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<p>Global obesity prevalence more than tripled between 1975 and 2022; over one billion people are affected. In Germany, according to the Robert&#xa0;Koch-Institut; (RKI; 2019/2020), 46.6 of women and 60.5% of men are obese, with older individuals showing higher prevalences. Despite the efforts of many professional societies, no trend reversal is apparent. Obesity is influenced by genetic, environmental, behavioral, and physiological factors and is gaining importance given demographic change. Diagnosis was long based on body mass index (BMI; ≥ 30 kg/m<sup>2</sup>), but this is controversial as it does not directly measure body fat. Since 2024, European Association for the Study of Obesity (EASO) recommends additionally the waist–height ratio (&gt; 0.5&#xa0;with BMI &gt; 25 kg/m<sup>2</sup> or BMI &gt; 30 kg/m<sup>2</sup>). The new S3&#xa0;guideline and a&#xa0;Lancet consensus also recommend combining biometric parameters and assessing comorbidities (“staging”). One recent study showed that limiting sugar intake in the first 1000&#xa0;days of life reduces the risk of type&#xa0;2 diabetes and hypertension in adulthood. Another study highlighted the interaction between genetic risk and lifestyle; a&#xa0;healthy lifestyle can reduce risk despite high genetic predisposition, although genes play a&#xa0;dominant role (60–70%). Weight loss improves blood sugar control in type&#xa0;2 diabetes; remission is possible with 15–25% loss. Glucagon-like peptide‑1 (GLP-1) medications enable similar weight loss to be achieved. Intentional weight loss reduces fat and fat-free mass (FFM), with the proportion of FFM reduction depending on baseline amount of body fat. Strategies to stimulate protein synthesis (e.g., increased protein intake, resistance training) can reduce muscle mass loss. Discontinuation of GLP‑1 medications often leads to weight regain. Data do not suggest that drug-induced weight loss leads to frailty.</p>

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Adipositas und Diabetes

  • 期刊论文

  • 发表日期：

    2025年5月30日

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  • Jens Aberle

摘要

Global obesity prevalence more than tripled between 1975 and 2022; over one billion people are affected. In Germany, according to the Robert Koch-Institut; (RKI; 2019/2020), 46.6 of women and 60.5% of men are obese, with older individuals showing higher prevalences. Despite the efforts of many professional societies, no trend reversal is apparent. Obesity is influenced by genetic, environmental, behavioral, and physiological factors and is gaining importance given demographic change. Diagnosis was long based on body mass index (BMI; ≥ 30 kg/m2), but this is controversial as it does not directly measure body fat. Since 2024, European Association for the Study of Obesity (EASO) recommends additionally the waist–height ratio (> 0.5 with BMI > 25 kg/m2 or BMI > 30 kg/m2). The new S3 guideline and a Lancet consensus also recommend combining biometric parameters and assessing comorbidities (“staging”). One recent study showed that limiting sugar intake in the first 1000 days of life reduces the risk of type 2 diabetes and hypertension in adulthood. Another study highlighted the interaction between genetic risk and lifestyle; a healthy lifestyle can reduce risk despite high genetic predisposition, although genes play a dominant role (60–70%). Weight loss improves blood sugar control in type 2 diabetes; remission is possible with 15–25% loss. Glucagon-like peptide‑1 (GLP-1) medications enable similar weight loss to be achieved. Intentional weight loss reduces fat and fat-free mass (FFM), with the proportion of FFM reduction depending on baseline amount of body fat. Strategies to stimulate protein synthesis (e.g., increased protein intake, resistance training) can reduce muscle mass loss. Discontinuation of GLP‑1 medications often leads to weight regain. Data do not suggest that drug-induced weight loss leads to frailty.