Adiposity and a growing body-mass-index increase the risk of complications and associated secondary diseases (sequelae). Malicious is that these illnesses begin without symptoms or pain.
An increasing body weight will lead to metabolic complications. This so-called Metabolic Syndrome means: insulin resistance and a beginning diabetes, high blood pressure, fatty liver, arteriosclerosis and fat metabolism disorders. Untreated these disorders will lead to serious diseases.
Additionally, complications such as shortness of breath or joint pain can occur. Alongside the individual causes for adiposity the sequelae are a focus of the therapeutic efforts. Those sequelae make consistently increasing body weight a serious health risk. Therefore, the therapy of morbid overweight is necessary in the first place. Obese persons often suffer psychologically due to the rejection and prejudices in society.
Type -2-diabetes (diabetes mellitus)
Type-2-diabetes describes a group of metabolic diseases that prevent the body from processing the sugar that is dissolved in the blood for different reasons. The consequence is a very high concentration of sugar in the blood that can cause damage to the organs and even death if it is left untreated. In a healthy body the hormone insulin, which is produced by the pancreas, is the adversary of the sugar. For example, it opens muscle cells for sugar molecules like a key. The sugar molecules are processed and thus metabolized in the muscle cells.
In the case of type-2-diabetes, the insulin cannot be sufficiently effective anymore. At first this is described as an insulin resistance. Taking the image of the insulin as a key once again, than you still have the key, but the locks are broken one after another. The insulin can no longer help to transport the sugar from the blood to the cells. As a reaction to the increasing sugar level, the pancreas produces more and more insulin – until it reaches its own capacity limit. At a certain point the pancreas can no longer produce enough insulin and an insulin deficiency is created. The sugar concentration in the blood increases, which can lead to organ damage in the worst case if it is left untreated. Not later than now more insulin has to be injected from outside.
Fasting blood sugar is measured in mmol/l or mg/dl. If this value is more than 7 mmol/l in a fasting person (this corresponds to 126 mg of sugar per deciliter of blood), you can speak of diabetes mellitus. In order to reach a more exact determination and classification compared to other diseases, there are some other factors to consider that can be determined in a laboratory. Among those are the so-called HbA1c, the C-peptide, urinary glucose and the concentration of fructosamines.
Exercise and weight reduction have been proven to be effective in the improvement of sugar processing in the body. For newly diagnosed type II diabetes patients it is often enough to lose weight to regain a normal fasting blood sugar value. If the possibilities of exercise and weight loss are exhausted, blood sugar can also be treated medicinally. With heavily overweight patients a surgical intervention in the form of a gastric bypass, stomach stapling or a gastric band can become necessary to improve the glucose values.
A healthy nutrition consisting of 50% carbohydrates, 30% fats and 20% proteins together with enough exercise (at least 3-4 times 30 minutes cardio sports a week) is the ideal prevention of type-2-diabetes.
Arteriosclerosis is a disease of the arteries. The arteries transport blood that has high oxygen content from the heart to the other organs. Today scientists assume that the artery walls are aggravated chemically and small excrescences, so-called atheromatous plaque, are formed. This plaque will constrict the arteries more and more until it becomes impossible to supply the organs with enough oxygen. High LDL cholesterol levels can be responsible for the chemical aggravation, for example. In the worst case scenario the consequence is a cardiac infarction or a stroke. Arteriosclerosis in very small arteries is often a result of a long-standing diabetes. Overweight and high blood pressure also contribute to the development of arteriosclerosis. The development of atheromatous plaque in the arteries is, however, reversible. It was discovered in studies with patients that endurance sports can lead to regression of the mutations in the arteries.
To determine whether a patient suffers from arteriosclerosis and how far advanced it is, several methods can be used. A blood screening shows its composition and whether the levels of glycerin, LDL cholesterol or other blood lipids are elevated. Depending on the associated diseases and the place of the plaque formation, a CT, an MRI, an angiography or an ultrasound can inform about the extent of the disease.
In addition to the avoidance or constriction of risk factors, such as smoking, overweight, high stress and lack of exercise, arteriosclerosis can also be treated medicinally or surgically. Drugs can regulate high blood pressure and elevated serum lipid levels. Very constricted arteries can be extended by a balloon or a stent. A bypass surgery can be used to bypass the damaged area.
There are risks that cannot be influenced. Among those are age, genetic preposition and the gender (men are affected more often than women). In addition there is, however, a number of risks that can be influenced and whose avoidance and/or reduction have a verifiable positive effect on the state of health. The biggest risk is smoking, followed closely by high blood pressure and an elevated level of LDL cholesterol. Endurance sports, weight loss (in the case of overweight) and stress management help with the avoidance and/or reduction of those risks.
Dyslipidemia is existent when one or more serum lipid levels are elevated. In conjunction with overweight, dyslipidemia often is accompanied by a overweight-caused diabetes (type II diabetes mellitus). The insulin that is responsible for the processing of sugar in the body, at the same time stops the catabolism of body fat. In the event of diabetes, the insulin can no longer be effective. In addition to a constantly increasing concentration o blood sugar, the catabolism of body fat continues undamped. The individual components of the body fat such as triglyceride or LDL cholesterol accumulate in the blood and can thus constrict the arteries. The consequences are cardiac infarction and stroke.
For the diagnosis the levels of total cholesterol, LDL cholesterol and HDL cholesterol as well as triglyceride are measured in the scope of a blood picture.
The following limit values apply:
- Total cholesterol under 5.16 mmol/l blood and/or 200 mg/dl
- LDL cholesterol maximum 4.1 mmol/l (160 mg/dl)
- HDL cholesterol minimum 1.03 mmol/l (40 mg/dl) for men, minimum 1.16 mmol/l (45 mg/dl) for women
- Triglyceride under 2.26 mmol/l (200 mg/dl)
The focus of the treatment for dyslipedemia is dietary measures as well as the reduction of LDL cholesterol by drugs. Most of the time so-called “statins” are administered in this context.
While the LDL cholesterol level can only be reduced moderately by a nutrition that is low in cholesterol, a high level of triglycerides can easily be reduced by dietary measures. In general a combination of a diet that is low in fats and cholesterol and exercise and weight loss are recommended for prevention.
A fatty liver is developed by a disorder of the fatty acids and triglycerides metabolism of the liver cell and can therefore have various causes. The biggest part of fatty liver diseases comes from an imbalance between the calorie supply (by nutrition) and calorie consumption (by exercise), which leads to a positive energy balance (an excess in calories). Stages of fatty liver disease are:
- Non-Alcoholic Fatty Liver Disease (NAFLD). This stage can exist various years undetected and without symptoms.
- Non-Alcoholic Fatty Steatohepatitis (NASH)
- Fatty Liver Cirrhosis
If an inflammation of the liver (steatohepatitis) can be detected, the disease can develop into a liver cirrhosis (in about 10 percent of the cases).
Fatty liver disease is a common disease. About 25 percent of the Western adult population has a fatty liver. The unhealthy lifestyle that is often accompanied by overweight, diabetes and a lack of exercise is presumed to be the cause for fatty liver. The fatty degeneration of the liver is likely a leading sign for the metabolic syndrome.
Fatty degeneration of a liver is often detected during a sonography or an MRI. If the liver is biopsied for another reason fatty liver can also be documented histologically.
A fatty liver (without signs of an inflamed liver) has little pathological significance. But since it can develop into steatohepatitis and it can be an early sign for the metabolic syndrome, the following recommendations apply:
- Reduction of the calorie supply
- Increase of the calorie consumption
- Ban on alcohol
A balanced diet and enough exercise are the most sensible and most effective prevention measures against a fatty liver.