Overweight / obesity Structured treatment in the practice of Prof. Dr. Bernhard Ludvik in Vienna

Overweight and obesity as risk factors

Overweight (BMI between 25 and 30 kg/m2) and obesity (over 30 kg/m2) are increasing worldwide and are responsible for the increased occurrence of high blood pressure, disorders of lipid metabolism and finally type 2 diabetes mellitus. As a result, heart attacks, stroke, fatty liver disease, joint and venous diseases, but also the increased occurrence of certain cancers (breast, colon) can develop. Above all, abdominal fat distribution (waist circumference in men over 102 cm, in women over 88 cm) is causally related to these risk factors. Extreme obesity (morbid obesity) with a BM over 40 kg/m2 poses a particular risk.

Causes of Overweight and Obesity

The increase in overweight and obesity is in large part due to our high-calorie diet combined with decreased physical activity. In particular, already finished foods with sugar, white flour products and animal fat, which are available almost everywhere at almost any time of the day, contribute to this epidemic. In addition, there is a general lack of exercise due to increasing motorization. However, there is also a relatively high proportion of heredity as a cause of overweight and obesity.

Conservative treatment of overweight and obesity

The first step is to change your diet. How the reduction in caloric intake takes place is not so important. However, food preferences must be addressed. There are different diets, including low-fat, high-protein or low-carbohydrate diets. It is important that the diet is not unbalanced so that there are no deficiencies. A low-calorie Mediterranean diet (fish, vegetables, lettuce, nuts, olive oil …) is highly recommended, with bread and pasta being replaced by whole grain products. Some people prefer structured diets where you only eat every other day or take breaks from eating (e.g. fasting for 16 hours, eating within 8 hours). Meal replacement therapy is an alternative, where two meals are replaced by milk-based shakes with a higher protein content; one meal can be freely chosen. It is important to know that diets only work as long as you stick to them, even after the target weight has been achieved. Because otherwise it can lead to the so-called Yo-yo effect leading to even more weight gain. That is why it is important to maintain the change in diet for life!

Physical activity in the form of increased everyday movement (at least 10,000 steps per day) and endurance and weight training are important pillars for weight reduction. You burn calories and prevent muscle breakdown during the diet phase. The higher the muscle mass, the higher the basal metabolic rate and thus the energy requirement!

Drug treatment of overweight and obesity

If diet and exercise do not lead to the desired results, additional weight loss medication can be used. However, this must be prescribed by a doctor and is not reimbursable by the health insurers. Three drugs are currently approved: Orlistat blocks the enzymes that absorb fat (lipases), but has diarrhea as side effects. Naltrexone / Bupropion is a combination of two psychotropic drugs and leads to an increase in the feeling of satiety and a decrease in hunger. Side effects include nausea and constipation. The glucagon-like peptide 1 receptor agonist 1 (GLP1-RA) liraglutide, which is also used in the treatment of type 2 diabetes, is injected under the skin once a day. It reduces hunger, increases the feeling of satiety and delays gastric emptying. Body weight can drop by up to 10%. A side effect is nausea, but it disappears over time. Therefore, the dose of this drug must be increased slowly. Weight loss medication should only be taken under medical supervision and will only work as long as you take it.

Surgical / bariatric treatment of overweight and obesity

If all attempts to reduce morbid obesity fail, surgical (bariatric) treatment should be considered. The health insurance companies in Austria cover the costs when a BMI of over 40 kg/m2 and, in the presence of concomitant diseases such as type 2 diabetes, of over 35 kg /m2 is present, despite attempts with conservative treatment modalities. It is important to clarify beforehand whether hormonal causes are responsible for obesity. This is done by endocrinologists. Dietological and psychological reports are also required preoperatively.

The most commonly used procedures are gastric bypass and sleeve gastrectomy. They lead to a satisfactory and long-lasting weight loss and beneficial effects on concomitant diseases such as diabetes mellitus. After a bariatric operation, lifelong care and the intake of vitamins and trace elements are necessary. Occasionally, iron or protein deficiency also needs treatment. Women should only become pregnant two years after the operation.