Das ZEPmax-Programm – effektive, leitliniengerechte multimodale Therapie von Adipositas und Folgeerkrankungen

Zusammenfassung

Hintergrund Adipositas und die assoziierten Folgeerkrankungen führen nicht nur zu einer erhöhten Morbidität und Mortalität, sondern auch zu einer Reduktion der Lebensqualität. Obwohl ein multimodaler Therapieansatz die leitliniengerechte Therapie der Wahl für die meisten Patienten ist, fehlen in Deutschland flächendeckend geeignete Programme und die Ansprechraten unstrukturierter Interventionen sind unzureichend.

Material und Methodik Das ZEPmax-Programm ist ein konservatives, multimodales, 1-jähriges Therapieprogramm mit initialer Formuladiätphase für Erwachsene mit Adipositas. Die Patienten treffen sich jede Woche für 3,5 Stunden am Zentrum. Die Daten der ersten 136 konsekutiv eingeschlossenen Patienten wurden hier als Intention-to-treat-Analyse ausgewertet. Neben Gewicht und BMI wurden Faktoren des metabolischen Syndroms untersucht.

Ergebnisse Die Teilnehmer hatten einen durchschnittlichen BMI von 43,0 kg/m². 11,8 % brachen das Programm im ersten Jahr ab. 87,5 % erreichten das primäre Therapieziel einer Gewichtsreduktion von > 10 % des Ausgangsgewichts bei einem durchschnittlichen Gewichtsverlust von 24,7 kg (19 % des Ausgangsgewichts). 72 % der Diabetespatienten (n = 18) erreichten eine vollständige Remission, d. h. einen normwertigen HbA1c ohne spezifische Diabetesmedikation. Der systolische Blutdruck der Hypertoniepatienten (n = 53) sank im Mittel um 22 mmHg. Das Gesamtcholesterin der Patienten mit Hyperlipidämie (n = 66) konnte um 23 mg/dl und das LDL-Cholesterin um 17 mg/dl gesenkt werden.

Schlussfolgerung Die vorliegende Arbeit zeigt, dass mit Hilfe des strukturierten, formuladiätbasierten, multimodalen Adipositas-Therapieprogramms ZEPmax ein nachhaltiger Gewichtsverlust mit hohen Ansprechraten erreicht werden kann. Durch erfolgreiche Therapie der Adipositas konnten die assoziierten Folgeerkrankungen Diabetes mellitus Typ 2, arterielle Hypertonie und Hyperlipidämie mit hohen Remissionsquoten behandelt werden. Die vorliegende Arbeit belegt den Stellenwert einer professionell durchgeführten konservativen Adipositastherapie in Deutschland.

Abstract

Background Obesity and related diseases are associated not only with an increased morbidity and mortality, but also with a reduced quality of life. Although a multimodal conservative therapy is recommended by guidelines, suitable programs are not offered nationwide in Germany and the response rates of unstructured interventions are insufficient.

Material and Methods The ZEPmax-Program is a conservative, multimodal, one-year therapy program with an initial formula diet for adults with obesity. The patients meet once a week for 3,5 hours at the center. In all 136 patients were included in this evaluation. Besides weight and BMI also the factors of the metabolic syndrome were assessed in an Intention-to-treat analysis.

Results The participants had an average BMI of 43,0 kg/m². 11,8 % did not complete the one-year program. The patients lost 24,7 kilograms or respectively 19 % of the initial weight and 87,5 % reached the therapeutic goal of 10 % relative weight loss. 72 % of the patients with diabetes (n = 18) achieved a complete remission with normal HbA1c and without medication. The systolic blood pressure of the patients with hypertension (n = 53) dropped by 22 mmHg. The cholesterol in patients with hyperlipidemia (n = 66) could be lowered by 23 mg/dl and the LDL-Cholesterol by 17 mg/dl.

Conclusion This survey shows that a sustained weight loss with high response rates can be achieved with a structured, formuladiet-based multimodal obesity treatment program (ZEPmax). Obesity related diseases like diabetes, hypertension and hyperlipidemia could be treated with high remission rates by an effective treatment of obesity. This evaluation demonstrates the significance of a professionally conducted conservative obesity treatment in Germany.

Schlüsselwörter

Adipositas - metabolisches Syndrom - multimodales Therapieprogramm - Lebensstilintervention

Keywords

obesity - metabolic syndrome - multimodal therapy program - lifestyle intervention

Publication History

Article published online:
07 December 2020

• Literatur

• 1 Scheidt-Nave C, Kamtsiuris P, Gosswald A. et al. German health interview and examination survey for adults (DEGS) – design, objectives and implementation of the first data collection wave. BMC Public Health 2012; 12: 730
• 2 Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes 2017; 7: 273-289
• 3 Bischoff SC. Adipositas im Erwachsenenalter. Aktuel Ernahrungsmed 2015; 40: 147-178
• 4 Geiss LS, Kirtland K, Lin J. et al. Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004–2012. PLoS One 2017; 12: e0173428
• 5 Hohenester S, Christiansen S, Nagel J. et al. Lifestyle intervention for morbid obesity: effects on liver steatosis, inflammation, and fibrosis. Am J Physiol Gastrointest Liver Physiol 2018; 315: G329-G38
• 6 Calle EE, Rodriguez C, Walker-Thurmond K. et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625-1638
• 7 Berg A, Bischoff SC, Colombo-Benkmann M. et al. S3-Leitlinie Adipositas 2014. Interdisziplinäre Leitlinie der Qualität S3 zur Prävention und Therapie der Adipositas. Im Internet: Stand: 22.04.2020 http://awmforg/leilinien/detail/ll/050-001html
• 8 Sellahewa L, Khan C, Lakkunarajah S. et al. A Systematic Review of Evidence on the Use of Very Low Calorie Diets in People with Diabetes. Curr Diabetes Rev 2017; 13: 35-46
• 9 Adams TD, Davidson LE, Litwin SE. et al. Weight and Metabolic Outcomes 12 Years after Gastric Bypass. N Engl J Med 2017; 377: 1143-1155
• 10 Sjostrom L, Narbro K, Sjostrom CD. et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741-752
• 11 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
• 12 Quinn Rothacker D. Five-year self-management of weight using meal replacements: comparison with matched controls in rural Wisconsin. Nutrition 2000; 16: 344-348
• 13 Leslie WS, Taylor R, Harris L. et al. Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis. Int J Obes (Lond) 2017; 41: 96-101
• 14 Rudolph A, Hellbardt M, Baldofski S. et al. [Evaluation of the One-Year Multimodal Weight Loss Program DOC WEIGHT(R) 1.0 for Obesity Class II and III]. Psychother Psychosom Med Psychol 2016; 66: 316-323
• 15 Apovian CM, Aronne L, Rubino D. et al. A randomized, phase 3 trial of naltrexone SR/bupropion SR on weight and obesity-related risk factors (COR-II). Obesity (Silver Spring) 2013; 21: 935-943
• 16 Pi-Sunyer X, Astrup A, Fujioka K. et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015; 373: 11-22
• 17 Lean M, Brosnahan N, McLoone P. et al. Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract 2013; 63: e115-124
• 18 Purcell K, Sumithran P, Prendergast LA. et al. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. Lancet Diabetes Endocrinol 2014; 2: 954-962
• 19 Baker S, Jerums G, Proietto J. Effects and clinical potential of very-low-calorie diets (VLCDs) in type 2 diabetes. Diabetes Res Clin Pract 2009; 85: 235-242
• 20 Lin WY, Wu CH, Chu NF. et al. Efficacy and safety of very-low-calorie diet in Taiwanese: a multicenter randomized, controlled trial. Nutrition 2009; 25: 1129-1136
• 21 Sacks FM, Bray GA, Carey VJ. et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360: 859-873
• 22 Bazzano LA, Hu T, Reynolds K. et al. Effects of low-carbohydrate and low-fat diets: a randomized trial. Ann Intern Med 2014; 161: 309-318
• 23 Bohm M, Schumacher H, Teo KK. et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet 2017; 389: 2226-2237
• 24 Japaridze L, Sadunishvili M. The short-term effect of atorvastatin plus ezetimibe therapy versus atorvastatin monotherapy on clinical outcome in acute coronary syndrome patients by gender. Kardiol Pol 2017; 75: 770-778
• 25 Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr 2003; 22: 331-339
• 26 Umphonsathien M, Prutanopajai P, Aiam ORJ. et al. Immediate and long-term effects of a very-low-calorie diet on diabetes remission and glycemic control in obese Thai patients with type 2 diabetes mellitus. Food Sci Nutr 2019; 7: 1113-1122
• 27 Malandrucco I, Pasqualetti P, Giordani I. et al. Very-low-calorie diet: a quick therapeutic tool to improve beta cell function in morbidly obese patients with type 2 diabetes. Am J Clin Nutr 2012; 95: 609-613
• 28 Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L. et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology 2015; 149: 367-378 e5; quiz e14-5
• 29 Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med 2017; 376: 1492
• 30 Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am 2018; 102: 183-197
• 31 Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology 2007; 132: 2226-2238