Fat Germans

At just 1.74 meters tall and weighing 152 kilos, Sonja Berzbach was obese. That was a few years ago. The 34-year-old now weighs 83 kilos.

Berzbach works as a nurse. She had left her parents' home at an early age and quickly fell in a rut.

"After night shifts, I would often eat pizza and chocolate," says Berzbach. "Eventually, I just started eating out of frustration."

And the kilos piled on until she realized it was time to stop. A healthy diet, exercise and self-discipline helped her lose weight.

But she also went in for surgery to lose more.

Body mass index

In Troisdorf-Sieglar near Bonn, Berzbach founded a support group to help people struggling with their weight.

Being overweight is defined as having an excess of body fat mass. It is calculated with the body mass index (BMI), which takes an individual's weight and divides it by the square of his or her height.

A healthy BMI is said to lie between 20 and 25 and those for people slightly overweight between 25 and 30. A BMI of over 30 is considered level-one obesity and over 35 level-two obesity. For those with a BMI of more than 40, doctors speak of severe level-three obesity.

Stefanie Gerlach of the German Obesity Society says level-three obesity requires medical treatment.

Poor eating habits are just one reason for overweight and obesity.

Other factors can include a genetic predisposition, a person's education or type of work, and where they live.

Some studies suggest that people with higher levels of education and income are more conscious of their health and have healthier diets.

Obesity can lead to a string of medical issues, including diabetes and cardiovascular disease. Depression is also common.

So treating obesity requires different disciplines, including dieticians and physicians, as well as psychologists and educators.

Hamburgers and fries

More and more children are also becoming overweight.

It is often said that poor diets, consisting of hamburgers and fries - instead of fruit and vegetables - and too many hours in front of a computer - instead of exercise - are contributing factors.

The German Obesity Society's Stefanie Gerlach says parents play a crucial role in defining the eating habits of their children.

"They determine the type of food that is available at home," says Gerlach. "They lay down the rules."

For some, a trip to the surgeon is the only way to lose weight.

A normal surgical procedure is to reduce part of the intestinal tract with a gastric band. As a result, patients eat less and fill up faster.

Unconventional approach

Martin Pronadl, a surgeon at the Krupp Hospital in Essen, says there are other surgical procedures that can reduce excess weight by as much as 80 percent.

Pronadl performs between 120 and 140 operations to reduce weight every year.

"Patients can often lose half their weight - or as many as 130 kilos with surgery," says Pronadl. Pronadl's heaviest patient weighed 270 kilos when he checked in. The surgeon removed 170 kilos of fat.

But Denmark has pursued a more unconventional approach to controlling weight.

Last year, it introduced the world's first - and only - fat tax. The tax is applied to foods that contain more than 2.3 percent of saturated fats. Affected foods include butter, milk, meat and pizza as well as industrial ready-to-serve meals.

Food producers are made to pay 16 Danish kroners (2.15 euros) per kilogram of saturated fat. Policymakers hope the tax will reduce the amount of saturated fats consumed in the country and the amount of people suffering from obesity or other weight issues.

Insults and jokes

Many people who are considered obese say they also suffer from discrimination in public - in streetcars, supermarkets and other places.

Sonja Berzbach is no exception. Berzbach says she was often the target of insults and jokes when she was overweight.

"Many overweight people hardly dare to leave their homes," says Berzbach. "They may still go to sports or a self-help group, but that's about it."

It is a long way to go from being overweight to having - what is considered - an average weight. And the process, says Berzbach, starts in your own head.

Author: Gudrun Heise / jrb
Editor: Zulfikar Abbany