Why overweight and obesity are more than an aesthetic concern
Obesity is recognised by the World Health Organization (WHO) as a chronic disease. According to current surveys, around half of adults in Austria are overweight, with a notable proportion classified as obese. The causes are multifaceted: genetic predisposition, hormonal factors, lack of exercise, eating habits, sleep quality, psychological strain and the effects of certain medications can all play a combined role.
As body fat increases — particularly around the abdomen — so does the risk of related conditions such as type 2 diabetes, high blood pressure, lipid metabolism disorders, fatty liver, joint problems, certain cancers and cardiovascular disease. Early, structured obesity treatment can help to reduce these risks.
When is it overweight, and when is it obesity?
The Body Mass Index (BMI) is often used for an initial assessment:
- BMI 25–29.9 kg/m²: overweight
- BMI 30–34.9 kg/m²: obesity grade I
- BMI 35–39.9 kg/m²: obesity grade II
- BMI ≥ 40 kg/m²: obesity grade III
However, BMI alone is only a rough guide. The picture becomes more meaningful when combined with waist circumference, the ratio of muscle to fat mass (e.g. via bioimpedance analysis), laboratory values and individual medical history.
The initial medical assessment: more than counting calories
Approaching weight loss with medical support begins with a thorough patient history. A nutritional-medicine assessment may include the following aspects:
Basic medical diagnostics
- A detailed interview about lifestyle, eating and exercise habits, sleep and stress levels
- Physical examination including blood pressure measurement
- Laboratory values: fasting blood glucose (and if needed HbA1c), blood lipids, liver values, kidney values, thyroid values, vitamin D, iron status
- Optionally: bioimpedance analysis to determine muscle, fat and water content
Identifying possible underlying causes
Sometimes there are treatable factors that contribute to weight gain — such as an underactive thyroid, polycystic ovary syndrome (PCOS), certain medications, sleep apnoea or hormonal changes during the menopause. A careful assessment can provide useful clues.
Components of nutritional-medicine support
In practice, nutritional medicine for weight reduction means developing individual strategies that fit into daily life, personal preferences and the patient's health situation. One-size-fits-all diet plans are usually insufficient.
1. An individual nutrition strategy
Rather than short-term diets, the focus is on a long-term, sustainable change in eating habits. Well-researched approaches include:
- Mediterranean diet: rich in vegetables, pulses, olive oil, fish and nuts
- Moderate reduction in energy intake: adapted to basal metabolic rate and activity
- Mindful use of sugar and highly processed foods
- Adequate protein intake to preserve muscle mass during weight loss
- Structured meals instead of frequent snacking
Which approach is suitable depends on co-existing conditions, metabolic status and personal preference.
2. Physical activity as the second pillar
Exercise supports weight reduction and is particularly crucial for maintaining results in the long term. A combination is generally recommended:
- Endurance activity (e.g. brisk walking, cycling, swimming)
- Strength or resistance training to preserve muscle mass
- More everyday movement (stairs instead of the lift, walking short distances)
If joint problems or cardiovascular conditions are present, the exercise programme should be coordinated with a doctor.
3. Behavioural and sleep-related aspects
Eating behaviour is closely linked to emotions, stress and sleep. Lack of sleep and chronic stress can affect metabolism and appetite. Looking at eating patterns, practising mindful eating and, where appropriate, psychotherapeutic support can be valuable parts of the overall concept.
4. Medication-based options
In certain cases — for example, obesity with co-existing conditions or insufficient success with lifestyle changes — medication may be considered as an additional measure. This includes, among others, active substances from the group of GLP-1 receptor agonists. Such medications are prescription-only, can have side effects, and do not replace lifestyle changes. Whether, when and which substance is appropriate is decided by the doctor on an individual basis.
5. Surgical options
In cases of severe obesity (usually from a BMI of 35 with co-existing conditions, or from a BMI of 40), bariatric surgery may be discussed once conservative measures have been exhausted. A comprehensive interdisciplinary assessment is a prerequisite here as well.
Realistic goals instead of quick results
Studies show that even a weight reduction of 5–10% of the starting weight can have health-relevant effects — for example, on blood pressure, blood glucose and blood lipid levels. Realistic planning is important:
- A slow pace: about 0.5–1 kg per week, depending on the starting point
- Regular follow-up checks: weight, waist circumference, laboratory values, body composition
- Adjustments along the way: plateaus are normal and often require a new strategy
- A focus on health, not just the scales
Staying on track in the long term: the phase after weight loss
The most important — and often most difficult — phase begins after reaching the target weight. The body responds to weight loss with adaptive mechanisms such as a reduced basal metabolic rate and altered hormone profiles. Continuous support can help to avoid weight regain (the "yo-yo effect"). Approaches that have proved useful include:
- Regular exercise as an established routine
- Maintaining the new eating habits
- Keeping an eye on weight and well-being
- Seeking support early in the event of setbacks
When is medical support particularly useful?
Structured obesity treatment is advisable when:
- Repeated attempts to lose weight on your own have not been successful
- Co-existing conditions such as high blood pressure, diabetes or fatty liver are present
- BMI is markedly elevated
- Medications that influence weight are being taken
- There is uncertainty about the most suitable individual approach
Nutritional-medicine care combines medical knowledge with strategies that work in everyday life — providing support that focuses not on quick results, but on lasting health.
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This article does not replace medical advice.