Home Diseases Adiposity (obesity): forms and causes

Adiposity (obesity): forms and causes

by Josephine Andrews
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Obesity is when you are overweight, which is harmful to your health. Obesity is a chronic disease that is associated with a reduced quality of life and a high risk of complications. Those affected suffer not only from the physical consequences, but also from stigmatization by the environment. Read here what exactly obesity is, how it manifests itself and what you can do about it.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

E66 E65

quick overview

  • Treatment: Nutritional, exercise, behavioral therapy, medication, stomach reduction , obesity cure
  • Symptoms: Unusually strong accumulation of fat in the body, reduced performance, shortness of breath, excessive sweating , joint and back pain , mental disorders, fatty liver , gout , kidney stones as secondary clinical signs
  • Causes and risk factors: Genetic predisposition, unhealthy eating habits, lack of exercise, slow metabolism, various diseases and medications, psychological and social factors
  • Course and prognosis: If left untreated, obesity is a progressive disease with a high risk of complications and a shortened life expectancy. The earlier a treatment or cure takes place, the better the prognosis. Possible consequential damage is diabetes, cardiovascular diseases and various types of cancer.
  • Prevention: Physical activity and a healthy, balanced diet, avoiding or minimizing stress, nutritional advice, obesity is difficult to prevent in the case of triggering diseases

What is obesity?

Obesity or obesity is not a physical problem of people with weak character, but a recognized, chronic disease. It belongs to the group of hormonal, nutritional and metabolic diseases. The World Health Organization (WHO) and the German Obesity Society (DAG) define obesity as an accumulation of fatty tissue in the body that exceeds normal levels and causes damage to health.

Obesity, also known as obesity, puts a strain on the whole body and therefore carries a high risk of secondary diseases – from heart attacks and diabetes to various types of cancer. The fact that a quarter of men and women in Germany are obese is therefore a major social problem. After all, 67 percent of men and 53 percent of women are considered overweight.

Experts are also concerned about the rapid increase in obesity among children and young people. Around six percent of children in Germany are now obese, and a further 15 percent are overweight.

Obesity in childhood and adolescence

If children are already overweight before puberty , they have a high risk of being overweight as adults and thus developing a wide variety of diseases at an early age.

But not only the physical consequences of obesity are problematic: social exclusion and bullying in childhood sometimes lay the foundation for later mental disorders and have a lasting impact on personality development.

There are many reasons for obesity in childhood and adolescence. In addition to genetic predisposition, lack of exercise and poor nutrition play an important role. Parents often pass on an obesity-promoting lifestyle to their children.

Guideline body mass index (BMI)

Being overweight is not the same as obesity. People who are overweight are not necessarily obese. Obesity or obesity usually develops gradually. In order to better assess this development and the status of overweight or obesity, the so-called body mass index (BMI for short) serves as a guideline.

According to the guidelines of the World Health Organization (WHO), a person is considered overweight with a body mass index of 25 or more, and severely overweight (obese) with a BMI of 30 or more. BMI is calculated as weight (in kilograms) divided by height squared (m 2 ). For example, a person who is 180 cm tall would be overweight if they weighed 81 kg and would be obese if they weighed 98 kg.

Based on the BMI value, a corresponding weight status is identified and thus different types of obesity can be subdivided.

BMI table in adults

The term pre-obesity is synonymous with the term overweight and is often used interchangeably, but is not universally applicable. Pre-obesity is considered a precursor to obesity and indicates that people with a BMI greater than 25 have a significantly increased risk of obesity and its complications.

Click here for the BMI calculator for adults

BMI is a guideline for adults, not an absolute measure. Itses are that weakness of gender and age, which are important factors, are not included in the calculation. For children and adolescents who are still physically developing, the so-called percentiles are included in the calculation of the BMI. The percentiles are values ​​​​or a statistical measure to assess the relationship between height and weight of a child in terms of age and gender. The so-called BMI percentile also takes into account the age and sex of the child.

Accordingly, the BMI table for children and adolescents looks like this :

  • Overweight: BMI percentiles > 90 – 97
  • Obesity: BMI percentiles > 97 – 99.5
  • Extreme obesity: BMI percentile > 99.5

Permagna obesity

From a BMI of 40, doctors speak of obesity permagna or obesity grade 3. Those affected are very obese and their quality of life is therefore usually severely restricted. They even find it difficult to walk or sit slowly.

They are particularly likely to suffer from complications such as diabetes and high blood pressure , and their life expectancy is reduced. Self-confidence usually suffers from being overweight, and those affected are stigmatized by their environment.

Losing significant weight is crucial for the very obese to regain health. You can read more about grade III obesity in the article Obesity permagna .

What forms of obesity are there?

How dangerous the fat is depends not only on the amount, but also on where it accumulates. Fat stores in the abdominal region are considered to be particularly unfavorable to health. The so-called visceral fat not only accumulates under the skin , but above all around the organs. The body silhouette with this fat distribution is also known as the “ apple type ” or android fat distribution . It is particularly typical for men.

In women, on the other hand, fat accumulates primarily on the hips and thighs. Therefore, this shape is referred to as the ” pear type ” or gynoid fat distribution . These depots are less harmful to health than those of the apple type, with both forms harboring increased health risks above a certain level of obesity.

What treatment is there for obesity?

Losing some weight in the short term is not enough to treat obesity. In order to avert serious secondary diseases, people with obesity must permanently reduce their weight and normalize their energy metabolism again.

In order for obesity therapy to be successful in the long term, profound changes in lifestyle are necessary. Obesity therapy is always based on nutrition, exercise and behavioral therapy. Doctors call the combination of these treatment methods multimodal conservative therapy (mmk).

nutritional therapy

Changing your diet permanently is not easy. What has crept in as a habit for a long time is not easy to get rid of. People with obesity should therefore receive nutritional advice that is individually tailored to their needs. The personal and professional environment should be taken into account.

It is important that concrete goals are formulated. For example, cutting 500 calories every day. The practical aspects of dietary changes should also be considered. For example, the patients learn what to look out for when shopping and how to cook in a variety of ways with little effort.

In the case of those affected who, in addition to obesity, also suffer from diabetes mellitus, the nutritional therapy is usually also connected to diabetes counseling.

exercise therapy

Movement is a central component of obesity therapy. To lose weight effectively, patients should engage in at least 150 minutes of moderate exercise per week while consuming 1,200 to 1,500 calories. The focus here is usually on strength and endurance sports. If you are very overweight, you should choose sports that do not put additional strain on your joints and skeleton.

behavior therapy

The first step in fundamentally changing your lifestyle is to develop an awareness of the problem. Specially trained therapists help to uncover the emotional causes of obesity and behaviors and patterns that promote obesity.

Many overweight people compensate for negative feelings such as sadness, frustration and stress with food. It is not easy to discard such behavioral patterns that have been ingrained over years or even decades.

With the help of psychosomatic medicine and behavioral therapy, the patient opens up new ways of replacing unhealthy behavior with healthier ones. This theoretical knowledge is consolidated and practiced in practical exercises.

If this basic therapy consisting of nutrition, exercise and behavioral therapy does not lead to the desired result or if it does not promise sufficient success due to the extent of the overweight, medicinal or surgical measures such as a stomach reduction can also be considered.


There are countless pills and powders that are designed to help you lose weight. For example, by supposedly curbing appetite, boosting metabolism or channeling certain food components such as fats through the intestines undigested . These are called anorexics.

However, many over-the-counter remedies are expensive and ineffective at best, and hazardous to health at worst. Talk to your doctor about useful medication to help you lose weight.

Stomach reduction (bariatric surgery)

There are various methods for reducing the volume of the stomach. A gastric band or gastric balloon prevents you from eating large amounts of food. They are reversible – but also have a lesser effect than surgical stomach reduction (bariatric surgery).

A simple gastric sleeve, or gastric bypass, can be surgically created , which also involves bypassing part of the small intestine so that less of what has been eaten is absorbed by the body.

It is interesting that gastric surgery is often accompanied by astonishing changes in metabolism. For example, diabetes often improves quickly and drastically as a result. Stomach reductions are usually very effective weight loss measures. However, they always represent a major intervention in the body anatomy and can no longer be reversed.

In Germany, it is possible to apply for a stomach reduction surgery if you have a BMI of 40 or more, or if you have a BMI of 35 or more if you have secondary diseases such as diabetes. You can read more about this in the article Stomach reduction .

obesity cure

The goals and components of an obesity cure correspond to those of the basic therapy: a change in diet, a sports program and behavioral therapy measures. However, as part of an obesity cure, a much more intensive treatment takes place. The change in lifestyle is also easier for many patients if it takes place in a different environment.

Obesity cures are usually carried out by rehabilitation clinics or special obesity clinics. There are both inpatient and outpatient options. The cure must be applied for together with a doctor. You can read about the requirements for a cure and how to make an application in the article Obesity cure .

Signs of overweight or obesity

The more pronounced the excess weight is and the longer it has existed, the greater the physical symptoms are usually. The risk of secondary diseases also increases. The messenger substances that are formed in the fatty tissue, so-called adipokines, also contribute to this. While there are quite a few in the overweight segment who are physically fit and healthy, the obese are unlikely to be.

Main symptom abnormal accumulation of fat

The main symptom of obesity is excessive accumulation of fat deposits in the body. They put a strain on the body with the sheer burden that it then has to carry. Due to the increased stress, the body needs more oxygen and nutrients.

The fat deposits are also not just fat stores. They produce messenger substances that negatively affect metabolism and many other bodily functions.

Limited physical ability

Being overweight puts particular strain on the heart and circulatory system. Even minor physical exertion is sometimes a strenuous undertaking. This is partly due to the weight load, but also because more blood flows through the tissue overall.

The limited physical performance is primarily noticeable through shortness of breath or shortness of breath. This occurs when the heart and lungs are not able to compensate for the increased oxygen demand and there is therefore a lack of oxygen in the blood and tissues.

Since any physical activity is very strenuous because of the weight and uncomfortable because of the shortness of breath, many people with obesity shy away from physical exertion. However, lack of exercise is one of the main causes of obesity. Those affected often get caught in a vicious circle of lack of exercise and weight gain, which drives their weight up and up.

joint wear

In addition to the cardiovascular system, the musculoskeletal system in particular suffers from obesity. Due to the high load on the joints, they wear out prematurely. In the process, the fine layer of cartilage in various joints is gradually irreparably destroyed (arthrosis). Knees, hips and ankles are particularly commonly affected. Obesity also often leads to premature wear and tear of the intervertebral discs between the vertebrae and sometimes also causes a herniated disc (herniated disc).

Increased sweating (hyperhidrosis)

Many obese people sweat profusely. One reason for this is the increased physical strain caused by weight, another is the poorer heat dissipation via the fatty tissue. Those affected are very uncomfortable with their profuse sweating.

reflux (heartburn)

In many cases, the fat stores in the abdomen continuously press on the digestive organs, for example on the stomach . Acidic gastric juice is then forced back up into the esophagus , causing heartburn there. In the long term, the acid attacks change the cells of the esophagus: a so-called Barrett’s esophagus develops, which may develop into cancer.

sleep apnea

People with sleep apnea syndrome (SAS) experience pauses in breathing during sleep. The most common form of this disease is the so-called obstructive sleep apnea syndrome (OSAS). The muscles in the upper respiratory tract relax during sleep. This impedes the airflow of normal breathing and sleep quality is poor. This is often the case in overweight people.

People with sleep apnea are often very tired and lack concentration. The lack of recovery during sleep also puts a strain on the psyche.

Varicose veins (varicosis) and thrombosis

Varicose veins are more common in obese people . This is an enlargement of the superficial veins on the legs. Pronounced varicose veins carry an increased risk of blood clots (thrombosis) in the leg veins.

It has not yet been clearly clarified why people with obesity are more prone to varicose veins. The comparatively weaker connective tissue of obese people may be the reason. Researchers also suspect that the fat cells release a number of messenger substances that weaken the vessel walls of the veins.

mental problems

People with obesity are often stigmatized because of their weight. Surveys show that two-thirds of Germans suspect the reasons for obesity to be laziness in exercise and overeating. Most respondents assumed obesity was self-inflicted. Those affected are often confronted with these sweeping assessments in everyday life. Social withdrawal and possibly increased comfort food are possible consequences.

Stigmatization often triggers numerous mental illnesses: people with obesity, for example, suffer more from depression and anxiety disorders. Children and young people are particularly affected by social isolation and rejection by their peers. In some cases, negative formative experiences at this age massively damage the mental stability of the adolescents and thus cause lasting mental disorders.

Other clinical signs of obesity

  • Gallstones (cholecystolithiasis) : Obesity is one of the most important risk factors for gallstones. Obese people often have high cholesterol levels . When cholesterol crystallizes, gallstones form, sometimes causing abdominal cramps (colic). Cholesterol stones are the most common type of gallstone in industrialized countries.
  • Gout (hyperuricemia) : Obesity often increases blood uric acid levels. When the uric acid in the blood has exceeded a critical concentration threshold, it crystallizes out. The uric acid crystals are then deposited in the joints, where they become inflamed and cause a gout attack with great pain.
  • Fatty liver (steatosis hepatis) : If a person eats too much and too much fat, this also puts a strain on the liver . It stores ever larger amounts of fat – a so-called fatty liver develops, which usually does not cause any symptoms for a long time. It becomes really problematic when the liver begins to scar and remodel itself: a shriveled liver (liver cirrhosis) forms.

Causes and risk factors

There are numerous individual factors that have a significant impact on metabolism and thus on individual energy balance and weight. These include the genetic makeup, the mother’s diet during pregnancy and also the hormones . Therefore, someone who is overweight does not necessarily eat more or exercise less than a lean person.

The causes of obesity go far beyond overeating and not exercising enough. A whole range of factors seem to influence and reinforce each other. The exact mechanisms have not yet been fully elucidated. However, it is becoming apparent that the disease tends to take on a life of its own: the more pronounced the overweight, the more stubbornly the body defends the extra pounds.

Eating behavior (alimentary obesity)

Anyone who eats too much and is also very high in calories is more likely to gain weight. But how much is too much depends on many factors and varies from person to person.

Some researchers are also of the opinion that it is not the total amount of calories that is decisive for the development of obesity, but the composition of the diet. For example, that oils with polyunsaturated fatty acids accumulate less than saturated fat. Or that sweets make you fatter than vegetables with the same amount of calories.

Still other hypotheses state that longer breaks in eating, in which the body has time to break down food stores, help to become or stay slim. Anyone who eats something in between meals is more likely to gain weight with the same calorie intake. Experts therefore recommend at least four calorie-free hours between meals.

lack of exercise

If the daily calorie balance is “positive”, ie more calories are consumed than consumed, you gain weight. So if you like exercise, you can eat more without gaining weight. On the one hand, more energy is of course consumed during the movement itself. But there is also the so-called afterburn effect: Even after the activity has ended, the body uses more energy than usual for a while.

It is not only the current level of movement that is decisive: if you move little, you have less muscle mass. Even at rest, muscles consume more energy than fat tissue, for example. If the muscle mass decreases, the so-called basal metabolic rate also decreases, ie the body’s energy requirements at rest.

The problem is that social networks tempt young people in particular to spend the day sitting with virtual friends rather than actually exerting themselves physically or being active in sports.

More and more adults are also leading a lifestyle that makes them susceptible to being overweight: many employees spend a large part of their time on the computer. Cycling and walking have been replaced by driving or public transport, and climbing stairs has been replaced in many places by escalators and elevators.


The basal metabolic rate depends on other factors. There are actually people who eat normally and still get fat. They are called “good feed converters”. That sounds good at first, but is problematic in times of an overly large supply of food. This is partly predisposition, but is sometimes caused or exacerbated by dieting. Then your metabolism slows down.

On the other hand, there are also very slim people who eat a good amount of food – without moving too much to compensate.

Obese people also lose less thermal energy due to the insulating layer of fat under the skin. Therefore, they have to convert comparatively less energy into heat, so they burn fewer calories.

Environment shapes eating habits

Eating habits are significantly shaped in childhood and adolescence. A growing number of children are not learning how to eat properly, either at home or at school. For example, uncontrolled access to sweets disrupts the natural rhythm of hunger and food intake: as a result, children and young people eat constantly.

Families often lack the time to cook and eat together. Fast food offers often fill the gap. As a result, some consume high-calorie convenience foods practically around the clock. Sugary, greasy foods are also usually much cheaper than high-quality foods.

genetic causes

Genes play a major role in the development of obesity: The results of twin studies suggest that obesity can be traced back to genetic causes in around 40 to 70 percent of cases.

However, it is currently still unclear how many genes are actually involved in the development of obesity and in what way. Around 100 genes are known to date that are suspected to be linked to overweight and obesity.

In particular, the “FTO gene” is the focus of obesity research. The gene appears to be involved in appetite control. People with a mutation in this gene may have a delay in eating and may therefore gain weight more easily.

An “individual target weight” is probably also genetic. The underlying mechanisms are so far completely unclear. However, studies with adopted children speak for such a genetically programmed target weight: In these studies, the weight of the adopted children in adulthood was less often the same as that of the adoptive parents, but more often the weight of the biological parents and siblings .

Epigenetic Programming

It’s not just the genes themselves that have a big impact on weight, but also how active they are in the body. A large part of the genes is even completely muted and is not used at all.

Which these are influenced, among other things, in the womb. If the mother is overweight or develops gestational diabetes, the children are often born large and heavy. Your risk of obesity is then high because the body is used to an oversupply of food. The child has a lifelong tendency to overeat. In addition, his body tolerates higher blood sugar levels.

Before birth and in childhood, the so-called epigenetic imprint is particularly strong. But the living conditions are also decisive in later life. Sport, stress, hunger or constant overeating – all these factors often change the functioning of the body’s cells. The good news is that with a healthier lifestyle, even in adulthood, many negative genes can be turned off and positive ones turned on.

Diseases as a cause of obesity

Certain diseases and medications also promote weight gain and thus obesity. Then experts speak of secondary obesity .

  • Polycystic ovary syndrome (PCOS): Around four to twelve percent of women of childbearing age have this cystic disease of the ovaries (ovaries). Menstrual cycle disorders and obesity are characteristic of PCOS.
  • Cushing’s disease (hypercortisolism): In this disease, the adrenal glands release an unnatural amount of cortisone into the blood. If the blood level is permanently elevated, the hormone cortisone causes a strong increase in weight, especially in the trunk (“stem obesity”).
  • Underactive thyroid (hypothyroidism): If the thyroid is underactive, the thyroid hormones T3 and T4 are not produced in sufficient quantities. Among other things, they regulate energy turnover, which is lower than normal when there is a lack of T3 and T4.
  • Testosterone deficiency in men (hypogonadotropic hypogonadism ): Due to insufficient hormone production in the pituitary gland ( pituitary gland ) or diencephalon ( hypothalamus ), men with this condition produce less testosterone . This also promotes fat storage.
  • Genetic syndromes: People with Prader-Willi syndrome (PWS) or Laurence-Moon-Biedl-Bardet syndrome (LMBBS) are often extremely obese.
  • Mental illnesses: People with depression or anxiety disorders often also suffer from obesity. Eating serves as a short-term relief for the psyche. The psychological stress, in turn, may increase as a result of increasing body weight, causing those affected to eat even more to feel better again.
  • Binge Eating Disorder: Binge Eating Disorder, in which those affected repeatedly have binge eating, can also cause severe weight gain.


Some medications have the undesirable side effect of stimulating appetite or increasing water retention. These drugs include:

  • Antihistamines (medicines for allergies)
  • Psychotropic drugs such as antidepressants and antipsychotic drugs
  • Cortisone for long-term and/or high-dose use
  • Antidiabetics , especially active ingredients such as glibenclamide ,glimepiride , nateglinide and repaglinide
  • Blood pressure medications, especially beta blockers
  • Antiepileptics, for example valproic acid and carbamazepine
  • Migraine medications such as pizotifen, flunarizine, or cinnarizine

Waist circumference risk factor

As a rule of thumb, a waist circumference of over 80 cm is considered risky for women and over 94 cm for men. This increases the risk of stroke and type 2 diabetes, among other things. With a waist circumference of more than 88 cm in women and 102 cm in men, the risk is even significantly higher.

investigations and diagnosis

If you have problems because of your increased body weight or if you gain weight for no apparent reason, seek advice from your family doctor first. In the so-called anamnesis interview, he will first ask you a few questions in order to narrow down the possible causes:

  • How long have you been overweight?
  • Have you ever had problems with your weight?
  • Are you still gaining weight?
  • Do you have physical complaints such as back pain, knee problems or shortness of breath?
  • What does your daily meal plan look like?
  • Do you exercise regularly?
  • Do family members (parents, siblings) have problems with being overweight?
  • Do you regularly take medication?

Determination of the body mass index

The doctor determines the extent of obesity by first calculating the body mass index.

Since the BMI is only a guide value and gives a first indication of possible obesity, the doctor usually takes other measurements that more clearly limit the extent of overweight and the risk of secondary diseases. This includes, for example, waist and hip measurements.

blood tests

Blood lipid levels are often elevated in people with obesity . Therefore, the doctor also examines the cholesterol and triglyceride levels.

The liver often suffers when you are overweight. The liver values ​​provide information about this.

If there is a suspicion that the obesity is hormonally related, the doctor determines various hormones in the blood, for example the thyroid hormones.

Cardiological examinations

If the patient complains of shortness of breath and shortness of breath, further cardiological examinations are necessary. Although a massively increased body weight is in many cases the explanation for shortness of breath, heart disease sometimes triggers these symptoms. The following are mainly used:

  • Cardiac catheterization, for example if there is reasonable suspicion of coronary artery disease, cardiac insufficiency or a heart valve defect

Studies in children and adolescents

The first point of contact for obesity at this age is the pediatrician. This clarifies whether a forwarding to an obesity center is necessary. Doctors also use the BMI to determine obesity in children and adolescents. However, age and gender are included in the calculation (BMI percentiles). A BMI calculator for adults is therefore not applicable for calculating BMI for children.

Course of the disease and prognosis

Obesity is rapidly becoming a global problem. The German Obesity Society estimates that around 16 million people in Germany are currently obese, and the trend is rising. Obesity does not appear suddenly, but develops over years or decades. Adults between the ages of 30 and 60 are mostly affected. Severe obesity not only limits the quality of life, it increases the risk of various serious diseases. The reason for this is, among other things, messenger substances that occur in fatty tissue. For example, they trigger chronic inflammatory reactions in the body.


A possible consequence of this chronic, silent inflammation is type 2 diabetes, which occurs primarily in overweight people. Atherosclerosis is also common in people with obesity. Hardening of the arteries, in turn, is the cause of the two most common causes of death worldwide: heart attacks and strokes.

Also, various cancers are more common in obese people. There is a particularly strong connection between obesity and breast cancer, but also other types of cancer such as colon cancer , esophageal cancer , renal cell cancer, uterine cancer and pancreatic cancer .


A person becomes overweight or obese if he supplies his body with more energy than he uses (positive energy balance) over the long term. Food intake and exercise are two parameters that can be used to influence weight.

Losing weight is difficult for most people. So get professional help if you are severely overweight. Even a comparatively small weight reduction improves the metabolism significantly and thus reduces the risk of secondary diseases. Exercising is especially important for overweight people. Physical activity not only helps you lose weight, it also improves the metabolism in your body.

With enough physical activity and a balanced diet, the development of obesity can already be prevented. For example, people who also have an increased risk of obesity should eat sweets, high-fat foods and snacks, and sweetened beverages in moderation. Instead, regular meals are beneficial. Experts recommend three main meals and a maximum of two snacks. If you get hungry or just have an appetite, fruit and vegetable snacks are a good idea.

Unsweetened tea and water are ideal drinks because they don’t contain any added sugar. Drink enough and especially before you eat anything. Often what appears to be appetite or hunger is simply thirst. Experts strongly advise against forcing children and young people to always empty their plates. They often receive portions that are too large. It is better to serve smaller meals and add a little more if necessary.

Prohibitions and waivers, for example about diets, are not very successful. Such measures should be avoided, especially in childhood. Positive stimulation and education, on the other hand, are good ways to make the child feel good and develop a healthy attitude towards eating. Nutritionists will provide you with support if you need help with this. Talk to your family doctor or, if necessary, your pediatrician.

Other triggering factors such as stress or illness, on the other hand, are not so easy to counteract. Recognizing these triggers is often difficult and usually only possible with medical advice. So ask your family doctor if you suspect it.

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