Gewichtneutrale Ansätze zur Behandlung von Adipositas

In Deutschland sind 19% der Erwachsenen von Adipositas betroffen [1]. Traditionelle Gewichtsreduktionsprogramme zur Behandlung von Adipositas bringen häufig nicht die gewünschten Erfolge bei der Gewichtsreduktion. Es werden daher dringend alternative Behandlungsansätze benötigt, um die Versorgung von Personen mit Adipositas zu verbessern. Bisherige Interventionen zu gewichtsneutralen Ansätzen zeigen vielversprechende Ergebnisse.

Abstract

Prevalence rates of overweight and obesity in Germany are high. The weight-centred health paradigm assumes that all individuals with a BMI≥30 kg/m² or with a BMI≥25 kg/m² and comorbidities should be advised to lose weight. However, traditional weight loss programs have limited evidence regarding long-term weight loss and other beneficial outcomes. Therefore, alternative approaches to improve the treatment of individuals with obesity are needed. The aim of this article is to provide an overview of weight-neutral approaches for the treatment of obesity including a case study of a weight-neutral nutrition counselling. Weight-neutral approaches assume that individuals with a higher weight status can also achieve health and well-being. The most prominent weight-neutral approach is Health At Every Size (HAES). HAES is based on five principles (2013): Weight inclusivity, health enhancement, eating for well-being, respectful care and life-enhancing movement. Weight-neutral programs focus on different modules: Body acceptance, eating behaviour, nutrition behaviour, physical activity, and social support. A case study of a weight-neutral nutrition counselling is presented that targeted these modules. Exercises within these modules are for example the development of a biographical timeline in which the relationship between weight and self-esteem is reflected upon, introspection through journaling, and the separation of interoception and action. The effectiveness of weight-neutral programs has been demonstrated regarding various health parameters, including cardiovascular, anthropometric, and psychological parameters as well as physical activity. However, more studies of high methodological quality are needed, especially in Germany.

Schlüsselwörter

Adipositas - gewichtsneutral - intuitives Essverhalten - Health At Every Size - Gesundheitsförderung

Keywords

Obesity - weight-neutral - intuitive eating - Health At Every Size - health promotion

Publication History

Article published online:
16 April 2025

• Literatur

• 1 Schienkiewitz A, Kuhnert R, Blume M. et al. Übergewicht und Adipositas bei Erwachsenen in Deutschland – Ergebnisse der Studie GEDA 2019/2020-EHIS. J Health Monit 2022; 7: 23-31
• 2 Calogero RM, Tylka TL, Mensinger JL. et al. Recognizing the Fundamental Right to be Fat: A Weight-Inclusive Approach to Size Acceptance and Healing From Sizeism. Women Ther 2019; 42: 22-44
• 3 Mensinger JL, Calogero RM, Stranges S. et al. A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite 2016; 105: 364-374
• 4 Kushner RF, Ryan DH. Assessment and Lifestyle Management of Patients With Obesity: Clinical Recommendations From Systematic Reviews. JAMA 2014; 312: 943-952
• 5 Wiebe N, Lloyd A, Crumley ET. et al. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24: e13588
• 6 Winter JE, MacInnis RJ, Wattanapenpaiboon N. et al. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 2014; 99: 875-890
• 7 Flegal KM, Kit BK, Orpana H. et al. Association of All-Cause Mortality With Overweight and Obesity Using Standard Body Mass Index Categories: A Systematic Review and Meta-analysis. JAMA 2013; 309: 71-82
• 8 Tomiyama AJ, Hunger JM, Nguyen-Cuu J. et al. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. Int J Obes 2016; 40: 883-886
• 9 Flegal KM. Use and Misuse of BMI Categories. AMA J Ethics 2023; 25: E550-E558
• 10 Bosy-Westphal A, Müller MJ. Diagnosis of obesity based on body composition-associated health risks – Time for a change in paradigm. Obes Rev 2021; 22: e13190
• 11 Mann T, Tomiyama AJ, Westling E. et al. Medicare’s search for effective obesity treatments: Diets are not the answer. Am Psychol 2007; 62: 220-233
• 12 Tomiyama AJ, Ahlstrom B, Mann T. Long-term Effects of Dieting: Is Weight Loss Related to Health?. Soc Personal Psychol Compass 2013; 7: 861-877
• 13 Fildes A, Charlton J, Rudisill C. et al. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health 2015; 105: e54-e59
• 14 Anderson JW, Konz EC, Frederich RC. et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001; 74: 579-584
• 15 Machado AM, Guimarães NS, Bocardi VB. et al. Understanding weight regain after a nutritional weight loss intervention: Systematic review and meta-analysis. Clin Nutr ESPEN 2022; 49: 138-153
• 16 Khattab R. Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management. Curr Nutr Rep 2024; 13: 478-499
• 17 Rhee E-J. Weight Cycling and Its Cardiometabolic Impact. J Obes Metab Syndr 2017; 26: 237-242
• 18 Zou H, Yin P, Liu L. et al. Association between weight cycling and risk of developing diabetes in adults: A systematic review and meta-analysis. J Diabetes Investig 2021; 12: 625-632
• 19 Brown RE, Kuk JL. Consequences of obesity and weight loss: a devil’s advocate position. Obes Rev 2015; 16: 77-87
• 20 Puhl RM, Heuer CA. The Stigma of Obesity: A Review and Update. Obesity 2009; 17: 941-964
• 21 Sikorski C, Spahlholz J, Hartlev M. et al. Weight-based discrimination: an ubiquitary phenomenon?. Int J Obes 2016; 40: 333-337
• 22 Stein J, Luppa M, Ruzanska U. et al. Measuring Negative Attitudes towards Overweight and Obesity in the German Population – Psychometric Properties and Reference Values for the German Short Version of the Fat Phobia Scale (FPS). PLoS ONE 2014; 9: e114641
• 23 Phelan SM, Burgess DJ, Yeazel MW. et al. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16: 319-326
• 24 Schvey NA, Puhl RM, Brownell KD. The Impact of Weight Stigma on Caloric Consumption. Obesity 2011; 19: 1957-1962
• 25 Puhl R, Suh Y. Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Curr Obes Rep 2015; 4: 182-190
• 26 Tylka TL, Annunziato RA, Burgard D. et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. J Obes 2014; 2014: 983495
• 27 Association for Size Diversity and Health. Health At Every Size^® Principles. 2013; Im Internet https://asdah.org/haes/ Stand: 25.03.2024
• 28 Aphramor L, Gingras J. Helping People Change: Promoting Politicised Practice in the Health Care Professions. In: Rich E, Monaghan LF, Aphramor L, Hrsg. Debating Obesity: Critical Perspectives. London: Palgrave Macmillan UK; 2011: 192-218
• 29 Bacon L. Health At Every Size: The Surprising Truth About Your Weight. Dallas, USA: BenBella Books; 2010
• 30 Chmielewski F, Hanning S. Therapie-Tools Selbstwert. Weinheim: Beltz; 2021
• 31 Ulian MD, Aburad L, Da Silva Oliveira MS. et al. Effects of health at every size ^® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev 2018; 19: 1659-1666
• 32 Clarke ED, Stanford J, Gomez-Martin M. et al. Revisiting the impact of Health at Every Size^® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta-analysis. Nutr Diet 2024; 81: 261-282
• 33 O’Hara L, Ahmed H, Elashie S. Evaluating the impact of a brief Health at Every Size^®-informed health promotion activity on body positivity and internalized weight-based oppression. Body Image 2021; 37: 225-237
• 34 Taylor J, O’Hara L, Talbot L. et al. Promoting Health. 7. Auflage. Amsterdam, Niederlande: Elsevier; 2020
• 35 Bacon L, Stern JS, Van Loan MD. et al. Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters. J Am Diet Assoc 2005; 105: 929-936
• 36 Carroll S, Borkoles E, Polman R. Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological well-being in obese premenopausal females with the metabolic syndrome. Appl Physiol Nutr Metab 2007; 32: 125-142
• 37 Gagnon-Girouard M-P, Bégin C, Provencher V. et al. Psychological Impact of a “Health-at-Every-Size” Intervention on Weight-Preoccupied Overweight/Obese Women. J Obes 2010; 2010: 928097
• 38 Ulian MD, Benatti FB, De Campos-Ferraz PL. et al. The Effects of a “Health at Every Size^®”-Based Approach in Obese Women: A Pilot-Trial of the “Health and Wellness in Obesity” Study. Front Nutr 2015; 2: 34
• 39 Bacon L, Keim NL, Van Loan MD. et al. Evaluating a ‘non-diet’ wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. Int J Obes 2002; 26: 854-865
• 40 Leblanc V, Provencher V, Bégin C. et al. Impact of a Health-At-Every-Size intervention on changes in dietary intakes and eating patterns in premenopausal overweight women: Results of a randomized trial. Clin Nutr 2012; 31: 481-488
• 41 Provencher V, Bégin C, Tremblay A. et al. Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention. J Am Diet Assoc 2009; 109: 1854-1861
• 42 Borkoles E, Carroll S, Clough P. et al. Effect of a non-dieting lifestyle randomised control trial on psychological well-being and weight management in morbidly obese pre-menopausal women. Maturitas 2016; 83: 51-58
• 43 Jackson EG. Eating order: a 13-week trust model class for dieting casualties. J Nutr Educ Behav 2008; 40: 43-48
• 44 Mensinger JL, Calogero RM, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite 2016; 102: 32-43
• 45 Carbonneau E, Bégin C, Lemieux S. et al. A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women. Clin Nutr 2017; 36: 747-754
• 46 Bégin C, Carbonneau E, Gagnon-Girouard M-P. et al. Eating-Related and Psychological Outcomes of Health at Every Size Intervention in Health and Social Services Centers Across the Province of Québec. Am J Health Promot 2019; 33: 248-258
• 47 Penney TL, Kirk SFL. The Health at Every Size Paradigm and Obesity: Missing Empirical Evidence May Help Push the Reframing Obesity Debate Forward. Am J Public Health 2015; 105: e38-e42
• 48 Cloutier-Bergeron A, Provencher V, Mongeau L. et al. Does Health At Every Size^® fit all? A group-based trajectory modeling of a non-diet intervention. Appetite 2019; 143: 104403
• 49 Bombak A. Obesity, Health at Every Size, and Public Health Policy. Am J Public Health 2014; 104: e60-e67
• 50 Ruzanska UA, Warschburger P. Intuitive eating mediates the relationship between self-regulation and BMI – Results from a cross-sectional study in a community sample. Eat Behav 2019; 33: 23-29
• 51 Müller MJ, Gaetjens I, Bosy-Westphal A. Prävention der Adipositas. In: Herpertz S, de Zwaan M, Zipfel S, Hrsg. Handbuch Essstörungen und Adipositas. Berlin, Heidelberg: Springer; 2022: 533-542