Obesity (BMI> 30 kg/m2) has developed relatively rapidly in industrialized nations from a marginal group phenomenon to a real socio-economic problem. The changed living conditions of our society have led to the fact that more and more adults, adolescents, but also children are overweight worldwide. Nevertheless, from today’s point of view it is not at all certain whether obesity may be called a disease at all, although a significantly more frequent number of secondary and concomitant diseases is seen in morbid obesity (BMI> 35 kg/m2).
What seems clear is that obesity is usually caused by an imbalance between energy intake and energy consumption. However, the fact that this imbalance leads to an increase in weight is not yet necessarily a pathological process, but initially a physiological one. In evolutionary terms, this undoubtedly increased our ancestors’ chances of survival. Only today, at the beginning of the 21st century, is the former evolutionary advantage becoming a problem in industrialized countries. This problem is now called a “disease” – despite the fact that it is largely also the type of diet (the possibilities of energy intake) and the lack of physical activity that promote this very “disease”. The majority of the population in the labor process hardly works physically anymore and performs its work in a sedentary manner. Whereas physical work used to have a natural place in the daily routine, today it has to be built in almost consciously due to the facilitations of everyday life. Of course, this is not used by people who already have weight problems, but rather by those who seek a balance to their sedentary work in sports and also have the sufficient time and financial resources. Physical activity outside of work is increasingly becoming a luxury good in our society, which not all classes can afford or want.
With increasing numbers of overweight people in our population, there is a need for a corresponding expansion of therapeutic options for the treatment of chronic obesity. These include not only conservative but also increasingly invasive concepts and will probably lead to a variety of areas of tension in politics and society in the future, characterized by a wide range of basic ethical and moral attitudes toward this phenomenon.
Philipp C., M.D. Nett
