Dtsch Med Wochenschr 2015; 140(01): 24-28
DOI: 10.1055/s-0040-100426
Dossier
Adipositas
© Georg Thieme Verlag KG Stuttgart · New York

Konservative Therapie der Adipositas – wann und wie?

Conservative obesity treatment – when and how?
Matthias Blüher
1   Klinik und Poliklinik für Endokrinologie und Nephrologie, Medizinisches Forschungszentrum Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
12 January 2015 (online)

Zusammenfassung

Adipositas ist mit einer Prävalenz von 24 % in der erwachsenen Normalbevölkerung in Deutschland eine häufige Erkrankung. Adipositas erfordert eine effektive Prävention und Therapie, vor allem weil sie mit einem erhöhten Risiko für Typ 2 Diabetes, Erkrankungen des Herz-Kreislaufsystems, des Stütz- und Bewegungsapparats, der Psyche und anderer Organsysteme einhergeht. Die Indikation zur Adipositastherapie wird in Abhängigkeit von BMI und Körperfettverteilung und unter Berücksichtigung von Komorbiditäten gestellt. Die wesentlichen Therapieziele sind eine Gewichtsabnahme sowie die Stabilisierung des reduzierten Gewichts. Um diese Ziele zu erreichen, werden in der konservativen Basistherapie eine energiereduzierte Mischkost mit einem täglichen Defizit von 500 kcal, eine Erhöhung der körperlichen Aktivität, eine Verhaltensmodifikation oder Verhaltenstherapie zum Beispiel im Rahmen evaluierter Gewichtsreduktionsprogramme empfohlen. Wenn mit dieser Basistherapie die individuellen Therapieziele nicht erreicht werden, erfolgt eine stufenweise eskalierende zunächst konservative Therapie, die niedrig-kalorische Kostformen, Pharmakotherapie und endoskopische Verfahren beinhalten kann. Eine weitere Stufe in der Adipositastherapie sind chirurgische Interventionen, die im Vergleich zur konservativen Therapie hinsichtlich der Gewichts- und Körperfettreduktion, der Verbesserung von Adipositas-Begleiterkrankungen, der langfristigen Gewichtsstabilität und der Senkung des Sterblichkeitsrisikos deutlich wirksamer sind.

Summary

With a prevalence of 24 %, obesity is a frequent disease in the general population in Germany.

Obesity requires an effective prevention and treatment, mainly because it significantly increases the risk of developing type 2 diabetes, cardiovascular, orthopaedic, psychologic and other disorders. The indication for the treatment of obesity is based on BMI and body fat distribution, but also includes considerations based on comorbidities. Main treatment goals include body weight reduction and weight maintenance after weight loss. To achieve these goals, a conservative treatment strategy is primarily recommended which consists of energy-reduced diet with a daily deficit of 500 kcal, increased physical activity, behavioral modifications or treatment. Several multimodal conservative treatment programs have been evaluated. If individual treatment targets could not be achieved, stepwise conservative treatment intensification should be initiated with very low calorie diets, pharmacotherapy and / or endoscopic obesity therapies. Surgical interventions represent an additional step in the obesity treatment algorithm, which have been shown to be more effective than conservative approaches with regard to weight and body fat reduction, improvement in obesity-related comorbidities, long-term weight maintenance and reduced mortality.

 
  • Literaturverzeichnis

  • 1 World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of a WHO consultation. 894. World Health Organization Technical Report Series; 2000: 1-253
  • 2 Wirth A, Wabitsch M, Hauner H. Clinical practice guideline: The prevention and treatment of obesity. Dtsch Arztebl Int 2014; 111: 705-713
  • 3 Hauner H, Moss A, Berg S et al. Interdisziplinäre Leitlinie der Qualität S3 zur “Prävention und Therapie der Adipositas”. Adipositas 2014; 8: 179-221
  • 4 Kurth BM. Erste Ergebnisse aus der “Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 980-990
  • 5 Blüher M. Insulin or surgery? The perspective of a diabetologist. Chirurg 2014; Oct 18. [Epub ahead of print] PMID: 25323489
  • 6 Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA 2003; 289: 76-79
  • 7 Weinstein AR, Sesso HD, Lee IM et al. Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA 2004; 292: 1188-1194
  • 8 Wadden TA. Treatment of obesity by moderate and severe caloric restriction. Results of clinical research trials. Ann Intern Med 1993; 119: 688-693
  • 9 Sharma AM, Blüher M. Konzept für Eine Ätiologie-basierte Adipositas-Behandlung. Chirurgische Allgemeine 2010; 11: 600-609
  • 10 Schulze MB, Hoffmann K, Boeing H et al. An accurate risk score based on anthropometric, dietary, and lifestyle factors to predict the development of type 2 diabetes. Diabetes Care 2007; 30: 510-515
  • 11 Pischon T, Boeing H, Hoffmann K et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105-2120
  • 12 Spranger J, Kroke A, Möhlig M, Bergmann MM, Ristow M, Boeing H, Pfeiffer AF. Adiponectin and protection against type 2 diabetes mellitus. Lancet 2003; 361: 226-228
  • 13 Schleinitz D, Böttcher Y, Blüher M et al. The genetics of fat distribution. Diabetologia 2014; 57: 1276-1286
  • 14 Reaven GM. Importance of identifying the overweight patient who will benefit the most by losing weight. Annals of Internal Medicine 2003; 138: 420-423
  • 15 Stefan N, Kantartzis K, Machann J et al. Identification and characterization of metabolically benign obesity in humans. Archives of Internal Medicine 2008; 168: 1609-1616
  • 16 Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes (Lond) 2009; 33: 289-295
  • 17 Padwal RS, Pajewski NM, Allison DB, Sharma AM. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ 2011; 183: E 1059-1066
  • 18 Kuk JL, Ardern CI, Church TS et al. Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab 2011; 36: 570-576
  • 19 Hamer M, Stamatakis E. Metabolically Healthy Obesity and Risk of All-Cause and Cardiovascular Disease Mortality. J Clin Endocrinol Metab 2012; 97: 2482-2488
  • 20 Kantartzis K, Machann J, Schick F et al. Effects of a lifestyle intervention in metabolically benign and malign obesity. Diabetologia 2011; 54: 864-868
  • 21 Karelis AD, Messier V, Brochu M et al. Metabolically healthy but obese women: effect of an energy-restricted diet. Diabetologia 2008; 51: 1752-1754
  • 22 van Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord 2014; 14: 9
  • 23 Blüher M. MECHANISMS IN ENDOCRINOLOGY: Are metabolically healthy obese individuals really healthy?. Eur J Endocrinol 2014; Jul 10. pii: EJE-14–0540 [Epub ahead of print]
  • 24 Blüher M. Predisposition – obesity phenotype. Dtsch Med Wochenschr 2014; 139: 1116-1120
  • 25 Arsenault BJ, Cote M, Cartier A et al. Effect of exercise training on cardiometabolic risk markers among sedentary, but metabolically healthy overweight or obese post-menopausal women with elevated blood pressure. Atherosclerosis 2009; 207: 530-533
  • 6 Sharma AM, Padwal R. Obesity is a sign – over-eating is a symptom: an aetiological framework for the assessment and management of obesity. Obes Rev 2010; 11: 362-370
  • 27 Astrup A, Grunwald GK, Melanson EL et al. The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obes Relat Metab Disord 2000; 24: 1545-1552
  • 28 Nordmann AJ, Nordmann A, Briel M et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med 2006; 166: 285-293
  • 29 Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 2010; 9: 1-12
  • 30 Witham MD, Avenell A. Interventions to achieve long-term weight loss in obese older people: a systematic review and meta-analysis. Age Ageing 2010; 39: 176-184
  • 31 Shai I, Schwarzfuchs D, Henkin Y et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359: 229-241
  • 32 Esposito K, Marfella R, Ciotola M et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004; 92: 1440-1446
  • 33 Donnelly JE, Blair SN, Jakicic JM et al. American College of Sports Medicine. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009; 41: 459-471
  • 34 Blüher M, Zimmer P. Metabolic and cardiovascular effects of physical activity, exercise and fitness in patients with type 2 diabetes. Dtsch Med Wochenschr 2010; 135: 930-934
  • 35 Paffenbarger Jr RS, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986; 314: 605-613
  • 36 Blair SN, Kohl 3rd HW, Barlow CE et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995; 273: 1093-1098
  • 37 Peters A, Kubera B, Hubold C, Langemann D. The corpulent phenotype-how the brain maximizes survival in stressful environments. Front Neurosci 2013; 7: 47
  • 38 Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155-161
  • 39 de Castro ML, Morales MJ, Martínez-Olmos MA et al. Safety and effectiveness of gastric balloons associated with hypocaloric diet for the treatment of obesity. Rev Esp Enferm Dig 2013; 105: 529-536
  • 40 Patel SR, Hakim D, Mason J, Hakim N. The duodenal-jejunal bypass sleeve (EndoBarrier Gastrointestinal Liner) for weight loss and treatment of type 2 diabetes. Surg Obes Relat Dis 2013; 9: 482-484
  • 41 Marinos G, Eliades C, Raman Muthusamy V, Greenway F. Weight loss and improved quality of life with a nonsurgical endoscopic treatment for obesity: clinical results from a 3- and 6-month study. Surg Obes Relat Dis 2014; 10: 929-934
  • 42 Wadden TA. Treatment of obesity by moderate and severe caloric restriction. Results of clinical research trials. Ann Intern Med 1993; 119: 688-693
  • 43 Hunter GR, Brock DW, Byrne NM et al. Exercise training prevents regain of visceral fat for 1 year following weight loss. Obesity (Silver Spring) 2010; 18: 690-695
  • 44 Catenacci VA, Ogden LG, Stuht J et al. Physical activity patterns in the National Weight Control Registry. Obesity (Silver Spring) 2008; 16: 153-161
  • 45 Carlsson LM, Peltonen M, Ahlin S et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 2012; 367: 695-704
  • 46 Sjöström L, Narbro K, Sjöström CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741-752
  • 47 Sjöström L, Gummesson A, Sjöström CD et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 2009; 10: 653-662
  • 48 Mingrone G, Panunzi S, De Gaetano A et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012; 366: 1577-1585
  • 49 Schauer PR, Bhatt DL, Kirwan JP et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med 2014; 370: 2002-2013