Multimodale Interventionen in der Therapie von Adipositas im Alter

Zusammenfassung

Mit der zunehmenden Prävalenz von Adipositas bei älteren Menschen gewinnen maßgeschneiderte therapeutische Strategien an Bedeutung. Aktuelle Leitlinien empfehlen multimodale Ansätze für das Gewichtsmanagement bei Erwachsenen, enthalten jedoch keine spezifischen Empfehlungen für ältere Menschen. Altersbedingte Veränderungen der Körperzusammensetzung, geriatrische Syndrome und Multimorbidität sind bei Therapieentscheidungen zu berücksichtigen. Eine Gewichtsreduktion kann den altersbedingten Verlust von Muskel- und Knochenmasse verstärken und das Risiko ungünstiger Folgen erhöhen. Daher sind Therapiekonzepte notwendig, die den Verlust von Fettmasse, den Erhalt von Muskel- und Knochenmasse sowie die Verbesserung des funktionellen Status anstreben.

Dieser Artikel gibt einen Überblick über die multimodale Adipositastherapie im Alter und fasst klinische Studien zusammen, die solche Interventionen bei älteren Menschen mit spezifischen Komorbiditäten durchgeführt haben. Multimodale Interventionen, die moderate Kalorienrestriktion, kombiniertes Kraft- und Ausdauertraining sowie verhaltenstherapeutische Strategien umfassen, haben sich als sicher und effektiv erwiesen. Allerdings wurden Komorbiditäten und geriatrische Syndrome in den Studien selten berücksichtigt. Zudem gibt es wenige Studien, die spezielle Krankheitsbilder oder Syndrome wie Herzinsuffizienz, Arthrose oder Gebrechlichkeit als Einschlusskriterium adressieren, was die Übertragbarkeit der Ansätze einschränkt.

Abstract

With the increasing prevalence of obesity in older adults, effective therapeutic strategies tailored to this population are gaining importance. Current guidelines recommend multimodal approaches for weight management in adults but do not provide specific recommendations for older individuals. However, age-related changes in body composition, geriatric syndromes, and multimorbidity, which contribute to functional impairments, must be considered in therapeutic decisions. Weight loss can inadvertently exacerbate the age-induced loss of muscle and bone mass, increasing the risk of adverse outcomes. This highlights the need for therapeutic concepts that target fat mass reduction, muscle and bone mass preservation, and functional status improvement.

This article provides an overview of multimodal obesity therapy in older adults and summarizes clinical studies that have implemented such interventions in older individuals with specific comorbidities. Multimodal interventions combining moderate caloric restriction, strength and endurance training, and behavioral strategies have been shown to be safe and effective for older adults with obesity. However, the underlying studies have largely overlooked comorbidities and geriatric syndromes. Additionally, few studies have included specific diseases or syndromes, such as heart failure, osteoarthritis, or frailty, as inclusion criteria, limiting the applicability of these approaches to these groups.

Schlüsselwörter

Altern - Adipositas - multimodale Interventionen - Komorbiditäten - Frailty

Keywords

Aged - obesity - multimodal interventions - comorbidities - frailty

Publication History

Article published online:
28 February 2025

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