Zusammenfassung
Adipositas ist eine schwerwiegende und chronische Erkrankung, die zu ausgeprägten
gesundheitlichen Folgeerkrankungen sowie einer erhöhten Mortalität führt und deshalb
Therapiestrategien langfristiger Natur sein sollten. In diesem Beitrag wird ein Überblick
über den Forschungsstand zur Psychotherapie bei Adipositas gegeben. Verhaltenstherapeutische
Ansätze finden dabei die größte Beachtung. Zu humanistischen und psychodynamischen
Therapien gibt es keine systematischen und gut kontrollierten Untersuchungen. Wenige
Studien zu psychotherapieverwandten Verfahren wie Entspannungstraining oder Hypnose
konnten keine durchschlagenden Erfolge nachweisen. Verhaltenstherapeutische, auch
mit kognitiven Elementen kombinierte Gewichtsreduktionsprogramme und Lifestyleinterventionen
führen kurzfristig zu einer Gewichtabnahme von durchschnittlich 10 % des Ausgangsgewichtes.
Die langfristigen Erfolge solcher Programme hingegen sind enttäuschend. Die Forschungsergebnisse
sprechen überwiegend dafür, dass längerfristig angelegte Nachsorgeprogramme zu einer
dauerhaften Verhaltensänderung der Patienten im Alltag beitragen und einer erneuten
Gewichtszunahme entgegen treten können. Weitere Untersuchungen zur effektiven Nachsorge
sind deshalb notwendig, um die Versorgung von adipösen Patienten zu optimieren. Dabei
sollte dem Nutzen neuer Medien, insbesondere dem Einsatz internetgestützter Nachsorgeprogramme,
eine größere Bedeutung zukommen.
Abstract
Obesity is a serious chronic disease, associated with severe sequelae and increased
mortality rates, and therefore requires long-term care. This article gives an overview
of the current state of research on psychotherapeutic treatment of obesity, focusing
on behavioral approaches. Systematic well-controlled studies on humanistic and psychodynamic
therapies are not available. A small number of studies on psychotherapy-related approaches,
e. g. relaxation therapy or hypnotherapy, failed to demonstrate any decisive positive
outcomes. While weight loss programs using methods of behavior therapy and lifestyle
modification approaches result, on the average, in a short-term weight loss of 10
% of the initial weight, long-term effects of such programs are disappointing. Further
evidence suggests, however, that long-term maintenance programs may facilitate lasting
behavioral changes of patients in their daily lives and work against weight regain.
More research on effective maintenance programs is called for to further improve care
of obese patients; it should lay stronger emphasis on internet-based weight maintenance
programs.
Key words
obesity - psychotherapy - treatment - randomized-controlled-trial - maintenance
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Prof. Dr. med. Stephan Zipfel
Universitätsklinikum Tübingen, Medizinische Klinik VI, Psychosomatische Medizin und
Psychotherapie
Osianderstraße 5
72070 Tübingen
Email: stephan.zipfel@med.uni-tuebingen.de
