More Complex Than “Overweight”: Understanding Obesity
Obesity is burdened with prejudice. Yet the problem is not a lack of discipline, but a chronic, multifactorial disease characterized by excessive accumulation of adipose tissue.
In today’s article, we discuss why and how obesity must be distinguished from overweight, and why hormones, inflammation, and metabolic processes play a central role. We also explain approaches in complementary medicine that are used in practice to support metabolic regulation.
What Obesity Really Is
Obesity (lat. obesus~“grown fat through eating“, which is not really accurate) is classified as an independent disease by international medical societies and the World Health Organization (WHO) — with relevant health consequences and long-term treatment requirements (WHO fact sheet “Obesity and overweight”).
Like overweight, obesity is often defined using the body mass index (BMI). This classification is practical but insufficient. While overweight refers to body weight above the normal range (BMI ≥ 25), obesity involves a pronounced increase in body fat mass. Obesity begins at a BMI ≥ 30 and is divided into different severity grades (obesity classes I–III). What is decisive, however, is primarily the metabolic activity of adipose tissue — that is, the extent to which it produces signaling molecules. In particular, signaling molecules produced by abdominal fat promote adverse processes.
Metabolically active adipose tissue can affect the following:
· inflammatory processes
· insulin sensitivity
· appetite and satiety regulation
· vascular function.
Accordingly, increasing fat mass raises the risk of insulin resistance, type 2 diabetes, cardiovascular disease, and other conditions (Bray et al., 2018).
Inflammation and Regulatory Dysfunction
Obesity is not merely a problem of energy storage but a state of chronic low-grade inflammation. Adipocytes and immune cells within adipose tissue increasingly release pro-inflammatory signaling molecules that permanently influence metabolism (Gregor & Hotamisligil, 2011).
These processes significantly contribute to the fact that:
- insulin becomes less effective
- energy expenditure decreases
- hunger and satiety signals are altered.
As a result, obesity often becomes self-perpetuating.
Genetics, Lifestyle, and Environment
Obesity arises from a complex interaction of genetic predisposition, hormonal regulation, environmental factors, as well as diet and physical activity. Modern living conditions favor a positive energy balance, while the body simultaneously activates evolutionarily conserved energy-saving mechanisms. This discrepancy explains why sustainable weight regulation is difficult (Blüher, 2019).
Complementary and Naturopathic Approaches in Obesity
In complementary and naturopathic practice, no “slimming agents” are used, but rather measures aimed at regulating appetite, metabolism, and inflammation:
o Dietary fiber and soluble plant fibers, such as psyllium husks or inulin, can increase satiety and reduce energy intake. Studies show associations between higher fiber intake, moderate weight loss, and improved metabolic parameters (Slavin, 2005; Reynolds et al., 2019).
o Bitter compounds from plants such as gentian or artichoke are used to influence digestive processes and hormonal satiety signals. Bitter taste receptors in the gastrointestinal tract are involved in appetite regulation and glucose metabolism (Janssen et al., 2011).
o Green tea extracts containing catechins (secondary plant metabolites) are used to support energy expenditure. Meta-analyses show small but measurable effects on body weight and fat mass (Hursel & Westerterp-Plantenga, 2010).
o Certain probiotic strains are associated with moderate effects on fat mass and insulin sensitivity (Kobyliak et al., 2016).
o Fasting-based approaches have long been used in complementary medicine. Current reviews show that intermittent fasting can lead to weight reduction and metabolic improvements, without being fundamentally more effective than continuous calorie restriction (de Cabo & Mattson, 2019).
Why Obesity Often Leads to Diabetes
Obesity is considered the most important risk factor for type 2 diabetes. As insulin resistance increases, the burden on the pancreas rises until insulin production is no longer sufficient. For this reason, obesity and diabetes are increasingly viewed together today — in both prevention and therapy (WHO fact sheet “Obesity and overweight”).
Long-Term Strategies for Obesity
Sustainable stabilization can only be achieved when several aspects are addressed simultaneously:
o Relieving metabolic load in the long term: Improving insulin sensitivity plays a central role. Chronically elevated insulin levels promote fat storage and hinder fat loss. Measures that relieve metabolic strain — such as regular physical activity, weight reduction, and structured meal timing — have been shown to contribute to metabolic stabilization (Bray et al., 2018).
o Reducing inflammatory processes: Obesity is associated with chronic low-grade inflammation. Long-term strategies aim to modulate inflammatory processes, for example through diet, weight loss, and metabolic improvement. Studies show that even moderate weight reduction can lower inflammatory markers (Gregor & Hotamisligil, 2011).
o Considering hormonal regulation: Hunger and satiety are hormonally regulated. After weight loss, the body often responds with increased hunger and reduced energy expenditure. Long-term strategies must take these adaptations into account and aim for realistic target weights rather than short-term maximal reductions (Blüher, 2019).
o Long-term dietary change: Sustainable effects do not arise from diets, but from dietary patterns that can be maintained long term. A fiber-rich, nutrient-dense diet is associated with better weight stabilization and metabolic health (Reynolds et al., 2019).
o Physical activity as a regulatory factor: Regular physical activity exerts its effects less through calorie expenditure than through improvements in insulin sensitivity, muscle mass, and inflammatory status. It is considered one of the most important factors for long-term weight stabilization after weight loss (Bray et al., 2018).
o Gut health as an accompanying factor: Changes in the microbiome are associated with body weight and insulin sensitivity, even though the evidence base is heterogeneous. (Kobyliak et al., 2016).
Long-term success is not based on short-term interventions, but on sustained adjustments of biological and behavioral processes.
Conclusion: Addressing Obesity Without Prejudice But Strategically!
When objectivity and realistic self-assessment replace (self-)blame and unrealistic expectations, pathways open toward a healthy approach — even to this complex metabolic and regulatory disorder.
FAQ – Frequently Asked Questions About Obesity
1. Why is overweight not automatically associated with the same metabolic changes as obesity?
Overweight initially describes increased body mass without necessarily involving pronounced hormonal, inflammatory, or metabolic changes. In obesity, however, adipose tissue is often more metabolically active, influences inflammation, insulin sensitivity, and hormonal regulation, and thereby increases the risk of secondary diseases.
2. Why do people with similar dietary habits sometimes experience different weight trajectories?
Genetic factors, hormonal regulation, gut microbiota, sleep, stress, and previous weight history all influence energy balance. Obesity therefore does not develop according to a single uniform pattern.
3. Why does the body often struggle to reduce weight?
Because the body responds to weight loss with hormonal adaptations that lower energy expenditure and increase hunger. These mechanisms evolved to ensure survival, but in obesity (and overweight) they act counterproductively and promote weight regain.
4. Does the location and distribution of body fat matter for health?
Yes, visceral fat in the abdominal cavity is particularly metabolically active and is more strongly associated with insulin resistance, inflammation, and cardiovascular risk than fat deposits on the hips or thighs.
5. Is weight stabilization without further weight loss a success?
Yes, in the presence of obesity, weight stabilization is a meaningful and realistic goal, especially if metabolic and inflammatory parameters improve as a result.
Our next article’s topic will be a possible associated condition of obesity: diabetes. Additional information on metabolic disorders and many other topics can be found in the articles on our blog, the volumes of our “Codex Humanus”, and the “Medizinskandale” series. You are welcome to visit our online shop.
Sources:
· World Health Organization (WHO): “Obesity and overweight” (Fact sheet).
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
· Bray, G. A. et al. (2018): “The Science of Obesity Management: An Endocrine Society Scientific Statement,” Endocrine Reviews.
· Gregor, M. F., & Hotamisligil, G. S. (2011): “Inflammatory mechanisms in obesity,” Annual Review of Immunology.
· Blüher, M. (2019): “Obesity: global epidemiology and pathogenesis,” Nature Reviews Endocrinology.
· Slavin, J. L. (2005): “Dietary fiber and body weight,” Nutrition.
· Reynolds, A. et al. (2019): “Carbohydrate quality and human health: a series of systematic reviews and meta-analyses,” The Lancet The Lancet
· Janssen, S. et al. (2011): “Bitter taste receptors and α-gustducin regulate the secretion of ghrelin with implications for obesity and metabolic disorders,” Proceedings of the National Academy of Sciences (PNAS).
· Hursel, R., & Westerterp-Plantenga, M. S. (2010): “Green tea catechins, caffeine and body-weight regulation,” Physiology & Behavior.
· Kobyliak, N. et al. (2016): “Probiotics in prevention and treatment of obesity: a critical view,” Nutrition & Metabolism.
· de Cabo, R., & Mattson, M. P. (2019): “Effects of intermittent fasting on health, aging, and disease,” New England Journal of Medicine.