Obesity E 66.99

Adiposity, also known as obesity, refers to a greatly increased amount of fatty tissue in the body. In women, one speaks of obesity if the proportion of fat mass exceeds 30%, in men the limit is 20%. The percentage of fat is estimated by means of the body mass index (BMI).

In the western industrialized countries, the prevalence is increasing as a function of age. In Europe, obesity affects about 25% of school children and up to 50% of adults.

Note: In Asia, other BMI values are considered to be indicative of obesity.

Obesity is a multicausal disease and is divided into primary and secondary forms.

Primary obesity (prevalence 95 %), causative factors:

Genetic factors: About 5% of all patients with grade III obesity have a mutation of the MC4R gene (mostly patients with eating disorders). In addition, leptin resistance is suspected as a possible cause. Other possible genetic causes are a gene mutation of GNB3-825T, the FTO gene and syndromes that promote obesity.

Over-nutrition, an unhealthy lifestyle, physical inactivity

Psychological factors (stress, frustration and loneliness): Eating for comfort or addiction can lead to a loss of the healthy feeling of satiety.

Secondary obesity (prevalence 5%) Factors of origin:

Endocrinological diseases like hypothyroidism, Cushing's disease, insulinoma, testosterone deficiency (in men)

Centrally caused obesity: brain tumours; after their surgery or radiotherapy

Obesity is the most common cause of non-alcoholic-fatty liver (NAFL). Obesity is associated with joint complaints (especially hips and knees) and spinal complaints and reduced physical resilience.

In the context of an obesity diagnostic procedure, the following sub-areas should be identified:

• Evaluation of body weight using BMI or Broca's formula
• Determination of the fat distribution type
• Detection of other coronary risk factors
• Recording of a dietary history
• Exclusion of endocrine disorders
• Exclusion of bulimia

In the context of obesity-related disease, the following complications and comorbidities may occur:

• Non-alcoholic fatty liver disease
• Metabolic syndrome
• Obesity is a risk factor for arterial hypertension, stroke and coronary heart disease, sleep apnea syndrome, hypertensive pregnancy disorders, cancers, arthrosis, leg vein thrombosis.
• Hormonal disorders:
• Men: increased aromatase activity of fat cells
• Women: hirsutism, hair loss, seborrhea, acne, secondary amenorrhea, infertility, polycystic ovary syndrome
• intertrigo, striae
• negative influence on cardiac insufficiency
• Depression

Change of diet and calorie reduction

Exercise therapy and endurance therapy

Behavioural Therapy

Possibly obesity surgery (including gastric banding, gastric balloon)

Preventive measures are recommended to improve the way of life already in childhood

Calculation of the BMI = weight (kg) / body surface in m²

• • BMI < 20: Underweight
  • BMI 20-25: Normal weight
  • BMI 25-30: Overweight
  • BMI > 30: Obesity
  • BMI > 40: Obesity per magna
• The limit value for the diagnosis of obesity is a waist circumference (measured at navel height) of 80 cm for women and 94 cm for men.
• The waist/hip ratio is calculated as follows: circumference of the waist/hip circumference. The circumference of the hip is measured at the strongest point above the buttocks. The ratio should be < 1.0 for men and < 0.85 for women.