Psychological factors in development and treatment of obesity

Background: The prevalence of obesity has distinctly increased in almost al l industrial countries in the past decades and is considered today to be on e 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 arter ial hypertension, lipometabolism disorders and type-2 diabetes mellitus, ob esity is connected to severe psychosocial burdens. The genesis of obesity i s multifactorial, besides genetic factors environ mental ones such as an in crease in hypercaloric food and at the same time a reduction of physical ac tivity 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 personali ty variables are most frequently associated with obesity, the discussion in the past decades has increasingly shifted towards psychosocial consequence s. It does, however, seem justified to adhere to a "psychogenesis" of obesi ty in a subgroup of obese people. Psychosomatic/psychiatric disorders lead to a change in eating behavior and physical exercise, the result being a su stained positive energy balance with overweight and obesity. Psychosocial Problems and Treatment Concepts: This paper describes the psyc hosocial problems of obese people with an emphasis on the question of psych iatric co-morbidity in general and eating disorders in particular. The resu lts of mainly behaviorial therapeutically oriented treatment concepts are p resented and school-overlapping concepts discussed.