made in the last. 60 minutes. joining us from africa the moral story link to exceptional stories and discussion from the news of easy to our web site d w dot com slash africa join us on facebook. for. playing. welcome to in good shape coming up this week gender medicine why men and women often need different therapies. fixing your teeth when it makes sense to give them that he said dental prosthesis. i'm working out when you're over white

a fitness group shows you how. and here's your host dr cost and 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 a lot the cook islands this is not going to meet for for some a ts blew up. but. dr mathias blue is head of the of the city patient clinic for adults that his patients have the body mass index b.m.i. of over fatty. you get your b.m.i. when you take your. weight in kilograms and divided by the square of your height in

meters a person with a b.m.i. of $18.00 to $25.00 is considered normal a person with a b.m.i. between $25.30 is overweight and over 30 obese given my height to be considered obese adults have to wait around 100 key to craps visibly a thanks for having me today thank you what kind of big chair is this here and this is really what it really huge is it 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 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 effect distribution so if you have a very central distribution it may be that you don't fit into the chair ok there 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 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 sue move restless for instance and there are studies suggesting that always patients who are fit are better off than slim patients who are not fit but it's very difficult and you're overweight to go into gym.

if you can't do any more just do a little bit. today and motion. as 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 and for him this time for to take anything. i like exercising any group 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 we i think every 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 does a participant or a group of like minded people and they enjoy insight. it's going great people are having fun one that's good and that's a point 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. or about to have shoulder operation but we got i fit enough so they didn't need them anymore so 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 and that the participants have made such progress after what i just typed in the most anxious time the organizers are looking to get even more participants involved in the classes they sent out in the midst of a good 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 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 the very very obese people in our exercise programs when i speak to overweight people in my practice and don't tell them they

should eat less and exercise more many of them say well it's all the genes to blame or stressed about the metabolism saying truth about this for 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 hormonal disturbances may contribute to overweight such as those thyroid function or increased stress hormone levels. we also know that with aging 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. what about really obese patients because the risk there so we think that between 30 and 60 diseases 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 metabolic 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 know we need our body perfectly defense to mix in more 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 courses overweight and obesity what kind of patients come to you how biko their oh we see patients who have like 5 to 10 kilograms overweight and patients who weigh up to 300 kilograms which wouldn't fit in the 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 a course 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 hormone of course of obesity metabolism causes of

obesity but also psychological cause 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 s. and it may bring patients to the decision to go for beria trick surgery which is in the long term so far the most effective treatment strategy so surgery like gastric banding for instance or even gastric bypass can make all the difference. leslie here 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 like. i almost cut my weight in holland especially when i see the slacks i know i've reached my goal of 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 loop 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 pretend 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 markets are absolutely essential we're forming these kinds of operations. so being as life changed dramatically after the operation she now eats much less she lost more than 50 kilos in 9 months any 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. 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 fruit so for instance the gastric banding which restrict the size of the stomach so per meal you can approximate eat like a smaller amount of maybe 200 grams or milliliters or so. very with 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 they are by leading to. 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 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 include some medications who would limit the absorption effect such as or just that for instance and others are predominantly very king under brain centers of appetite and satiety control. and told 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 effect size of the different treatment approaches is quite variable. as the 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 50 percent of your initial bodyweight of course this has to be

considered and weighed out 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 at hearings 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 a 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 you think 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 societies 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. even in college majors 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. moderately to hold light and i 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 an approach that's known as gender medicine. they are as. looking asian and my background is in cardiology. the differences are already noticeable in everyday life if it is your 1st sample they tend to be more men in the intensive care unit. of the samyn. 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 and men and women it often affects different blood vessels.

men and women also react differently to certain medications from aspirin to widely used antihypertensive. the kidneys work differently in men and women too. even the success of cancer treatments depends on the sex of the patients. the fold among them says the woman and the man get the same cancer at the same age and in the same state of health since 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 and you know as an expert on diabetes and the

different forms it takes in men and women. this is how to charles. 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 a light. 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. divine for skiing we want to understand how this works because not everyone is able to exercise vigorously it 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 the 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. 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 are adapting 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. tended words even for teeth. for either known or 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 decent dentistry. it's

a technique that's been used increasingly to replaced 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 that roe is again complete. the implants always require an operation often bone grafting but we generally don't perform any surgery when putting in an adhesive bridge and we don't need to grind off any healthy. so it's less. invasive. it's been 14 years since the reaper got her new teeth just looking at are it's impossible to tell which ones are artificial. by. different ones and 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 orthodontic fixture the technique can also be used to replace motors. we call

these bonding attachments of the in there used to anchor a partial denture with a piece of this then they prefer and hold very well. that. 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 teeth pulled even though they were still healthy so the 76 year old looked around for a better solution. 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 bombs

a tiny pin onto the back of a neighboring to the 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 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 it will usually be an issue of the bonding which is easy to repair when you know how i mean wise of you to hear that's good that's today it should be a matter of course that dentists inform patients about the option of adhesive dentistry pitchman suspiciously 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's an alternative. energies of 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 natural looking teeth. that's it for today see you next week and until then let's all try to stay in good shape.

the 1st. kickoff life. 30 years ago mark the beginning of difficult times for the east german soccer team today none of the teams from the former east german top division played in the bundesliga morning is that we ask a player from the keeps me in the last. 30

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a. small. part documentary starts nov 14th w. live. place . this is the news live from ballina for elections 8 no 4 years polls open in spain yet and now the election on various issues looking for change or suffering and next in haiti acting prime minister has or sanchez hopes to finally secure a majority we'll go live to our correspondent in madrid. also coming up and if he

is president claims that he is the victim or they could do even more about it anti democratic groups are trying to the post him it's a nice change sides are enjoying pretty.