Healthy weight loss: How can I reduce excess weight in the long term?
Scientific support: Prof. Dr. Christina Holzapfel
When losing weight, your appearance should not rank first. Instead, the focus should be on health, well-being and quality of life. People who are overweight or obese have a significantly increased risk of heart disease such as atrial fibrillation or heart failure, as well as type 2 diabetes and many other diseases. Losing weight reduces the risk of disease.
Healthy weight loss means changing your lifestyle forever.

This is based on 3 aspects:
- A balanced and calorie-reduced diet
- Regular exercise
- A long-term change in your behavior
Nutritional advice tailored to personal needs from a qualified nutritionist, clear goals and exercise in a group can be motivating and supportive. Crash diets for quick success, on the other hand, lead to the yo-yo effect and endanger health.
Contents
1. Healthy weight loss: Why is it important?
More than every second person in Germany is overweight or obese. Men are more frequently affected than women. There are various reasons for the high number of people who are overweight or obese. These primarily include lifestyle and environmental factors such as:
- Long periods of sitting and lack of exercise
- Increased consumption of processed and high-calorie foods
- Constant availability of food
- Increase in portion sizes in supermarkets and fast food restaurants
However, there are also other factors that can promote overweight and obesity. These include genetic predisposition, illnesses such as depression, eating or hormonal disorders or pregnancy. Persistent stress and side effects of medication can also play a role.
At the same time, the following applies: In the case of severe obesity, even a moderate reduction in weight has many positive effects. For people with diabetes, for example, this means that a weight loss of just 1 to 3 kilograms has a positive effect on blood sugar levels. Blood pressure also drops by an average of 1 mmHg (systolic and diastolic) for every kilo lost. Those who lose 5 to 10 kilograms measurably reduce their cholesterol and blood lipid levels, relieve the liver and also the musculoskeletal system.
Obesity: Consequences for the heart
Being obese has health consequences, especially for the heart. People with obesity are significantly more likely to suffer from cardiovascular disease than people of normal weight.
Numerous heart diseases such as atrial fibrillation, heart failure or stroke, occur more frequently in people with obesity. The combination of obesity and type 2 diabetes is considered to be particularly fatal for the heart and blood vessels, but anyway the cardiovascular risk increases in the case of severe obesity.
Good to know:
Among women who take the contraceptive pill, those who are obese have a significantly higher risk of developing blood clots that can block the blood vessels compared to women of normal weight.
Normalizing body weight also reduces the risk of cardiovascular disease. People who already have heart disease also benefit from losing weight: A large overview study shows that people with obesity and heart failure were able to significantly improve their heart function, physical resilience and quality of life by losing weight.
Increased risk of type 2 diabetes in case of obesity
Sugar metabolism is often disturbed in both overweight and obese people. The increased fat content in the body favors insulin resistance. In case of insulin resistance, the body cells no longer react sensitively to the hormone insulin and absorb less sugar (glucose) from the blood. The blood sugar level rises and so does the risk of type 2 diabetes. Doctors refer to this stage as prediabetes. Excessive overweight (obesity) is one of the most important factors in the development of type 2 diabetes. The risk of developing type 2 diabetes is more than 3 times higher with obesity. Losing weight can reduce this risk.
Good to know:
Overweight and obesity can also lead to complications in blood sugar metabolism during pregnancy: Pregnant women who are very overweight have an increased risk of gestational diabetes.
2. What is the difference between overweight and obesity?
Being severely overweight – or being obese according to experts – is both an autonomous chronic disease and a risk factor for various complications. Whether a person is overweight or obese can be determined using the body mass index (BMI).
The BMI is a unit of measurement used to estimate body weight in relation to height. People with a BMI between 18.5 and 24.9 kg/m² are considered to be of normal weight. Overweight is defined as a BMI of 25 kg/m² or higher. A BMI of 30 kg/m² or more is referred to as obesity.
The BMI is calculated as follows: Body weight (kg) divided by the square of the height (m²).
Example calculation:
An adult person who is, for example, 1.75 meters tall and weighs 90 kilograms has a BMI of 29.4 kg/m² – and is therefore considered overweight.
BMI = 90 / (1.75 x 1.75) = 29.4 kg/m2
The BMI is divided into weight classes using the following table:
Body mass index | Weight class |
BMI less than 18.5 kg/m² | |
Underweight | |
BMI 18.5 to 24.9 kg/m² | Normal weight |
BMI 25 kg/m² and higher | Overweight |
BMI 25 to 29.9 kg/m² | Pre-obesity |
BMI 30 kg/m² and higher | Obesity |
BMI 30 to 34.9 kg/m² | |
Grade I obesity | |
BMI 35 to 39.9 kg/m² | Grade II obesity |
BMI 40 kg/m² or higher | Grade III obesity |
Good to know:
In addition to the BMI, the distribution of body fat also plays an important role with regard to the risk of complications. Abdominal obesity in particular is associated with a greatly increased risk of cardiovascular disease and type 2 diabetes. The abdominal fat can be determined by measuring the waist circumference.
In women, a waist circumference of 88 centimeters or more is considered abdominal obesity. In men, abdominal obesity is present from a waist circumference of 102 centimeters or more.
3. Healthy weight loss – is that important for me?
When losing weight if you are already overweight or obese, the focus is on your own health, well-being and quality of life: People who are (very) overweight can gradually reduce the consequences for their health by losing weight in a healthy way and thus prevent many different illnesses.
This is particularly important in the case of severe overweight (obesity). When men and women with obesity lose weight, their risk of developing high blood pressure or other cardiovascular diseases decreases, as does the risk of dying from these diseases.
The risk of type 2 diabetes is also reduced by losing weight if you are already overweight or obese. People who are very overweight and have prediabetes at the same time can prevent the development of type 2 diabetes if they reduce their body weight by 10 percent.
Good to know:
A permanent and consistent change in lifestyle is essential for weight loss in obesity. Talk to your doctor about the best way to lose weight in a healthy way without putting too much strain on your body. A qualified nutritionist should accompany the change in diet.
4. Healthy weight loss – what is important?
Weight loss requires an energy deficit or a negative energy balance. This means that the body consumes more energy than is absorbed. The daily consumption of a person’s energy varies from person to person and can be measured or estimated by doctors or nutritionists, for example. A strategy for healthy weight loss can then be developed on this basis.
Tip:
Regardless of energy consumption and calories: Your scales will tell you whether your energy balance is positive (weight gain), negative (weight loss) or even (weight maintenance).
It is generally advisable to consult a doctor before losing weight if you are obese. After a detailed consultation and a health check, the doctor can also advise on a suitable weight loss strategy with regard to pre-existing conditions, laboratory values and the musculoskeletal system (e.g., joint problems).
You should set realistic goals and start off in a small way. After initial successes, you can adjust your goals. A weight loss of 5 to 10 percent of your body weight already has positive effects on your health. You should lose about 1 to 2 kilograms per month.
Good to know:
It is important not to be thrown off course by temporary weight fluctuations or a standstill. A comparison with others does not always help either. Men often lose body fat faster than women, especially at the beginning. In the long term, however, both sexes benefit from the health advantages.
Take up less energy through your diet
Healthy weight loss is primarily a question of your diet: However, zero diets or other diet strategies that promise quick success in losing weight are not helpful. It is better to reduce your weight in small but sustainable steps. Experts recommend taking up around 500 to 600 kilocalories (kcal for short, often referred to colloquially as calories) of energy less than you actually need every day. This corresponds to a weight loss of 1 to 2 kilograms per month.
To lose weight in a healthy way, you should eat more foods that contain few calories but as many nutrients, fibers and vitamins as possible – for example vegetables, fruit, legumes or whole-grain products. Calorie reduction can be achieved through various nutritional approaches. For example, a reduced intake of carbohydrates and saturated fatty acids and an increased consumption of high-fiber foods and plant-based sources of protein are considered suitable. It is important to choose a strategy that suits you well and can be implemented in the long term.
You should also take time to eat and enjoy it consciously. This helps you to become more aware of your own feelings of hunger and satiety. With a food diary, you can better assess your own eating and drinking habits and discover unnecessary calorie traps. The diary can also be discussed during a nutritional consultation.
You can find more information on what a healthy diet can look like here.
Exercise boosts fat burning
Regular exercise is a suitable means of improving your energy balance and losing weight in a healthy way in the long term. Through sport and regular exercise, the body builds up muscles, which require more energy than fat tissue – even at rest. This increases energy consumption.
To reduce excess weight, experts recommend at least 150 minutes, preferably 200 to 250 minutes of endurance training per week. This can increase personal fitness and well-being. It is important to consult a doctor in advance to determine which type of sport is suitable in each individual case. Sports that are easy on the joints, such as swimming, cycling or Nordic walking, are usually suitable.
Tip:
It helps to join a group or club to increase your physical activity. It’s more fun together and it’s also easier to overcome your own weaker self in a group.
There are usually numerous ways to incorporate more exercise into your everyday life and break up long periods of sitting. This includes, for example, taking the stairs more often, getting off the bus one stop earlier and walking the rest of the way or taking a relaxing walk in the evening.
Adapt lifestyle habits in the long term
In addition to diet and exercise, previous lifestyle habits often need to be reconsidered and changed in order to reduce body weight in the long term and keep it stable. Behavioral therapy adapted to your individual situation can help develop strategies to implement the lifestyle change in the long term and develop new behaviors.
Behavioral therapy can also be used to learn approaches for dealing better with setbacks and problems.
Yo-yo effect: How does this happen and how can it be avoided?
Crash diets and one-sided diets can lead to a lack of nutrients and usually end in what is called the yo-yo effect, so that you quickly weigh more afterwards than before. The body’s defense of its weight is a survival strategy that dates back to a time when food was scarce. During periods of hunger, the body reduces its energy consumption, while during times of abundance it stores energy reserves in the form of fat. This results in rapid weight loss during a crash diet of several weeks. Immediately afterwards, however, only a slightly higher energy intake than during the diet is sufficient to put on weight again.
The yo-yo effect is not only frustrating, but can also have a negative impact on your health. The added fat accumulates in the abdominal region, increasing the risk of type 2 diabetes and cardiovascular disease.
To avoid the yo-yo effect and maintain one’s weight in the long term, it is essential to lose weight slowly and change your lifestyle permanently. You should therefore be able to integrate your new eating and exercise habits into your everyday life in the long term and establish them as a new routine.
5. Tips for healthy weight loss
If you are overweight, healthy weight loss is an important step on your way to a better quality of life and for your own health. As is well known, all beginnings are difficult. Nevertheless, it is always worth starting – even small steps can help you reach your goal. The following tips can help you make long-term lifestyle changes and lose weight in a healthy way:
Tip 1: Get support
Nutritionists can help you lose weight. For example, they will work out an individual diet plan or give you recipes to help you lose weight.
Tip 2: Clear goals lead to success
Those who set realistic weight or calorie goals usually lose more weight. It is therefore worth keeping a record of your personal goals, for example in a weight diary. Discuss with your doctor which goals are realistic.
Tip 3: Integrate sport and exercise into your everyday life
Regular exercise increases energy consumption and helps with weight loss. Even after losing weight, regular exercise is important to maintain the weight achieved, avoid a yo-yo effect and stay healthy overall.
Tip 4: Switch to a balanced high-fiber diet
The aim should be to permanently change your diet and provide your body with all the important nutrients. Try to enjoy the colorful variety of fresh foods and give preference to plant-based foods. Reduce your consumption of highly processed, high-fat, high-sugar and animal-based foods. This also includes sweetened drinks.
Good to know:
Apps for your cell phone can also be a good way to bring more exercise and a balanced diet into your everyday life. Since the Digital Healthcare Act came into force, health insurance providers have been obliged to cover the costs of certain apps, which are called digital health applications (DiGAs for short). This requires that the app is prescribed by a doctor. Ask your doctor whether there is a suitable DiGA for your condition.
Sources:
Chi, M. et al.: Effects of weight loss in heart failure patients with overweight and obesity: a systematic review and meta-analysis. In: Eur J Prev Cardiol, 2023, 30: 1906-1921
Christensen, P. et al.: Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes. In: Diabetes Obes Metab, 2018, 20: 2840-2851
Deutsche Adipositas Gesellschaft et al.: S3-Leitlinie: Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. 2. Auflage. Version 2.0. 2014 (Gültigkeit abgelaufen, in Überarbeitung)
Holzapfel, C. et al.: Gewichtserhaltung nach Gewichtsreduktion – wie der Körper sein Gewicht verteidigt. In: Dtsch med Wochenschr, 2011, 136: 89-94
Mensink, G. B. M. et al.: Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). In: Bundesgesundheitsbl, 2013, 56: 786-794
Opio, J. et al.: Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta-analysis of prospective cohort studies. In: Obes Rev, 2020, 21: e13127
Schienkiewitz, A. et al.: Übergewicht und Adipositas bei Erwachsenen in Deutschland – Ergebnisse der Studie GEDA 2019/2020-EHIS. In: J Health Monit, 2022, 7: 23-31
Skurk, T. et al.: Empfehlungen zur Ernährungsprävention des Typ-2-Diabetes mellitus. In: Diabetol Stoffwechs, 2023, 18: S449-S465
SRH Hochschule für Gesundheit et al.: Patientenleitlinie zur Diagnose und Behandlung der Adipositas. 1. Auflage. 2019
Yen, I. W. et al.: Overweight and obesity are associated with clustering of metabolic risk factors in early pregnancy and the risk of GDM. In: PLoS One, 2019, 14: e0225978
Zou, H. et al.: Body-Weight Fluctuation Was Associated With Increased Risk for Cardiovascular Disease, All-Cause and Cardiovascular Mortality: A Systematic Review and Meta-Analysis. In: Front Endocrinol, 2019, 10: 728
As of: 07.05.2024