1. overweight and obesity are not taboo subjects!
Overweight and obesity are serious health problems that affect around one in two adults in Germany (Eurostat, 2019). Being overweight means having more body fat than is good for your health (BMI>25). Obesity is an even more severe form of overweight that increases the risk of many diseases (BMI>30).
2 Psychological stress caused by overweight and obesity
Overweight and obesity can affect not only physical health, but also mental health. Many people who are overweight or obese suffer from low self-esteem, depression, anxiety, eating disorders or social isolation. They may also feel discriminated against, stigmatized or bullied, which adds to their psychological distress.
It is important to realize that overweight and obesity are not character flaws or issues of guilt, but complex health problems that require professional help. To this end, we work together with our psychologists/psychiatrists and ecotrophologists/nutritionists at Stephansplatz and can provide straightforward mediation.
3 Causes of overweight and obesity
In addition to an imbalance between the energy you take in through food and drink and the energy you expend through physical activity and metabolism, there are other important factors that can contribute to overweight and obesity. For example:
- Genetics: Some people have a predisposition to put on weight more easily than others. A distinction is made between polygenetic and monogenetic diseases, with monogenetic diseases being far less common. In the majority of those affected, polygenetic, i.e. multifactorial, causes can be assumed as influencing factors:
- Microbiome: The entirety of microorganisms that colonize the intestine also plays an important role in weight regulation. Specific measures in this area are still the subject of current research.
- Medication: Some medications, such as antidepressants, steroids or diabetes medication, can cause weight gain as a side effect.
- Lifestyle: An unhealthy lifestyle that includes little exercise, a lot of stress, irregular meals, too many carbohydrates, fast food, alcohol and sweetened drinks can lead to overweight and obesity.
- Environment: The environment in which you live can influence your eating habits and physical activity. For example, it can be more difficult to eat healthily or exercise if you live in an area with few green spaces, high levels of traffic or few healthy options.
- Hormonal disorders or changes can also affect metabolism and appetite and therefore also weight. The most common endocrine disorders in this context include
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- Thyroid dysfunction (hypo- and hyperthyroidism): The thyroid gland produces too few thyroid hormones, which are important for regulating energy consumption and body temperature. An underactive thyroid can lead to a reduced metabolic rate, lower heat production, increased water retention and weight gain. However, hyperthyroidism can also lead to weight gain in a small number of patients due to its appetite-increasing effect.
- Cushing's syndrome (hypercortisolism): The body produces too much cortisol, a stress hormone that affects blood sugar, blood pressure and inflammatory reactions. An increased cortisol level can lead to an increased appetite, an increased accumulation of fat in the abdomen, a reduction in muscle mass and weight gain.
- Polycystic ovary syndrome (PCOS): The ovaries produce too many male hormones (androgens), which impair ovulation, menstruation and fertility. PCOS can lead to insulin resistance, impaired blood sugar regulation, increased fat accumulation in the abdomen, hair growth on the face and body and weight gain.
- Testosterone deficiency in men (hypogonadism): The testicles produce too little testosterone, which is important for the development of male sexual characteristics, muscle mass, bone density and libido. A testosterone deficiency can lead to reduced muscle mass, increased fat mass, erectile dysfunction, depression and weight gain.
Although hormonal causes are rare overall (approx. 5 percent of all those affected), they should be clarified in the basic diagnostics, if necessary also with further specific test procedures, which we offer in our practice at Neuer Wall.
The diagnosis of a hormonal disorder also requires a thorough medical history, a physical examination and a blood test to determine the hormone levels.
4 Therapy options for overweight and obesity
Depending on the type and severity of the disease, hormone replacement therapy, drug therapy or surgical therapy may be indicated to restore the hormone balance and alleviate the symptoms.
Treatment of a hormonal disorder can also contribute to weight loss by normalizing the metabolism and appetite. However, this is usually not enough to achieve a healthy body weight. It is therefore important to combine hormonal therapy with a basic therapy that includes a calorie-reduced diet, regular physical activity and a change in behavior.
If basic therapy and hormonal therapy do not lead to sufficient weight loss, additional drug therapy options can be considered. Drug therapy aims to inhibit appetite, increase satiety, reduce fat absorption or increase energy burning. The prescription drugs liraglutide 3.0 mg and semaglutide 2.4 mg are currently approved for weight loss in Germany. These drugs can lead to weight loss of 5 to 15 %, but must be taken long-term and can have side effects.
Dr. med. Andreas Frahnow
