Obesity Therapy Following S3 Guidelines

Obesity is a chronic disease with neurobiological, hormonal, and environmental factors — not primarily a matter of willpower. The S3 Guidelines AWMF 050-001 (Update 2024) from German professional societies^[1] recommend a multimodal therapy that integrates medical, nutritional, movement-based, and behavioral medicine aspects.

Structured, Physician-Guided Weight Loss

Sustainable weight loss does not work with crash diets or short-term measures. We recommend long-term structured weight loss for:

• BMI ≥ 30 kg/m² (obesity grade I-III), or
• BMI ≥ 27 kg/m² with comorbidities (arterial hypertension, type 2 diabetes, metabolic syndrome, OSA)

The goal is a weight loss of 5-10% within 6-12 months. Already this moderate reduction leads, according to the S3 Guidelines^[1], to measurable improvements: improved insulin resistance and blood glucose control, blood pressure reduction, improved blood lipids, and reduction of the severity of obstructive sleep apnea.

What the Treatment Includes

• Medical History & Goal Setting: Assessment of weight history, comorbidities, medications, psychosocial factors, and realistic goal setting.
• Nutritional Medicine Consultation: Counseling by a physician with additional qualification in nutritional medicine — specifically: what you eat, why, and what can realistically be changed?
• Movement Concept: Recommendations that fit your daily life — not the standard sheet with 10,000 steps.
• Behavioral Medicine Aspects: Support for behavioral changes, management of stressors, emotional eating, and psychological barriers.
• Medication Options: If needed, GLP-1 receptor agonists (e.g., semaglutide, tirzepatide) as an individual health service (IGeL) with complete cost transparency in advance.
• Supportive Diagnostics: Laboratory tests, blood pressure monitoring, body composition analysis (BIA), and sleep diagnostics if needed to assess sleep apnea.

One principle has proven helpful in practice: one change per appointment. We don't turn your whole life upside down at once — we work step by step on what is realistically sustainable in your daily routine, and check at the next visit what worked and what didn't.

dr. med. univ. Albrecht Wenzel is a certified obesity specialist (DAG-DDG, 2024) and an active member of the German Obesity Society (DAG). Treatment is based on the current S3 Guidelines on Obesity (AWMF 050-001).

Why sleep must be considered in obesity treatment

The importance of sleep for weight regulation is often underestimated. Sleep deprivation and sleep disorders affect metabolism through several mechanisms:

• Increased ghrelin secretion (appetite hormones) and decreased leptin levels^[2] → increased appetite and altered satiety. A University of Chicago study showed: just 1.2 additional hours of sleep per night reduced daily calorie intake by approximately 270 kcal^[5]
• Promotion of visceral fat deposition (the most harmful form of abdominal fat) and worsening of insulin sensitivity — both independent risk factors for type 2 diabetes and cardiovascular disease^[3,6]

Obesity is the main risk factor for obstructive sleep apnea (OSA)^[3,4]. Conversely, OSA can increase body weight. Therefore, we integrate sleep diagnostics and therapy into obesity treatment.