Konservative Therapie der Adipositas – wann und wie?

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.

Schlüsselwörter

Bewegungstherapie - Ernährungstherapie - Adipositas - BMI - metabolisch gesunde Adipositas

Key Words

physical activity - nutrition - obesity - metabolically healthy obesity

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