Obesity and overweight

What is obesity?

Obesity is the accumulation of more body fat than normal, and it is dangerous to health. Excess fat mainly starts to build up in the abdominal cavity. This is called visceral fat, or abdominal (central) obesity.

Sometimes a patient follows every recommendation, yet the weight stays the same or keeps rising. In such cases the cause should be sought in hormonal disorders.

Causes: lifestyle and hormones

The main cause of ordinary weight gain is excess calories and too little physical activity. In addition, disorders of the thyroid, adrenal glands, ovaries and pituitary gland can also cause obesity.

• Hypothyroidism (underactive thyroid). Thyroid hormones control appetite and body weight and regulate metabolism. When these hormones are lacking, metabolism slows down, food is broken down very slowly, and even a person who eats little may gain weight. Fluid retention in the body also adds to the weight.
• Insulin resistance. The body no longer responds to the hormone insulin as effectively as before. This condition can remain hidden for a long time without tests and may be linked to sugar cravings, abdominal fat and weight gain. Its main causes include poor eating habits, excess sugar, a sedentary lifestyle and lack of sleep.
• Polycystic ovary syndrome (newly named PMOS). Because it is linked to insulin resistance, it disrupts metabolism and leads to obesity and a higher risk of diabetes.
• Cortisol and prolactin disorders. An imbalance of pituitary and adrenal hormones can also lead to changes in weight.

How does ordinary weight gain differ from hormonal obesity?

• Ordinary weight gain (related to an unhealthy diet and lifestyle): develops against a background of excess calories and low physical activity, fat is distributed over different parts of the body, diet and exercise show results quickly, and hormone tests are normal.
• Hormonal obesity (caused by endocrine disorders): fat accumulates mostly around the abdomen, waist and neck, weight stays the same or increases despite diet and exercise, additional signs such as insomnia, depression, hair loss and menstrual irregularities are present, and blood tests reveal abnormalities in hormones such as insulin, cortisol, TSH and prolactin.

Waist circumference and related conditions

Waist circumference is the objective and most sensitive indicator of abdominal obesity. A waist of more than 94 cm in men and more than 80 cm in women is one of the most important risk factors for cardiovascular disease and diabetes. A growing waistline raises the risk of the following conditions:

• metabolic syndrome and insulin resistance;
• diabetes;
• cardiovascular disease and hypertension (high blood pressure);
• cancer;
• Alzheimer’s disease.

Which signs call for a check-up?

If you gain weight without eating much, or find it hard to lose weight, you should see an endocrinologist. The assessment considers the clinical picture, risk factors and laboratory results together: thyroid hormones (TSH, T3, T4), fasting and post-meal blood sugar, HbA1c, insulin and the HOMA-IR index of insulin resistance, and, if needed, cortisol and prolactin.

• weight that stays the same or increases despite diet and exercise;
• insomnia, depression, hair loss, menstrual irregularities;
• dark, thick, velvety skin on the neck, armpits or groin (acanthosis nigricans);
• numerous small, soft skin tags in these areas;
• type 2 diabetes in the family, a history of gestational diabetes, polycystic ovary syndrome.

Approach to treatment

With accurate tests, a correct diagnosis and individual treatment, it is possible to bring both your weight and your health under control. If a hormonal cause is found, that disorder is treated first. The main approach includes:

• weight control;
• a low-glycaemic-index diet and cutting sugar out of the diet;
• regular physical activity;
• managing sleep and stress;
• medication if needed. Semaglutide (a GLP-1 hormone mimetic, e.g. Ozempic) is not a cosmetic slimming product but a prescription medicine: it was developed primarily for type 2 diabetes and is not suitable for every patient. Such injections may be prescribed only to patients with a body mass index above 30 or with metabolic conditions such as insulin resistance, prediabetes or type 2 diabetes, after an endocrinologist’s examination and laboratory tests.

Prevention

Giving up sugar is not just about losing weight; it matters for preventing diabetes, obesity and cardiovascular disease in the future. Diet, physical activity and weight management can delay or prevent the development of type 2 diabetes.

If you have risk factors, do not wait for symptoms: have your tests done in good time and consult a doctor. Never use any hormonal injection without preventive tests.