Psychische Komorbidität und Lebensqualität adipöser Menschen, eine prospektive, kontrollierte Studie

Zusammenfassung

Die 2001 begonnene multizentrische, prospektive Längsschnittstudie verfolgt das Ziel, Prädiktorvariablen für den Gewichtsverlauf nach konservativer oder chirurgischer Behandlung der Adipositas zu erforschen. Die Studie untersucht die Prävalenz und den Verlauf komorbider psychischer Störungen sowie demografische, psychosoziale und psychosomatische Variablen einschließlich der Lebensqualität adipöser Menschen mittels strukturierter psychiatrischer Interviews und Selbsteinschätzungsinventare. Die Studie besteht aus einer Querschnitts- und einer Längsschnittuntersuchung mit Messzeitpunkten zwei und vier Jahre nach Intervention. Im Rahmen der initialen Querschnittsstudie wurden Teilnehmer einer konservativen Adipositasbehandlung (n = 251) und Adipositaschirurgiepatienten (Magenband-OP) (n = 153) untersucht. Als Kontrollstichproben dienten zufällig aus dem Einwohnermeldeamt der Stadt Essen ausgewählte adipöse (n = 128) und normalgewichtige Probanden (n = 174) ohne Anliegen einer Gewichtsreduktion oder Diätverhalten zum Zeitpunkt der Untersuchung. Adipöse Frauen, die an konservativen Gewichtsreduktionsmaßnahmen teilnahmen oder sich wegen ihrer Adipositas operieren ließen hatten eine höhere Prävalenz psychischer Störungen im Vergleich zu normalgewichtigen oder adipösen Frauen ohne Adipositasbehandlung. Die Prävalenz psychischer Störungen war bei adipösen im Vergleich zu normalgewichtigen Männern unabhängig von der Inanspruchnahme von Gewichtsreduktionsmaßnahmen höher. Die Anzahl komorbider somatischer Erkrankungen bzw. psychischer Störungen und nicht das Körpergewicht hatte einen Einfluss auf die globale Lebensqualität. Zumindest bei psychisch wie physisch gesunden Menschen ging ein höheres Körpergewicht mit einer höheren psychischen Lebensqualität einher. Bei den operierten Patienten war ein und zwei Jahre nach der Operation eine deutliche Besserung der depressiven Symptomatik und der Lebensqualität zu beobachten. Präoperativ diagnostiziertes gestörtes Essverhalten („binge eating”, „grazing”) oder die Präferenz für Süßigkeiten („sweet eating”) hatte keinen Einfluss auf den postoperativen Gewichtsverlauf. Wurde gestörtes Essverhalten allerdings postoperativ diagnostiziert, so ging es mit einem deutlich geringeren Gewichtsverlust einher.

Abstract

The multicenter prospective study which started in 2001 aimed at identifying predictors of the course of weight after conventional and surgical weight loss treatment. By means of structured psychiatric interviews and self-rating questionnaires the study evaluated prevalence and course of comorbid mental disorders of obese individuals. Of further interest were demographic, psychosocial and psychosomatic variables including quality of life. The study consisted of both cross-sectional and longitudinal analyses with follow-up assessments one, two, and four years after treatment. At baseline participants of conventional weight loss treatment (n = 251) and obesity surgery patients (gastric banding) (n = 153) were assessed and compared to random samples of obese (n = 128) and normal-weight (n = 174) residents of the City of Essen who were not participating in any weight loss treatment. Obese women, participating in conventional weight loss treatment or undergoing obesity surgery showed a higher prevalence rate of mental disorders compared to normal-weight or obese women not participating in any weight loss treatment. Compared to normal-weight men prevalence rates of mental disorders of obese men were higher independent of participating in a weight loss treatment. The number of comorbid somatic illnesses and mental disorders but not body weight had an impact on quality of life. At least in physically and mentally healthy obese individuals a higher body weight was associated with higher emotional well-being. In obesity surgery patients, weight loss was associated with a significant decrease of depressive symptoms and improvement in quality of life. When diagnosed presurgery, disordered eating patterns („binge eating”, „grazing”) or sweet eating had no influence on the course of weight after surgery. However, if disordered eating patterns were diagnosed after surgery, they were associated with considerably less weight loss.

Key words

obesity - weight loss treatment - psychiatric comorbidity - eating disorders - bariatric surgery

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