youth's as a child. some residents are suspicious of refugees in the neighborhood. but americans curious about the bar's regulars. across the road worlds apart. starting november 11th on d.w. . welcome to in good shape coming up this week gender medicine men and women often need different therapies. fixing your teeth when it makes sense to give them that he said dental prosthesis. plans working out when you're over white a fitness group shows you how. and here's your host dr coston let's go tot excessive weight is a worldwide problem you as

a regular viewer of in good shape should be a rail fit but some people are so big that the world health organization says that it is a disease called obesity take the cook islands for instance where 50 percent of the inhabitants are morbidly obese well this year i'm not the cook islands this is not see where i'm going to meet her for some a ts blew up. dr mathias blue is head of the obesity patient clinic for adults. his patients have a body mass index b.m.i. of over. you get your b.m.i. when you take your weight in kilograms and divide it by the square of your height in meters a person with a b.m.i. of 18 to 25 is considered normal. a person with a b.m.i.

between 25 and 30 is overweight and over 30 obese given my height to be considered obese i protest to weight around 100 kilograms visibly and thanks for having me today thank you what kind of big chair is this year and this is really why it really huge is because you treat a lot of overweight patients that's true we need those chairs to accommodate our patients so of course we want that our patients with overweight and obesity feel welcomed in our outpatient clinic but on the other hand it's also a very practical reason some patients don't even fit into this chair early so this is really heavy heavy can you patients speed that the chair doesn't crash it holds 500 kilograms but you also have to think of the fed distribution so if you have a very central distribution it may be that you don't fit into the chair there are

a lot of overweight patients and there in some of these patients and you distinguish between just being overweight and morbid obesity why is that because we . make our therapeutic decisions on b.m.i. above 30 for instance which requires more intensive and an earlier intervention compared to the work b.m.i. for instance when you think about overweight patients who always think that they're lazy just sitting around on the couch and watching telly but there are some overweight patients who are really fit take sumo wrestlers for instance and there are studies suggesting that overweight patients who aphids are better off than slim patients who are not fit but it's very difficult when you're overweight to go into the gym. if you can't do any more just do a little bit but then motion. fitness trainer you'll years the mourners putting her

class through their paces the people taking part in this exercise session for the overweight are giving it their all deana share has been coming to the class since it began and she knows exactly what she's hoping to achieve. this month i'm from boston photog began to think. i like him for sizing and he's very that doesn't make me feel self-conscious. i'm not really here in the beginning i did feel a little bit nervous coming here. but now i've started to gain self-confidence which is really great this is unfortunately. for many overweight people it can be a bit daunting trying to lose weight going to a gym and working out alongside people who are very fit the team at this gym came up with the idea for a class specifically for those who are overweight. yet you and i guess one of our

members if we'd ever thought about offering a class like that so we sat down thought about it a bit and decided the idea was great it's never been done before the participants are a group of like minded people and they enjoy them so. it's going great people are having fun bob that's good and now spoiled by taking part in the fit for a big class isn't just fun for many in the group it's been prescribed by their doctor as physical therapy and means they might be able to avoid surgery. i don't want to. we're about to have shoulder operation but we got to fit enough so they didn't need them anymore we worked directly on the problem areas when i was doing exercises that we wouldn't have been able to do a year ago it was very different in the beginning and we're really happy that we've made it to this point not the participants have made such progress after. the most anxious time the organizers are looking to get even more participants involved in

the classes isn't i'll miss about that we're all a little bit overweight and want to work on it it would be good to have more people like us join us we'd love it if more people came to the course. exercising with others who have the same goals. we just saw that the people in our report were exercising to get rid of their excess weight is this also an option if you're really really obese and principle everybody can exercise so exercise is part of our basic program for overweight patients and obese people. we have to consider of course potential side effects and risks for very very obese people in our exercise programs when i speak to overweight people in my practice and in the detail and they should eat less and exercise more many of them say well it's all the genes to blame or stressed about the metabolism is a truth about this one of the signs indeed

a lack of exercise. over eating is only part of the explanation to become overweight so we think that a slow metabolism also contributes to that the individual body shape or development of overweight for instance some disturbances may contribute to weight such as those thyroid function or increased stress hormone levels. we also know that with ageing we need less. calories being overweight is not just about feeling good it's also a big health risk involved and so life like diabetes is like a heart attack in some forms of cancer and what about really obese patients because the risk there so we think that between 30 and 60 the caesars are at least associated with obesity some of them are really a function simply of body weight like joint problems lung problems

like obstructive sleep apnea for instance even hypertension these are the seasons which are clear and clear function of the body weight but still we see independent of the body weight starting with overweight for some met up logic diseases including type 2 diabetes fatty liver that weight is only a contributor and we see across the entire range of body weight in increased risk for those metabolic diseases so why is it so hard to lose weight and keep the no weight our body perfectly defense dimmick simle body weight so we have several mechanisms including hormonal neuron and mechanisms protecting us from hunger now in times where we have everyway our food and we don't have to exercise and i will work and transportation modes are. sedentary if you want so. that falls back on us and of course as overweight and obesity what kind of patients come

to you how biko their oh we see patients who have like 5 to 10 overweight and patients who weigh up to 300 kilograms which wouldn't fit in a chair like this even in this because it's a very very big chair you know exactly so we even need some time special transportation modes for those patients and it requires 3 to 4. fire over across to help and. report people to come to us for a diagnosis and treatment and what kind of concept do you offer we try to offer our patients and at geology based treatment of obesity this of course requires in the 1st place a clear diagnosis which includes homeowner causes of obesity and metabolism causes of obesity but also psychological courses we are surprised that in many of our patients psychological courses including also stigmatisation of the society is one

of the main courses of obesity so we believe that obesity can be treated it cannot be cured as of today but it's an escalating thorough putin approach so we start with interventions focusing on increasing exercise decreasing food intake we can at pharmacotherapy use and it may bring patients to the decision to go for beriah trick surgery which is in the long term so far the most effective treatment strategy so surgery like gastric bending for instance or even just to bypass can make all the difference. less the year goes i've been a youngish he doesn't dreaded climbing stairs she used to weigh $150.00 kilos now she weighs only $95.00 and going up them has become much easier she still has a pair of slacks from the old days how does she feel about them now. if you make

later i feel lighter. when i almost cut my weight in holland especially when i see the slacks i know i've reached my goal because soft. it was the last straw for her when she found out she needed new knee joints that prompted her to ask for gastric bypass surgery to. she received a so-called on the go loopy gastric bypass the surgeons also had her stomach and small intestine. after that her body could only take in a fraction of the food it was a drastic step. to protect most of our lives like patients have to be observed for the rest of their lives they also need lifelong monitoring by the obesity center many have to take vitamin supplements for example and they need to be checked regularly to ensure the not suffering from any deficiencies. in the cuts are absolutely essential were performing these kinds of operations. sabina's life

changed dramatically after the operation she now eat so much less she lost more than 50 kilos in 9 months i need problems have gone and she started going out for walks again as suits the host who i know eat more consciously more slowly when my stomach says you're full and i stop even if there's a crumb on the plate or the other half of a roll i leave it there anita again an hour or 2 later. i feel reborn very high. appetite. permanent thanks to the gastric bypass surgery. so there is difficult choices this bending and gastric bypass surgery so so what's the difference so the differences between the obesity surgeries how much we restrict the amount of food which can be taken in. and also with the

absorption of food so for instance the gastric banding which restrict the size of the stomach so per meal you can approximately eat like a smaller amount of maybe 200 grams or milliliters or so. beareth with a gastric bypass you have also a restriction of the stomach that is becoming smaller due to the surgery but then food goes in deeper parts of the intestine thereby leading to action. or a restriction of the absorption at least so if you take a look into the yellow press they're often reports about magic pill and medication that can help you to reduce weight since so what does an expert say about this there are many pills under free market which are not really safe and successful but there are a couple of medications which are really approved for the treatment of obesity and

those includes medications who would limit the absorption effect such as or just that for instance and others are predominantly very king on the brain centers of epa tighten satiety control. and intel big other results if a patient decides that he wouldn't go for surgery and he would like to take any medication that just tries to lose weight with lifestyle changes so the effects of the different treatment approaches is quite variable. as a mean you may lose up to 5 percent of your initial bodyweight with diet and exercise interventions pharmacotherapy may provide a 10 to 15 percent of the weight loss but surgeries may provide of weight loss of more than 30 percent to 50 percent of your initial bodyweight of course this has to be considered and weighed against the side effects if we have patients who

do not want to go for family therapy or obesity surgery we know that the best predictors of a treatment success are the tyrannies to the program and high level of motivation. we got a lot of viewer questions like from han who wants to know if using weight fast isn't the problem if it's not dangerous like for kidneys there are indeed risks associated with fast weight loss particularly for the kidneys therefore we always recommend. a parallel monitoring by physicians or dieticians because too much protein it with a fast weight loss may be harmful for the kidneys bella flanagan is a teacher in australia and she's noticed an increase of children and she would like to know what she can do about it. indeed particularly in children and adolescents the prevalence of obesity and overweight significantly increased over recent years

. and we know that this is the very sensitive period in your life where you can really make a difference so nutrition education bringing people into exercise programs. also educate about the content of certain food may be critical in this period thank you so much for answering all my questions thank you and what about you if you don't have any love handles good for you but maybe you have some questions. in good shape if you're a weekly health show on d w that covers many aspects of health care we look at what's new in medical treatment nutrition fitness and beauty we discuss these topics and depth with specialists and offer you opportunities to pose your own questions so get in touch . at least in modern and enlightened society as the differences between men and women are declining but some gender

specific differences remain. school girls are less confident in math and physics and their male counterparts. in. even in college maybe students are more confident than female students. women are more generous and are more likely to share. and they take better care of their health and therefore they live longer. and because men and women react differently to symptoms medication and disease this is why the field called gender medicine was created. margarito hawk-eye now it was one of the 1st doctors and the german speaking world to apply a revolutionary principle to her work because men and women differ biologically they sometimes need different treatments it's not approach that's known as gender

medicine. they are as common as the coyote looking asian and my background is in cardiology. the difference is already noticeable in everyday life . example they tend to be more men in the intensive care unit. that's an odd statistic given that more women die from heart disease than men so where are the female patients. a gender specific perspective is like a magnifying glass that provides completely new insights some of which are vital for patient survival. or. a heart attack manifests itself differently in man and one and it often affects different blood vessels. men and women also react differently to certain medications from aspirin to widely

used antihypertensive. and the kidneys work differently in men and women too. even the success of cancer treatments depends on the sex of the patients. found among dunces a woman and a man get the same cancer at the same age and in the same state of health then the man has a much higher risk of dying from it if both died the man will die faster men are worse off chemotherapy works better for women. a gender specific perspective has to start with basic medical research design a whole fun from the helmholtz center a new nick is an expert on diabetes and the different forms it takes in men and women. in the to charles us it turns out that women have

a higher risk of developing diabetes if they are obese. and what's even more serious women also suffer more from secondary diseases and check out why. but why is that what role does estrogen play in this process and how does it interact with cholesterol for example. in order to alleviate the more severe progression of the disease in women the researchers are trying to develop a therapy that allows female patients to exercise more vigorously. this could help prevent the emergence of typical secondary conditions. defined for steve we want to understand how this works because not everyone is able to exercise vigorously would be great if we could develop a drug supply. the researchers are trying to understand the smallest details of gender differences and use those insights to develop new and improved treatments

. that will mean a reappraisal of well known active ingredients and pharmaceuticals oliver vets from the university of you know is working with his research group on what are known as anti like or trying a class of drugs with huge potential for the treatment of diseases like rheumatism and asthma. at least when tested on female patients. the development of these active substances began in 1980 s. and ninety's but the active substances were always tested on men and then it became clear that their efficacy was actually relatively low and if you now look at our data and see that the active substances are much more effective in female cells in female animals you can conclude that they could actually be more effective in women . so medical research shows that adopting treatment diagnosis and medication to the different needs of men and women there's

a logical step. one that will help take therapies to the next level. in the olden days it was all about plugging a hammering into nailing things but nowadays it's become very quiet because we just glue. words even 40. 3 the known lost 2 of her teeth to gum disease at the age of just $35.00 initially she suffered from bleeding gums there enjoying pregnancy her teeth grew loose and eventually fell out. the dentist try to save the teeth but the attempts were unsuccessful the river was told she'd need a denture or implants but then she heard about a d.c. of dentistry. it's a new technique that's being used increasingly to replace missing in sizes the real side of the neighboring tooth is filed slightly to accommodate the replacement

tooth which has a kind of wing on it the dentist this so called a decent bridge to the neighboring tooth and the road is again complete. implants always require an operation often bone grafting but we generally don't perform any surgery when putting in and he says bridge and we don't need to grind up any healthy told. so it's less. invasive. it's been 14 years since the reaper got her new teeth just looking at her it's impossible to tell which ones are artificial. by. the way are different ones of mine but the ones either side i knew that on one of the edges broken off slightly but i told the dentist not to repair it since it looks natural. with help from an orthodontist fixture the technique can also be used to replace most. if. we call these bonding attachments of the in there used to anchor a partial denture with

a piece of. them they prefer and hold very well. could. they go on sure always try to look after his teeth but as he grew older many of them still fell out. somehow they got infected. one tooth out after another until i got to the point where they said i would need full dentures. that would have meant having the rest of pulled even though they were still healthy so the 76 year old looked around for a better solution than i'd kill university's dental school he learned that there was indeed an alternative that would allow him to keep his own teeth. to allow a partial denture to be fitted permanently the dentist bones a tiny pin onto the back of a neighboring. denture has attachments that fit exactly on the pins the advantage

of this system is that it's both invisible and very robust. the technique is not yet widespread but it's already proved to be reliable. this is not new but ya this method has been scientifically proven and a stop last for a number of years if an adhesive bridge or attachment should happen to come loose a little usually be an issue of the bonding which is easy to repair when you know how my visor view has been cut let's go toward it that's today it should be a matter of course that dentists inform patients about the option of adhesive dentistry specially adhesive bridges and attachments so that their own teeth don't need to be ground down unnecessarily or if they need an implant that they know there is an alternative. like the 7 dentistry not only often certain advantages it's often cheaper than other techniques in germany it's already the standard for replacing missing in sizes to create

a whole row of natural looking teeth. that's it for today see you next week and until then let's all try to stay in good shape.

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blame . this is the w. news live from by a hong kong protesters dies of his injuries also 42 in the building is the 1st to see the death since the start of the anti-government campaign the pro-democracy activists vowed to escalate their protests also coming up u.s. secretary of state's mike on peo calls on democracies to work together on this thing but they don't.