Psychosomatic aspects of obesity

Overweight and obesity are widespread in industrial countries and are consi dered to be serious health problems in these countries. Population-based st udies in Germany have shown that between 12 and 18% of the adult population is obese. Overweight and obesity are accompanied by a large spectrum of he alth disorders and extreme psychosocial burdens. Besides the hereditary dis position, the life style including both intra- and inter-individual aspects determines the complex, etiology of obesity. Within the collective sample of the obese, one sub-sample is the "psychogenic obese" i.e. in which psych iatric disorders lead to a change in both eating and exercise behavior, the result then being a continuous positive energy reserve in the form of over weight and obesity. The paper describes the psychosocial problems of obese persons; especially the controverse question with regard to psychiatric mor bidity in general and eating disorders in particular are emphasized. The re sults of past, mainly behavioral oriented treatment concepts are presented and various concepts beyond single school orientation are discussed. Finall y, the problems with psychiatric psychological diagnostics in those obese p atients with the request for surgical weight reduction within the context o f insurance coverage and the surgeons are presented.