Obesity clinical picture causes diagnosis diabinfo the diabetes information portal diabetesinform

How is obesity diagnosed?A unit of measurement for the estimation of body weight in relation to height is the so-called
Body mass index, BMI for short, dar. The BMI is calculated from the quotient of body weight (in kg). Body size squared (in m²).

According to the World Health Organization (WHO), adults with a BMI between 18.5 and 24.9 kg/m² are considered to be of normal weight. Overweight is defined as a BMI of 25 kg/m² or greater. Obesity begins at a body mass index of 30 kg/m². A distinction is made between 3 different degrees of obesity.

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Formula for calculating the body mass index (BMI):

BMI = body weight (kg) / height squared (m²)

The higher the BMI, the higher the health risk for further diseases.


Body mass index (BMI) [kg/m²]

Risk of secondary diseases


In addition to weight classification, however, the distribution of body fat also has a strong influence on the risk of developing concomitant diseases. Increased abdominal fat particularly increases the risk of metabolic diseases, such as type 2 diabetes, and cardiovascular diseases. Fat pads that form primarily in the abdominal area are also referred to by experts as visceral fat mass. By measuring the waist circumference, abdominal fat can be assessed.

The Waist circumference is measured in the middle between the last rib and the highest point of the pelvic bone, the so-called iliac crest. In women, a waist circumference of 88 centimeters or more constitutes obesity abdominal (abdominal) obesity Prior to. For men, the definition includes a waist circumference of 102 centimeters or more. If the waist circumference exceeds these limits, the risk of metabolic diseases and diseases of the cardiovascular system is significantly increased. When are children. Adolescents obese?An unhealthy lifestyle – a high-calorie diet and too little exercise – can also lead to obesity in children and adolescents. If obesity is already present in childhood, the risk of other diseases also increases. In addition, overweight and obese children are more at risk of being bullied at school and suffering from depression.

As with adults, children and adolescents' Body Mass Index (BMI) Used as a measure to define overweight and obesity. However, due to growth, the factors of age. gender play a decisive role in the assessment of BMI. Against this background, age- and gender-specific reference values, so-called percentiles, are used to estimate body weight in relation to height in children and adolescents. The calculation of these percentiles for BMI was based on height and body weight data of more than 34.000 girls and boys aged 0 to 18 years from different regions of Germany.

Taking age and gender into account, overweight in children and adolescents is defined as a BMI that exceeds 90. Percentile is. This means that 90 out of 100 children of the same sex and age have a lower BMI. If the BMI exceeds 97. Percentiles apply to children. Adolescents as obese.

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On the website of the German Obesity Society you will find a corresponding BMI calculator for children and adolescents.

How obesity can be prevented? The development of overweight. Obesity can be prevented by several measures. Particularly the Lifestyle A healthy, balanced diet, plenty of exercise and regular weight control are the most important factors in maintaining a normal body weight. Try to eat a balanced diet. Eating a diet rich in fiber. Avoid high-energy foods with lots of unhealthy fats and free sugars. These include, for example, soft drinks, sweet snacks, fast food and fatty sausages. In turn, increase your consumption of foods with a low energy density, such as vegetables, fruits and whole grains. – Try to avoid alcoholic beverages if possible. Try to exercise regularly. Incorporate physical activity into your daily routine.

What are the health risks associated with obesity?

Obesity can result in a variety of health problems that can severely impair quality of life. In addition, overweight and obesity are associated with a reduced life expectancy due to the secondary diseases.

There is hardly an organ or organ system that cannot be affected by diseases related to obesity (obesity-associated).

In addition to a more than 3-fold increased risk of developing type 2 diabetes, obesity can lead to dyslipidemia, hypertension and cardiovascular disease. If these diseases are present at the same time in combination with obesity and a disturbed sugar metabolism, this is also referred to as metabolic syndrome.

Overweight and obese people also have an increased risk of tumors, gastrointestinal, kidney and lung diseases. There is also a link between obesity and hormonal disorders in women and men, such as polycystic ovary syndrome or infertility.

In addition to the medical health risks, psychosocial aspects also play an important role in obesity. Obesity still frequently leads to social exclusion. The consequences can be depression and anxiety disorders, a reduced participation in social events as well as a reduced self-esteem. The limited physical mobility can additionally impair the quality of life, which further increases the suffering of people suffering from obesity.

Generally speaking: The longer obesity persists and the more severe it is, the more difficult it is to treat and manage obesity-associated secondary diseases. In some cases, possible secondary diseases can no longer be reversed.

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Why obesity can lead to type 2 diabetes?

Body weight is closely linked to the risk of developing type 2 diabetes. The duration and severity of obesity play a particularly decisive role: for every 1 kg/m² higher BMI, the risk of type 2 diabetes increases by 20 percent. Researchers suggest that through persistent lack of exercise, an overabundance of energy- and sugar-rich foods, and altered release of messenger substances from adipose tie, obesity promotes the development of insulin resistance.

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Obesity is associated with an increased risk of diabetes.

The body's cells no longer react as sensitively to the hormone insulin and the sugar remains in the blood to a greater extent. The insulin-producing beta cells of the pancreas try to compensate for this by producing more and more insulin. However, this overexertion leads to beta cell exhaustion, which in turn leads to too little insulin being produced. The blood sugar level rises. Type 2 diabetes develops. About 80 percent of all newly diagnosed people with type 2 diabetes are overweight.

How can obesity be treated?

The most important goals of obesity treatment are a long-term reduction in body weight, the therapy or prevention of obesity-associated secondary diseases, and an increase in quality of life. For the best possible success, the treatment goals should be realistic. Adapted to the individual conditions. Losing as little as 5 to 10 percent of one's own body weight has a positive effect on health.

Good to know:

Even a loss of 5 to 10 percent of the initial weight improves health.

In addition, it should be noted that obesity is a chronic disease with a high relapse rate. Therefore, it is crucial to achieve long-term weight control beyond the actual weight loss phase.

From a medical point of view, weight reduction is recommended to the following people:

– Obese people with a BMI of 30 kg/m² or higher. – Overweight people with a BMI of between 25 and 29.9 kg/m² who also have – other diseases, such as high blood prere or type 2 diabetes, – abdominal fat distribution (abdominal obesity) with a waist circumference of over 88 centimeters (women) or 102 centimeters (men), or – increased psychosocial stress.

Good to know:

On the website of Obesity self-help you will find an overview of obesity self-help groups in Germany, Austria and Switzerland.

The basic program for the treatment of obesity consists of 3 pillars: diet, exercise and one's own behavior. Only if no or insufficient weight loss can be achieved through the basic program, can medicinal or surgical measures be used in some cases to treat severe obesity.


In order to lose weight, it is necessary that less energy is supplied to the body than it consumes. Per day, the energy intake should be about 500 kilocalories (kcal for short, often referred to colloquially as just calories) below the individual daily requirement. In this way, a continuous weight reduction of about 1 to 2 kilograms per month can be achieved.

The macronutrient composition of the ingested food plays a subordinate role here. Reduced energy intake can be achieved through reduced intake of fat, carbohydrates, or a combination of both. It is important to decide on a diet that suits you well and can also be implemented in the long term. Smaller exceptions to. Again are allowed.

Especially at the beginning of the therapy, it is recommended to participate in a Nutritional counseling. Within this framework, individual dietary recommendations and goals can be defined according to the personal circumstances and state of health of the person affected.

If, for example, medical reasons require a short-term high weight loss in people with a BMI of 30 kg/m² or more, special diets – so-called Formulas or formula diets – with a very low energy intake (total energy intake 800 to 1200 kcal per day) should be used. However, this should not last longer than 12 weeks. Only be used under medical supervision.

No matter what strategy is pursued, care should always be taken to ensure that the body continues to receive all essential nutrients. Highly unbalanced diets can be associated with high health risks. Do not lead to long-term weight loss success. They are therefore not recommended.


In addition to diet, exercise plays an important role in obesity therapy. Because physical activity leads to increased energy consumption and prevents the loss of muscle mass. In this way, exercise also contributes to weight reduction and stabilization. In addition, exercise has a positive effect on health and quality of life and can contribute to the improvement of cardiovascular, metabolic and psychosocial diseases.

The current guideline for the treatment of overweight and obesity recommends at least 150 minutes of exercise per week. Endurance sports such as hiking, walking, jogging, cycling or swimming are particularly suitable. The type and intensity of exercise should be selected individually according to the patient's state of health and preferences. For BMI over 35 kg/m², sports that are easy on the joints, such as swimming or water aerobics, should be preferred.

Before starting exercise therapy, this should be briefly discussed with the attending physician in order to clarify possible risks in advance.

Furthermore, you should try to keep your Make everyday life more active and incorporate more exercise. There are numerous ways to do this. Here are a few examples:

– Use the stairs more often instead of the elevator. – Refrain from using the car, streetcar or bus for shorter journeys. – Take a relaxing walk in the evening. – Place frequently used tools out of comfortable reach.


In order to reduce body weight and keep it stable in the long term, it is often necessary to adapt previous lifestyle habits in addition to changing dietary and exercise habits. Participation in a Behavioral therapy be helpful.

In behavioral therapy, various aspects and possible strategies are discussed that can help to implement the lifestyle change in the long term and to develop alternative behaviors and problem-solving approaches. It should be tailored in each case to the individual situation of the participants.


If the basic obesity treatment program has failed to achieve any weight reduction, or has achieved only a small reduction, drug therapy can be carried out in addition to nutrition, exercise and behavioral therapy.

The use of drug therapy is possible

– in obese people with a BMI of 28 kg/m² or higher who have additional risk factors, for example prediabetes or elevated blood lipid levels, and/or other secondary diseases, such as type 2 diabetes and cardiovascular disease, and – in obese people with a BMI of 30 kg/m² or higher if they – were able to lose less than 5 percent of their body weight within 6 months with the basic program or – gained more than 5 percent of their initial weight again within 6 months after losing weight.

Furthermore, drug therapy should only be continued if there is a weight reduction of at least 2 kg within the first 4 weeks.

Currently, only the drug Orlistat is recommended for drug therapy of overweight and obesity. Orlistat inhibits the absorption of fats from the intestines. So that calorie intake is also reduced. Common side effects include soft stools, increased bowel movements, and bloating.

If people with obesity also have type 2 diabetes, it is preferable to use blood sugar-lowering drugs, which also have a positive effect on body weight. These include GLP-1 receptor agonists, such as exenatide and liraglutide, and SGLT-2 inhibitors.

The GLP-1 receptor agonist liraglutide has recently been approved in higher doses (3 milligrams per day) for the treatment of obesity alone. However, the drug should be discontinued if a weight loss of 5 percent of baseline weight is not achieved within 12 weeks at a dosage of 3 milligrams per day.

Surgical therapy

Another treatment option is surgical therapy. Experts often speak in this context also of bariatric surgery. It is considered when extreme obesity is present and the basic program (diet, exercise and behavioral therapy) has not produced the desired results for at least 6 months.

For detailed information on the requirements for surgical intervention, the most common surgical procedures, and potential effects and risks, see our background article Obesity Surgery.

How widespread is obesity? In the last decades, the prevalence of obesity. Obesity on the rise. According to World Health Organization (WHO) estimates, the proportion of severely overweight people in many European countries has tripled since the 1980s. In Germany, around 2 thirds of men. Obesity affects half of women. Of these, about a quarter have a BMI of 30 kg/m² or higher and are considered obese.

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