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Obesity (Adiposity)

Obesity (adiposity) is a condition in which people are visibly overweight and have well-developed adipose tissue. Metabolic illnesses are rarely the cause. Obesity is defined as a BMI (Body-Mass-Index) above 30. Being overweight or obese is defined as an increase in body weight as a result of an excess accumulation of adipose tissue in the body.

Classification of Obesity

The classification of obesity is done using the Body-Mass-Index (BMI).

Being overweight or obese is categorised on the basis of the BMI as follows:


Normal weight

19 - 24.9


25 - 29.9

First degree of obesity

30 - 34.9

Second degree of obesity

35 - 39.9

Third degree of obesity

> 40

Another helpful method for classifying obesity is the size of the waist circumference. According to the WHO there is an increased risk if the size of the waist circumference is over 94 cm in men and over 80cm in women. The risk increases substantially if the waist circumference is over 102 cm in men and 88cm in women.

If the quotient of the waist-hip-ratio (WHR) is over 1.0 on men and 0.85 on women it is referred to as abdominal obesity (fat concentrated in the waist and hip region also known as "apple type" obesity.).

How common is obesity?

Every second adult in Germany is overweight (BMI = 25-30) and every fifth to sixth is obese (BMI > 30). The tendency is increasing. It is estimated that 15% of school children are already obese (BMI > 30). Obesity is more common in women than in men.

Reasons for obesity

1. Genetic factors
Genetic factors often play an essential role for the development of obesity (60 - 80%). The hereditary disposition can cause for example an increased dietary intake, a decreased basal metabolic rate or preferred energy storage in the form of fat. This predisposition combined with an excess of calories caused by an unhealthy diet and a lack of exercise leads to obesity.

2. Environmental factors

The ability to store energy (fat) in times of limited food resources, which is more or less during most of evolution, was a selection advantage which is how it became genetically fixed. It is only nowadays, with an almost unlimited supply of foods in certain parts of the world, that the very same genes are proving to be unfavourable for health and survival.

3. Psychological reasons

A variety of mental health problems can lead to obesity especially incorrect eating habits such as binge-eating or depression which usually involve an excessive diet rich in calories ("eating for comfort", "comfort food").

4. Regulating meals
In previous times it was seldom to have such an excessive and available supply of food. Energy reserves (fat storage) were absolutely vital for the body in times of food shortages.
Limiting food intake because of being full does not serve the purpose of blocking further energy intake but rather of optimising it. A time limit for the consumption of food is important in order to give the body time to digest and absorb the nutrient components.
Satiation (the feeling of being full) is facilitated by a complex interaction between the gastrointestinal tract and the central nervous system. The energy intake of very "energy dense", fatty food substances is higher than the energy intake of more voluminous but overall lower energy foods (carbohydrates, proteins and particularly dietary fibre) in the same period of time. The fundamental regulatory mechanism can easily be disrupted by the mind or any other sensory influences. The sensual delight in eating easily overrides the hunger/satiety signals. If the food is tasty you will eat it, regardless of whether you are full or not. The temptation to eat more can therefore easily lead to an excessive and unnecessary intake of energy.

The necessity for the treatment of obesity

According to the guidelines of the "Deutsche Adipositas Gesellschaft" (a German Obesity Society) it is necessary to get treatment if the BMI is more than 30. The treatment involves changing eating habits, a new diet, increasing physical activity and developing a strategy to deal with conflicts and problems. If a person is overweight (BMI 25-29.9) it is necessary to get treatment if weight associated symptoms (dyspnoea, joint pain etc.) and/or other consequential illnesses emerge and/or if the person is suffering from psychosocial/ psychological distress. If there are no accompanying complications it is recommended to at least maintain the weight or to consistently reduce it.

Weight reduction should not be carried out during pregnancy, lactation or during illnesses such as tuberculosis or cancer and other acute illnesses. Older people (>70 years) should be more careful with weight reduction. It must occur on an individual basis and be approached critically. The advantages and disadvantages of losing weight have to be weighed out if the patient has a chronic illness.


The risks of being obese

1. Increased blood pressure (Hypertension)
50% of the people who have high blood pressure are obese. The most common accompanying disease of obesity is high blood pressure (hypertension). The NHANES-II study revealed that the occurrence of high blood pressure was three times higher in a group of 20-75 year olds with a BMI > 27 and six times higher with the 20-45 year old group. Other studies showed similar results. Weight loss usually leads to a decrease in the blood pressure values.

2. Type 2 Diabetes mellitus
80 % of diabetics are obese. There are numerous studies which reveal the connection between obesity and type 2 diabetes mellitus. The risk of getting diabetes is already increased if your BMI is in the higher normal weight range. The risk of developing diabetes is higher for those with the "apple type" or upper body fat distribution than with the "pear type" or lower body fat distribution. In addition to this, the risk of developing diabetes increases with the duration of obesity.

3. Fat metabolic disorders such as hyperlipidaemia (too many lipids in the blood) and dyslipidemia (disorder of the blood lipids levels)
50 % of people with fat metabolism disorders are obese. Most obese patients generally have an increase in the triglyceride levels in the blood which leads to the lowering of the HDL-cholesterol level. The total cholesterol and the LDL-cholesterol do not increase as dramatically as the triglyceride levels. LDL-cholesterol can become particularly problematic with abdominally obese patients (patients with "apple shaped" obesity).

4. Coronary heart disease, heart failure
The risk of getting a heart attack or dying from a heart attack increases the higher the BMI. Heart failure is one of the more common problems with obese patients from which many die from. The risk of getting cardiovascular illnesses is dependant on how long the person has been overweight. The development of heart failure is increased if the patient is also suffering from high blood pressure and type 2 diabetes mellitus.

5. Stroke
The risk of getting a stroke likewise increases the higher the BMI. For women, the risk of getting a stroke is 75% higher with a BMI >27 and 137% higher with a BMI of >32 than women who have a BMI in the normal range.

6. Mortality (death rate)
A BMI > 25 increases the mortality rate. The increase in the death rate is not so significant up to a BMI of 30. However, a BMI > 30 increases the death rate considerably, regardless of the causes. People affected the most are those with cardiovascular illnesses. They have a 50-100% higher death rate than people with a BMI between 20 and 25.

7. Sleep apnoea syndrome (cessation of breathing during sleep)
One of the main risk factors of being overweight is the development of the sleep apnoea syndrome. About two-thirds of all sleep apnoea syndrome patients are obese.

8. Gout
An increasing body weight concurrently increases the risk of developing gout. Many studies have shown that there is an interaction between the weight and the uric acid production in the blood. The waist/hip circumference correlates more with the increase of the uric acid concentration in the serum, than it does with the weight.

9. Gall bladder disorder
One of the risk factors of obesity is the increased risk of developing gall stones.

10. Orthopaedic complications
Obesity promotes arthritis and back pain as a result of the excessive strain on the spine and the lower extremities (thigh, leg, foot and knee cap).

11. Psychosocial complications
Psychosocial complications are usually caused by the negative societal opinions towards being overweight. As a result of the youth and fitness orientation in the last few decades the view towards obese people has gotten worse. The consequence was that discrimination towards overweight people increased. People who are overweight often do not fit into social circles; they are regarded as unfriendly and less attractive. It has been proven that weight also has an impact on the average income and career opportunities. Overweight people are usually described as "weak-minded", clumsy" and "ugly".


Pounds & Inches: A New Approach To Obesity, Dr. A.T.W Simeons

The CalorieKing Calorie, Fat, & Carbohydrate Counter
Allan Borushek

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