[Obesity: state of research and therapy]

The classification of obesity into a hypertrophic and a hyperplastic type is apparently becoming less accepted since preadipocytes are not covered by investigation of adipose tissue cellularity. Obesity-associated insulin resistance is probably due to a decrease in number of insulin receptors, induced by hyperinsulinemia. Metabolic factors may contribute to insulin resistance. Long-standing hypersecretion of insulin may exhaust the B-cell, resulting in glucose intolerance and diabetes. There is increasing interest in the (possibly) disturbed energy metabolism in obesity, though clearcut conclusions are not yet possible. For the management of obesity an integrated treatment schedule is recommended including a 1000 calorie mixed diet, intensive nutritional education, motivation, group and individual psychotherapy, physical exercise and physiotherapy. Drastic methods for the treatment of obesity are critically reviewed.