel, A. Krannich, C. Spies, I. Nachtigall: Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. In: Journal of infection and public health. January 2016, doi: 10.1016 / j.jiph.2015.12.003 , PMID 26754202 .
- Jump up N. Halfon, K. Larson, W. Slusser: Associations Between Obesity and Comorbid Mental Health, Developmental, and Physical Health Conditions in a Nationally Representative Sample of US Children Aged 10 to 17. doi: 10.1016 / j.acap.2012.10. 007 .
- RM Reynolds, KM Allan, EA Raja, S. .. Bhattacharya, G. .. McNeill, PC Hannaford, N. .. Sarwar, AJ Lee, S. .. Bhattacharya, JE Norman: Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. In: BMJ. 347, 2013, pp. F4539 – f4539, doi: 10.1136 / bmj.f4539 .
- Gestational diabetes (GDM). (PDF) (No longer available online.) Technical University of Munich, March 1, 2016, archived from the original on December 14, 2016 ; accessed on December 14, 2016 .
- for children and pregnancy in the case of obesity. Retrieved December 14, 2016 .
- Rainer H. Straub (Ed.): Textbook of the clinical pathophysiology of complex chronic diseases. Volume 2: Special pathophysiology: with 20 tables. Vandenhoeck & Ruprecht, Göttingen 2007, therein Chap. 31B Pathophysiological concept for the development of type 2 diabetes mellitus (and obesity) with consideration of neuroendocrine interactions. P. 168 ff.
- R. Klinke, HC Pape, Stefan Silbernagl: Textbook Physiology. 5th edition. Thieme, Stuttgart a. a. 2005, in it chapter 16.6: The islet apparatus of the pancreas: insulin and glucagon. P. 551 ff., Especially p. 557 f: “According to more recent concepts, obesity and type 2 diabetes are diseases of the brain with defects in neuroendocrine functions. If the hierarchically superior parts of the brain (in the neocortex) allocate too little glucose to the brain, the energy supply of the brain is ensured through increased food intake, and as a result the body mass increases - obesity develops. In these patients, arterial hypertension and lipid metabolism disorders can often be observed, which is why the symptom complex is also called "metabolic syndrome". "
- A. Peters, U. Schweiger, L. Pellerin, C. Hubold, KM Oltmanns, M. Conrad, B. Schultes, J. Born, HL Fehm: The selfish brain: competition for energy resources In: Neurosci Biobehav Rev. 2004 . 28, pp 143-180. PMID 15172762 .
- HL Fehm, W. Kern, A. Peters: The selfish brain: competition for energy resources In: Prog Brain Res. 2006, 153, pp. 129-140. PMID 16876572 .
- S3 guideline : Prevention and therapy of obesity , AWMF register number 050 - 001 (online: full text ), as of April 30, 2014.
- Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance . In: New England Journal of Medicine , accessed March 27, 2011.
- Gisela Olias: Lose weight with protein-rich food ( Memento from December 5, 2013 in the Internet Archive ) SpringerMedizin.at, accessed on March 27, 2011.
- K. Shaw, H. Gennat, P. O'Rourke, C. del Mar: Exercise for overweight or obesity . In: Cochrane database of systematic reviews (online) . No. 4 , 2006, p. CD003817 , doi : 10.1002 / 14651858.CD003817.pub3 , PMID 17054187 .
- Biesalski, p. 259.
- Kurt A. Moosburger: Fat Burning in Sport - Myth and Truth ( Memento from February 2, 2010 in the Internet Archive ) (PDF; 61 kB).
- Finally: the appetite suppressant Sibutramine (Reductil) from the market. In: Medicinal Telegram . February 12, 2010, accessed on February 9, 2014 ( PDF; 104 KB ).
- Side effects: Rimonabant (Acomplia) from the market. In: arznei-telegram. November 7, 2008, accessed on February 9, 2014 ( PDF; 97 KB ).
- Costs for 84 capsules around 90 euros according to research in Internet pharmacies in May 2010 for Xenical 120 mg.
- Richard Daikeler, idols Use, Sylke Waibel: diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , pp. 34–36.
- Global Obesity Levels - Obesity - ProCon.org. Retrieved June 22, 2017 .
- Overweight and obesity. Retrieved June 22, 2017 (UK English).
- WHO: Obesity and overweight. February 16, 2018, accessed January 7, 2019 .
- Tables of the federal health reporting. Federal Statistical Office (destatis).
- Results of the study Gesundheit in Deutschland aktuell 2009 . Robert Koch Institute, Contributions to Federal Health Reporting: Data and Facts, p. 100.
- Obesity study calls for earlier help for those affected , last accessed on November 25, 2016.
- Cuxhaven: Designer chairs unstable - Nordsee-Hotel does not rent to fat report of the daily newspaper DIE WELT from June 5, 2020, accessed on June 5, 2020
- Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Retrieved August 3, 2020 .
- Obesity in 2030: Almost half of Americans will be obese. In: Süddeutsche Zeitung. June 29, 2012, accessed February 9, 2014 .
- How to Avoid Childhood Obesity - News from the IDEFICS Study ( Memento of February 12, 2012 in the Internet Archive ) European Food Information Council 2011.
- Stefanie Handl, Christine Iben: Current information on obesity in dogs and cats I: Risk factors, associated diseases and pathophysiological backgrounds. In: Kleintierpraxis , 57, 2012, pp. 196–210.