[Prognosis in obesity, what has changed?]

Since the publication of the Build Study 1979 further analyses have refined our concepts concerning the prognosis of obesity. We have recognized that intraabdominal fat depots especially favor the development of complications and shorten life. Smoking diminishes body weight slightly, but leads to a detrimental replenishment of this intra-abdominal fat accumulation. Body-Mass-Index (BMI)--especially if combined with waist-hip-ratio (WHR)--allows a better appreciation of the degree of obesity than the conventional Broca-Index. It also facilitates decisions on the necessity and the choice of suitable therapeutic measures (diet, combination with exercise and psychotherapy, surgical intervention). A slight overweight appears protective in senior citizens, but we shouldn't recommend a deliberate weight gain for this purpose. Paradoxically, there is still no definite proof yet that measures for weight reduction really improve mortality prognosis. First hints in this direction are coming from super-obese patients (BMI above 40) who have been operated by gastroplasty.