Obesity is a term for severe obesity by going beyond the usual degree increase in body fat, often with ill effects. There are three degrees of severity. The distinction between the different degrees of severity is usually done on the body mass index (BMI) with a BMI equal to or greater than 30
Definition and delimitation of obesity
Obesity is synonymous with obesity and excess body fat. Excess weight is inter alia using body mass index (BMI) were measured and classified. A particular disadvantage are fat deposits in the abdomen and internal organs. Indicators of the proportion of body fat and its distribution are the abdominal circumference and the waist-hip ratio (see figure test www.aiqum.co.uk)
BMI to the first self-assessment
Category (according to ), BMI (kg / m˛)
Normal weight 18.5 to 24.9
Overweight 25 to 29.9
Obese Class I from 30 to 34.9
Obese Class II from 35 to 39.9
Obese class III 40
On the basis of body weight and BMI, only limited statements are made about the risk of accompanying diseases such as cardiovascular disease. For the cardiovascular risk is less the scale of the obesity rather than the fat distribution pattern is critical. Particularly detrimental effects here fat deposits in the abdomen (especially the greater omentum) and the internal organs. This inner abdominal fat - Experts call it intra-abdominal fat, visceral fat is metabolically very active. It affects the fat and carbohydrate metabolism (sugar metabolism), so that the fat metabolism disorders and diabetes occur.
An initial self-diagnosis is simple: to measure waist circumference. An increased risk is inches in front for women over 88, men begin the risk range from 102 cm.
Sporty highly trained people have a lot of muscle tissue of high density and can thus achieve a high BMI without too much fat or overweight have to be. However, they are thus outside the area of obesity was relatively clearly identified as a risk factor for cardiovascular disease.
The previous limit of 30 kg / m˛ applies not for Asians - because of risk assessments, the WHO proposed here limits of BMI of 23 kg / m˛ for obesity, and 25 kg / m˛ for obesity .
[B] causes of obesity [/ b]
The following causes must be distinguished:
1. genetic factors
2. poor diet and too much of a hand, too little exercise (energy expenditure) on the other
3. disturbed eating behavior as an addiction
Obesity occurs more frequently in industrialized countries, where only a few people doing hard physical work and an abundance of food is available. The so-called emerging countries but also increasingly affected. Numerous studies have examined the relationship between BMI and food intake. The results of the VERA study  was surprising - there was no connection between the calories and the observed BMI. However, there were clear indications that the people studied usually too much fat - especially unhealthy saturated fat - and too few vitamins and minerals is increased.
Genetic factors for obesity
Genetic factors (hereditary) influence the metabolic rate, food utilization and the fat distribution pattern. The food utilization was in the days of hunter-gatherers is an important survival feature: who could save the excess into fat cells, could live on them in times of scarcity. Twin studies have shown that obesity has a strong genetic component.
Socio-cultural factors in obesity
Socio-cultural factors (nutrition sociology) to seduce both over-nutrition, as well as to malnutrition and lack of exercise:
Reduced movement by car, lift, escalator
Passive leisure (television, computer games, hanging out
Frustration, boredom, stress
Of goods on offer
As a substitute food for emotional and personal attention
Education: the dish is eaten empty, what will you eat, then you know what!
No common meals, convenience foods instead of freshly cooked meals from basic foodstuffs
Food in front of the TV or the movies, reading, eating, eating breakfast in the car on the way to work, drive-in counters at fast-food chains + eat in the parking lot, etc.
Negative role models: obese parents often have overweight children
Fast Food: Portion size, Essgeschwindigkeit, too high in fat, salt and sugar, not enough filling.
Glutamate flavor enhancer (prevents satiety)
Color and odor compounds that make the food appear more appetizing
Advertising of sweets and fat
Taste imprint of added sugars (soft drinks, baby food, sweetened tea, and even sausages () contain sugars!)
Yo-yo effect after a diet (by relapse into old eating habits)
Overweight ideal of beauty in some cultures
Lack of information, lack of education, lack of alternative products such as sausages reduced their fat content, while the animal fat is replaced by vegetable oil. [/ List]
The increasing prevalence of obesity in Western countries also correlates with the shortening of sleep, the higher average temperature in houses, the decrease in the number of cigarettes smoked and the increase of the weight of the ancestors. People with higher body weight and obesity have more children is also caused by genetic factors, and therefore also by the proportion of obese people in the total population. The increase in life expectancy also plays a role, because, among 40 - to 79-year-old obese patients, the proportion is about three times as high as among younger ones. The increasing use of antipsychotic drugs could also be an increase in obesity rates have caused. There are indications that the increasing prevalence of pesticides, dyes, flavors and aromas, plastic or solvents favors obesity. An older mother is a risk factor for the child to be overweight, and mothers were the last decades of aging. Marry rather obese and obese children conceived therefore an increased genetic risk have to be obese themselves .
[B] Pathological factors of obesity [/ b]
Eating disorders and addiction are to be assumed whenever consumed without feeling hungry and often obsessively large amounts of food. The causes of eating disorders and addiction see there.
Metabolic diseases are only about 2% of cases the cause of obesity: thyroid function, disorders of steroid metabolism (Cushing syndrome). Some drugs can promote weight gain: hormones, antidepressants, antipsychotics, corticosteroids. Suspected a connection with an infection by the adenovirus type of HAdV-36.
[B] consequences of untreated obesity [/ b]
Obesity is correlated with a number of serious diseases. This may be meant
that cause these diseases, obesity,
That obesity leads to other factors (cofactors) for these diseases or
That obesity and these diseases can be observed in scientific studies at the same time (in the sense of an ambiguous interaction, correlation) or
That they may have a common unknown cause. [/ List]
Of the listed consequences of obesity often exists only a correlation. Whether the cause is obesity really is so unclear. To be on the risk of these diseases but still associated with the consequences of obesity, although this is not often shown not clearly provable or even possibly (but not yet proven) is wrong.
Overweight and obesity (obesity), high risk factors for developing cardiovascular disease. Come two of the risk factors diabetes (diabetes), dyslipidemia (elevated cholesterol, or LDL) and high blood pressure added, the risk of cardiovascular disease (cardiometabolic risk factors) clearly increased, as is the risk of premature death.
Obesity contributes to increased incidences of many diseases of civilization. It increases the risk for hypertension (high blood pressure), diabetes mellitus type 2 (adult onset diabetes, diabetes), reflux, heart attacks, atherosclerosis, strokes, breast cancer, arthritis and osteoarthritis, joint pain, foot deformities (stem), gall bladder disease, gout and obstructive sleep apnea syndrome . The danger of a weak veins / vein thrombosis, also caused by obesity, has long been misunderstood. If the BMI in middle age from 25 to 29.9, the mortality risk is increased by 40%.  Other studies have come to the conclusion that people with slightly overweight, the lowest mortality risk.  Obesity reduces fertility. 9 kg weight gain increases the chance of infertility by 10%. 
The psychological consequences of obesity are serious. Sufferers often feel a failure and outcast. Often, psychological and even economic damage to those affected, because obesity is not tolerated by society and affected patients are often excluded professionally.
The thoroughly well as financial and socio-economic consequences of obesity are enormous. Serious damage to the supporting and musculoskeletal system (joint, muscle tension, bone deformation, damage to ligaments, tendons and bursae, scoliosis and herniated disc and bone growth disorders in children and young people) can lead to numerous secondary treatment and major surgery.
[B] Neurobiology [/ b]
Why is it that most people do not take off permanently, although they are under enormous pressure gesellschaftlickem, doctors strongly recommend this, and they spend lots of time, energy and money? The old energy balance model, which saw only the energy intake and energy consumption, was not able to explain this. Most people seem to have a relatively stable set point, the differences in the weight up or down again headed . In weight regulation seems to act in a feedback loop. The set-point changes during the course of a life mostly upwards. Through advances in molecular biology is beginning today to understand how this thing could loop .
To achieve an energy balance of the weight control circuit has different sources:
Leptin is a hormone that is produced in fat cells. The more fat in the fat cells is, the higher is the concentration of leptin. Primary informing the CNS if the body is starving now. It also inhibits the appetite. Most thicknesses seem to be suffering from a Leptinresitenz. There are two main explanations: a defect in leptin transport across the blood-brain barrier and a defective leptin receptor.
Insulin is produced in the pancreas. It regulates the concentration of glucose in the blood. Mice whose neurons are suffering do not have insulin receptors with mild obesity.
PYY, GLP-1, oxyntomodulin and CCK are produced in the gut and reduce the feeling of hunger.
Ghrelin is a peptide that is formed in the stomach. It looks appetizing. [/ List]
All this information is processed in the central nervous system and regulate appetite, energy expenditure, hormone levels and growth.
Treatment of obesity
Depending on the cause, different treatments are indicated. Realistic goals are a slight weight loss or stabilization of weight.  Long-term treatment results have not yet been demonstrated. A combination with nutritional, behavioral and exercise therapy does not change anything. 
[B] weight loss [/ b]
The fact that increases with BMI and mortality risk, but can not be concluded that losing weight reduces the risk of mortality. It's just not clear whether someone who has lost 10 kg, then just as healthy as someone who always had a lower weight. The studies that dealt with the intended weight loss and mortality yielded no clear results. Some even came to the conclusion that losing weight increases the risk of mortality. So if there is no evidence that losing weight helps to drive the health there are certainly patients who benefit from a weight reduction. In diabetes or high blood pressure, weight reduction is appropriate.  There is evidence that a diet after a heart attack may worsen the survival rate of patients . The fact that weight loss reduces the risk of cancer is not documented 
However, weight loss is often difficult: the fat reserves on the hips and abdomen are created only once, build it from the body difficult. Especially with obesity, the treatment proves to be very difficult. In particular, setbacks or lack of success cause the patients (and dentists and their relatives) often to abandon the project altogether. There are also often co-morbidities that complicate the suffering of patients and must be treated in parallel. It makes more sense, therefore, the early practice of a healthy lifestyle to avoid weight gain.
Diet and exercise
[B] diet [/ b]
Nutrition and physical activity are largely a matter of habit. For patients without mental illness elements, a simple information for healthier food and support for the change in diet and more exercise may well succeed. However, it is not entirely scientific evidence that diet provides the best remedy. Most are advised to avoid more fiber (see also whole foods) and fats, and food would be with a high proportion of saturated fats are replaced by foods with more essential fatty acids, or the total fat intake should be drastically reduced. Increase physical activity is the main antagonist in the energy balance. Especially endurance sports such as cycling, swimming, hiking and jogging are - performed consistently over months and years - losing weight.
[B] eating disorders [/ b]
In an eating disorder usually several weeks of therapy in a specialist clinic is required (see: Psychosomatic clinic), supplemented by regular long-time employees in a support group (such as Overeaters Anonymous).
[B] therapy [/ b]
If a behavior change in diet and exercise is difficult, it is clear that obesity is not only a civilization phenomenon, but behind it and any cause serious mental health problems. To overcome this, a purpose-oriented psychotherapy is required. The aim is to identify the individual causes of the eating disorder and to learn alternative behaviors. Has also proven the therapy in a group. In parallel, the person concerned is working regularly in a support group with like-minded people.
Inpatient or outpatient rehabilitation at a specialist clinic for eating disorders and psychosomatic clinic is an excellent start on the path to changing behavior and lifestyle. It is usually funded by health or pension insurance.
[B] diet [/ b]
Given the multiple causes for the development of overweight and obesity, there is no single measure alone ends the derailment of the weight term. Many suppliers of diets, it always manages to convince the people concerned as their special way so that they are able to their eating habits for the duration of the diet entirely be based on the diet rules. It is often very fast radical weight losses. If the diet but do not lead to the time of the diet also realized fundamental change in the overall eating and exercise habits to get in after the diet by the old habits again. This, and the yo-yo effect is the excess weight again inevitably. As an introduction to a new eating and lifestyle are all but diets that lead to better selection of food to their professional preparation and wise allocation of food intake during the day. An important aid in the efforts to achieve a lasting weight control, regular physical activity sufficient. eating aids, such as the introduction to other tastes as sweet, fat and calories and control appetite by drug Esshormons awakening of serotonin can only be complementary tools. Without the comprehensive change in the eating and exercise habits, they do nothing.
For the change in eating and exercise habits is difficult, the cause must be found and fixed. In particularly difficult cases, permanent relief from the pressures of hunger are also valuable. Pharmacological therapy should also be performed exclusively by the physician. In the U.S., often there is the-counter 5-hydroxy-tryptophan (5-HTP) except for the improvement of sleeping and waking behavior as antagonists of serotonin for a reduction in body weight taken over time. Adequate studies are here about it yet, but it is reported only minor side effects. The constant intake of 5-HTP Vorhormons needed the medical checks, especially since it is not only in the cerebrospinal fluid of the brain, but throughout the body. When hunger control by serotonin reuptake inhibitors and in the only one in Germany nor approved appetite suppressants referred incorrectly drug sibutramine (trade name Reductil ®) has been significant physical side effects. Long-term use of 5-HTP can be observed therefore critical. Recently, the active substance is rimonabant approved, but again be without change in diet and more exercise hardly achieved results.
Average weight loss drug over placebo
Sibutramine  2.8 to 4.4 kg
Orlistat  2.8 kg
Rimonabant  4.5 kg
If all conservative treatments fail, the obesity surgery is used.
[B] prevalence of obesity [/ b]
As the epidemiological data show that obesity takes in all countries where an adequate food supply for at least parts of the population exists. Possible genetic causes are denied on the grounds that the gene pool of the population did not in the past decade or two changed significantly. This is made by others with regard to an effective selection pressure over millions of years in question, the selection pressure made the people to champion energy efficiency. Thousands of years ago he was settled there, where favorable environment allowed agriculture and food more convenient. In essence, nothing else is happening today. The settled life relates to their own four walls, including the car can be counted. So it was no wonder that hardly any of the many diets offered a lasting effect and that hardly a program to reduce obesity was consistently successful so far.
Obesity as a complex disease affects all social classes and age groups (but not in equal measure) and is not limited to the industrialized countries. Were in 1995 still 200 million adults worldwide are obese, they were in 2000, 300 million, of which 115 million in developing countries. Were in Austria in 1991, 8.5% of adults were obese, they were in 2000 already 11%. Across Europe, 10-20% of men and 15-25% of women were obese. Here, a rise in obesity prevalence south and east is observed. This also applies to Austria, with the highest percentage of overweight in the east and the lowest share in the Tyrol and Vorarlberg.
In Germany, for decades seen a rise in prevalence. Says Wieser in 1999 to only half to one third of the population to a medically desired BMI 24.9. According to census-up survey of 2003 were 12.3% of men and 11.3% of women over 18 were obese (ie BMI 30 or higher). 
Worldwide, according to WHO, over 300 million people with obesity. Once the problem was limited for decades to the wealthy industrialized countries, is observed in recent times an increase in nutrition-related diseases in developing countries like India or China.
In the U.S., according to estimates by the CDC, 30% of the population have a BMI above 30 kg / m˛ and are thus considered as obese. In the U.S., found that socially disadvantaged (uneducated, poorer), and disadvantaged minorities (Indians, Blacks) are affected much more overweight than other, more privileged population groups, and also have a lower life expectancy. 
[B] References [/ b]
1. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation .. In: WHO (ed): WHO Technical Report Series. 894, 2000
2. Steering Committee of the Western Pacific Region of the World Health Organization, The International Association for the Study of Obesity and the International Obesity Task Force (2000): The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Melbourne: Health Communications Australia Pty Ltd, 2000:8-56.
3. VERA-Schriftenreihe: Food and nutrient intake in Germany (1985-1989), Volume XII, Scientific
Fachverlag, low-Kleen, 1994.
4. New Scientist, quoted in Alison Motluk, Super-size surprise, 4 November 2006, p. 34ff
5. Even mild obesity affects life expectancy, MMW-Fortschr. Med No. 51-52 / 2006 (148th date), p. 28
6. Flegal, KM et al (2005) Excess deaths associated with underweight, overweight, and obesity, Jama 293:293-294
7. Source: National Institute of Environmental Health Sciences
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