When your weight burdens you too much

What is obesity?

Obesity, commonly referred to as severe overweight, is a chronic condition characterised by an excessive accumulation of body fat. It goes well beyond normal overweight and can have serious health consequences. 

Obesity can range in severity. The most severe form is morbid obesity, where extreme excess weight causes significant limitations in daily life and can greatly reduce quality of life. In addition to symptoms such as shortness of breath, joint pain, increased sweating and reduced mobility, many people also suffer psychologically, for example due to social stigma or a negative self-image. Causes of obesity are varied and often result from a combination of genetic factors, hormonal influences, unhealthy diet, lack of physical activity, and psychological and social aspects.

Many believe that losing weight is simply a matter of “eating less and moving more”. For people with obesity it is much more complex. Their body oftenfunctions differently from that of a person of normal weight, particularly regarding metabolism, hormonal regulation and energy expenditure.

The body is programmed to store fat reserves and retain energy to survive periods of food scarcity. This means that weight gain is favoured and weight loss is made harder. In addition, people with obesity often burn less energy at rest than normal-weight individuals, because their body, due to a slowed basal metabolic rate, stores energy especially efficiently. Even if they eat less, less energy is expended, which complicates the weight-loss process. 

In obesity, hormonal influences on hunger and satiety are also disturbed. The hunger hormone ghrelin is produced in greater amounts, causing a stronger feeling of hunger. The satiety hormone leptin often no longer works properly, so it takes longer for a feeling of fullness to occur. As a result, people with obesity eat more frequently and find it harder to be satisfied with smaller portions. Many obese people have reduced insulin sensitivity. The body produces more insulin to regulate blood sugar. However, a high insulin level inhibits fat burning, making it harder for the body to break down fat.

Radical diets often cause the body to switch into an “energy‑saving mode”: the metabolism slows down to use the few calories efficiently. As soon as normal eating resumes, excess energy is stored as fat, which frequently leads to weight regain—often beyond the initial weight.

Why is obesity dangerous?

Obesity is not just a matter of appearance or well‑being — it is a serious health risk. Studies show that people with severe overweight have a reduced life expectancy. The rule of thumb is: the higher the weight, the shorter the life expectancy. 

The main reason lies in the numerous secondary diseases caused or promoted by excessive body fat. Obesity affects almost all organ systems — from the cardiovascular system and metabolism to the joints and even mental health.

Obesity often leads to high blood pressure and elevated cholesterol levels, which significantly increase the risk of heart attacks and strokes. Thickening of the heart muscle can also lead, in the long term, to heart failure. In obese patients, sugar metabolism is often impaired. Cells no longer respond adequately to the hormone insulin, leading to insulin resistance and ultimately type 2 diabetes. Diabetes in turn increases the risk of kidney problems, nerve damage, vision impairment and cardiovascular diseases.

Excess weight puts stress on the joints — especially the knees, hips and spine. This can lead to osteoarthritis, chronic back pain and reduced mobility. Many suffer from sleep apnoea, a disorder where breathing stops intermittently during sleep. This can cause choking episodes, daytime sleepiness, concentration problems and an increased risk of heart attack. Asthma and other lung diseases also occur more frequently in people with obesity.

Scientific studies show that obesity is associated with a higher risk of cancers, including colon, stomach, oesophageal and ovarian cancers. Hormonal changes and chronic inflammatory processes can promote tumour growth. In the case of infectious diseases, obesity can worsen the course of illness. Obese people often have reduced lung function, so their bodies cope less well with infections.

Obesity is not only a physical disease; it can also heavily affect mental health. Many people suffer from depression, anxiety disorders and low self‑esteem. They often experience social exclusion or discrimination, which further increases psychological burden. 

What causes obesity?

Obesity is a complex disease that is not caused solely by an unhealthy diet and lack of exercise. In fact, multiple factors play a role and can interact. The main causes can be grouped into genetic, lifestyle‑related, psychological and medical factors.

Heredity plays a significant role in the development of obesity. Studies show that people with obese parents have a higher risk of becoming overweight themselves. Genetic factors can influence metabolism, appetite and fat distribution in the body.

A persistent caloric surplus inevitably leads to weight gain. Particularly problematic are energy‑dense and sugar‑rich foods, large portions and frequent snacking, as well as a lack of fresh, minimally processed foods. At the same time, many people burn too little energy due to physical inactivity. Sedentary jobs, little sport and lack of everyday movement contribute to weight gain. 

Emotions strongly influence eating behaviour. Many people eat more in response to stress, boredom or frustration, which can lead to overweight over time. In addition, depression and eating disorders such as binge‑eating often occur in connection with obesity. 

Certain diseases and hormonal disorders can lead to obesity. Hypothyroidism slows the metabolism, resulting in fewer calories burned. Cushing's syndrome causes fat storage due to excess cortisol production. Polycystic ovary syndrome (PCOS) promotes weight gain.
Also, certain medications such as antidepressants, corticosteroids or beta‑blockers can increase appetite or slow metabolism.

Obesity can also be exacerbated by other influences. Lack of sleep can disturb the hormonal balance and increase feelings of hunger. Pregnancy involves hormonal changes and altered eating habits that can affect weight in the long term.

What is the difference between overweight and obesity?

The terms overweight and obesity are often used interchangeably, but they differ considerably. Both describe a weight above the normal range, whereas obesity is apathological form of overweight. Overweight often results from an unhealthy lifestyle, while obesity develops when overweight persists long‑term and additional factors such as genetic, hormonal or psychological influences come into play. While overweight can often be controlled by lifestyle adjustments, obesity frequently requires medical treatment.

The Body Mass Index (BMI) serves as a guideline for differentiation. It is a measure describing the relationship between body weight and stature. The calculation is done by dividing body weight (in kilograms) by the square of height (in metres). A BMI between 25 and 29.9 is considered overweight; obesity is defined from a BMI of 30. Obesity is divided into 3 grades: grade 1 (BMI 30 - 34.9), grade 2 (BMI 35 - 39.9) and severe obesity grade 3 (BMI over 40). 

While overweight is often a precursor of obesity, obesity is a chronic disease associated with serious health consequences. 

Besides BMI, the fat distribution pattern plays an important role. Abdominal fat ("apple type") is more dangerous because it increases the risk of cardiovascular disease and diabetes. Hip and thigh fat ("pear type") is less harmful. An increasedwaist circumference can already indicate an elevated health risk in the presence of overweight (for women, increased risk from 80 cm, substantially increased from 88 cm; for men, increased risk from 94 cm, substantially increased from 102 cm). 

What are the criteria for bariatric surgery?

Bariatric surgery is performed only under certain conditions. These concern the Body Mass Index (BMI), the presence of comorbidities and a comprehensive medical assessment.

BMI is the main criterion. With a BMI > 40 the indication for surgery is generally given; with a BMI 35 - 40 it is considered only if comorbidities such as high blood pressure, diabetes mellitus or chronic joint complaints are present. 

Every patient must undergo a series of examinations. In an endocrinological assessment hormonal causes of overweight (e.g. hypothyroidism, adrenal overactivity, diabetes) are checked. Psychological causes such as depression or eating disorders are also evaluated. Finally, a surgical consultation informs the patient about operative procedures, risks and the process. 

Before planning the operation, additional examinations are required: gastroscopy, nutritional counselling to prepare for the postoperative period, cardiological assessment (heart examination) and ultrasound of the neck vessels. From first presentation to surgery it takes about 6–9 months.

Obesity – what to do in case of severe overweight?

• Prefer whole, nutrient‑dense foods such as vegetables, fruit, whole grains and protein sources.
• Reduce sugar and processed foods and consume fewer soft drinks, sweets and convenience products.
• Eat slowly and mindfully to notice natural satiety and avoid overeating.
• Control your portions by using smaller plates and deliberately managing portion sizes.
• Protein‑rich nutrition helps preserve muscle mass and promotes a feeling of fullness.
• Maintain regular meals to reduce binge episodes and uncontrolled snacking.
• Ensure individually adapted exercise – light strength and endurance training according to your abilities. Strength training promotes muscle growth, increases basal metabolic rate and assists fat burning. Particularly joint‑friendly endurance activities for overweight people include swimming or cycling.
• Integrate more movement into your daily life: take the stairs, go for longer walks, cycle instead of driving. According to recommendations, this should amount to 150 minutes of moderate activity per week.
• Analyse your eating behaviour to identify causes of unhealthy eating (e.g. stress, boredom) and change them consciously.
• Recognise emotional eating patterns and develop stress‑management strategies that do not involve food.
• Keep self‑monitoring through a food diary to raise awareness of your eating habits.
• Set realistic goals. Small, achievable steps help maintain long‑term motivation.
• Seek social support. Participation in self‑help groups or nutritional counselling can be very helpful. 
• In combination with dietary and exercise therapy and under medical supervision, specific medications can be used.
• For extreme obesity, bariatric surgery is recommended. Gastric reduction (gastric bypass, sleeve gastrectomy) should be considered as a last resort for severe obesity (BMI > 40). 

Obesity is a challenge, but not an insurmountable fate. With the right combination of a healthy diet, more activity and conscious behavioural change, sustainable weight reduction and a substantial improvement in quality of life are achievable. In some cases medical or surgical measures can provide support. The crucial thing is to take the first step and keep going — every small improvement brings you closer to your goal.