There is no single cause of obesity. It is a multifactorial ailment. Genetic, hormonal and psychic factors as well as environmental factors such as family, society, politics and economy have a decisive influence on the development of this illness. Early diagnosis und therapy in infancy, involving the family, may prevent the development of obesity in adulthood. However, efforts in this direction often fail because of the parents’lack of understanding. As a consequence, obsessive children get caught in a fatal vicious circle. They are razzed by children of the same age, become depressed, console themselves with food, and become even fatter. Some of the patients have been sexually abused in their childhood and protect themselves from sexual infringement with extra body fat,non-attractive appearance, and a protective shell. That means they damage themselves. They repeat the injury but are able to keep the control. Thereby they receive a temporary satisfaction from the food they eat. Corpulent people who want treatment are difficult to handle. Their motivation is feeble and fragile. A stable relationship between doctor and the patient is difficult to achieve. The doctor often faces an insurmountable wall of resistance. Even if he wants to help in the beginning, he will become desperate and angry due to the failure of his efforts, without really understanding the patient. Only 4.73% of the obese patients can be cured successfully through psychotherapy. The reason for this is the patient’s resistance against an exposure of their personal conflicts. 7.37%were successful with surgical therapy which at the moment is the most effective method of treatment. Nonetheless, psychotherapy is an important aid for motivated patients and should be recommended to all obese patients (as a help). A psychological diagnosis is indispensable before surgery is resorted to. Psychiatric diseases as well as internal disorders must be excluded before. This can be illustrated by examples of surgically treated and not medicated patients.

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2005
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