Psychological factors in development and treatment of obesity

Background: The prevalence of obesity has distinctly increased in almost all industrial countries in the past decades and is considered today to be one of the most important health problems. In Germany, between it and 18% of the adult population is obese. Besides the known risk factors such as arterial hypertension, lipometabolism disorders and type-2 diabetes mellitus, obesity is connected to severe psychosocial burdens. The genesis of obesity is multifactorial, besides genetic factors environ mental ones such as an increase in hypercaloric food and at the same time a reduction of physical activity play a decisive role. Psychogenesis: Whereas earlier mainly psychic factors were discussed in the genesis of obesity, and here especially the question as to which personality variables are most frequently associated with obesity, the discussion in the past decades has increasingly shifted towards psychosocial consequences. It does, however, seem justified to adhere to a "psychogenesis" of obesity in a subgroup of obese people. Psychosomatic/psychiatric disorders lead to a change in eating behavior and physical exercise, the result being a sustained positive energy balance with overweight and obesity. Psychosocial Problems and Treatment Concepts: This paper describes the psychosocial problems of obese people with an emphasis on the question of psychiatric co-morbidity in general and eating disorders in particular. The results of mainly behaviorial therapeutically oriented treatment concepts are presented and school-overlapping concepts discussed.