Versorgungskonzepte für Kinder und Jugendliche mit extremer und/oder genetischer Adipositas

Zusammenfassung

Kinder und Jugendliche mit extremer und/oder genetischer Adipositas benötigen aufgrund des chronisch-rezidivierenden und progressiven Charakters der Adipositas eine langfristige und kontinuierliche Betreuung und Behandlung. Ziel dieser Arbeit ist es, ein strukturiertes Versorgungs- und Behandlungskonzept für Kinder und Jugendliche mit extremer und/oder genetischer Adipositas vorzustellen, welches den speziellen Anforderungen und Bedürfnissen dieser Patientengruppe entspricht. Kinder und Jugendliche mit extremer und/oder genetischer Adipositas sollten strukturiert und kontinuierlich nach dem „Chronic Care Model“ in spezialisierten Behandlungszentren in enger Zusammenarbeit mit niedergelassenen Arztpraxen versorgt und behandelt werden. Das Wissen über die zugrundeliegenden molekularbiologischen Mechanismen der Regulation von Hunger und Sättigung, des Körpergewichts und letztlich der Entstehung der Adipositas ermöglichen einen personalisierten Behandlungsansatz. Individualisierte, multimodale Behandlungsansätze sind die Grundlage für eine langfristige und effektive Behandlung der Adipositas bei Kindern und Jugendlichen mit extremer und/oder genetischer Adipositas. Neue pharmakologische Therapiemöglichkeiten, wie Inkretin-basierte Medikamente für Jugendliche mit extremer Adipositas oder speziell entwickelte Mechanismus-basierte Medikamente für Personen mit genetischer Adipositas, stellen einen bedeutenden Fortschritt im chronischen Gewichtsmanagement und eine effektive Ergänzung zu individuellen, multimodalen Lebensstilinterventionen dar.

Abstract

Children and adolescents with severe and/or genetic obesity require long-term and continuous care and treatment due to the chronic, recurrent, and progressive character of obesity. The aim of this article is to present a structured care and treatment concept for patients with extreme and/or genetic obesity that meets the special requirements and needs of this patient group. Structured care for these patients should be provided according to the “chronic care model” in specialized treatment centres and in close cooperation with local paediatricians. Knowledge about the underlying molecular biological mechanisms of the regulation of hunger and satiety, body weight and ultimately the development of obesity enables an individualised treatment approach. Individualized, multimodal treatment approaches are therefore the basis of a long-term and effective obesity treatment in children and adolescents with extreme and/or genetic obesity. New pharmacological treatments, as incretin-based drugs for adolescents with extreme obesity or mechanism-based drugs for patients with genetic obesity, represent a significant advance in chronic weight management and are an effective complement to individualised, multimodal lifestyle interventions.

Schlüsselwörter

extreme Adipositas - genetische Adipositas - strukturierte Versorgung und Behandlung - Kinder und Jugendliche

Keywords

severe obesity - genetic obesity - structured care and treatment - children and adolescents

Publikationsverlauf

Artikel online veröffentlicht:
08. Juli 2024

• Literatur

• 1 AWMF: S3-Leitlinie Therapie und Prävention der Adipositas im Kindes-und Jugendalter: Deutsche Adipositas-Gesellschaft e.V. (DAG) Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ); 2019
• 2 Hampl SE, Hassink SG, Skinner AC. et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151: e2022060640
• 3 Schienkiewitz A, Damerow S, Mauz E. et al. Development of overweight and obesity in children. Results of the KiGGS cohort. J Health Monit 2018; 3 DOI: 10.17886/RKI-GBE-2018-030.
• 4 Pinhas-Hamiel O, Hamiel U, Bendor CD. et al. The Global Spread of Severe Obesity in Toddlers, Children, and Adolescents: A Systematic Review and Meta-Analysis. Obes Facts 2022; 15: 118-134
• 5 Loos RJF, Yeo GSH. The genetics of obesity: from discovery to biology. Nature reviews Genetics 2022; 23: 120-133
• 6 Baldini G, Phelan KD. The melanocortin pathway and control of appetite-progress and therapeutic implications. The Journal of endocrinology 2019; 241: R1-r33
• 7 Courbage S, Poitou C, Le Beyec-Le Bihan J. et al. Implication of Heterozygous Variants in Genes of the Leptin-Melanocortin Pathway in Severe Obesity. The. Journal of clinical endocrinology and metabolism 2021; 106: 2991-3006
• 8 Farooqi IS, Wangensteen T, Collins S. et al. Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor. The New England journal of medicine 2007; 356: 237-247
• 9 Wade KH, Lam BYH, Melvin A. et al. Loss-of-function mutations in the melanocortin 4 receptor in a UK birth cohort. Nature medicine 2021; 27: 1088-1096
• 10 Zolotarjova J, Ten Velde G, Vreugdenhil ACE. Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obesity reviews: an official journal of the International Association for the Study of Obesity 2018; 19: 931-946
• 11 Geserick M, Vogel M, Gausche R. et al. Acceleration of BMI in Early Childhood and Risk of Sustained Obesity. New England Journal of Medicine 2018; 379: 1303-1312
• 12 Wabitsch M, v. Schnurbein J, Vollbach H. et al. Innovative medizinische Betreuungskonzepte für Jugendliche mit extremer Adipositas. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2020; 63: 831-838
• 13 Joisten C, Gellhaus I, Kauth T. et al. Die Versorgungslage von Kindern und Jugendlichen mit Adipositas – ist ein Disease Management Programm (DMP) eine Lösung? Adipositas - Ursachen, Folgeerkrankungen. Therapie 2022; 16: 149-158
• 14 Lennerz BS, Moss A, von Schnurbein J. et al. Do adolescents with extreme obesity differ according to previous treatment seeking behavior? The Youth with Extreme obesity Study (YES) cohort. International journal of obesity (2005) 2019; 43: 103-115
• 15 Effertz T, Engel S, Verheyen F. et al. The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective. The European journal of health economics: HEPAC: health economics in prevention and care. 2016; 17: 1141-1158
• 16 Sonntag D, Ali S, De Bock F. Lifetime indirect cost of childhood overweight and obesity: A decision analytic model. Obesity (Silver Spring. Md) 2016; 24: 200-206
• 17 Torbahn G, Lischka J, Joisten C. et al. Pädiatrische Versorgungstrukturen bei Adipositas 2023 – Wo stehen wir?. Monatsschrift Kinderheilkunde 2023; 171: 784-795
• 18 Lister NB, Baur LA, Felix JF. et al. Child and adolescent obesity. Nature Reviews Disease Primers 2023; 9: 24
• 19 Styne DM, Arslanian SA, Connor EL. et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. The. Journal of clinical endocrinology and metabolism 2017; 102: 709-757
• 20 Colquitt JL, Loveman E, O'Malley C. et al. Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database of Systematic Reviews 2016; 3: CD012105
• 21 Mead E, Brown T, Rees K. et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database of Systematic Reviews 2017; 6: CD012651
• 22 Al-Khudairy L, Loveman E, Colquitt JL. et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database of Systematic Reviews 2017; 6: CD012691
• 23 Knop C, Singer V, Uysal Y. et al. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatric obesity 2015; 10: 7-14
• 24 Danielsson P, Kowalski J, Ekblom Ö. et al. Response of severely obese children and adolescents to behavioral treatment. Archives of pediatrics & adolescent medicine 2012; 166: 1103-1108
• 25 Reinehr T, Hebebrand J, Friedel S. et al. Lifestyle intervention in obese children with variations in the melanocortin 4 receptor gene. Obesity (Silver Spring. Md) 2009; 17: 382-389
• 26 Wabitsch M, Farooqi S, Flück CE. et al. Natural History of Obesity Due to POMC, PCSK1, and LEPR Deficiency and the Impact of Setmelanotide. Journal of the Endocrine Society 2022; 6: bvac057
• 27 Trier C, Hollensted M, Schnurr TM. et al. Obesity treatment effect in Danish children and adolescents carrying Melanocortin-4 Receptor mutations. International journal of obesity (2005) 2021; 45: 66-76
• 28 Kühnen P, Biebermann H, Wiegand S. Pharmacotherapy in Childhood Obesity. Hormone research in paediatrics 2022; 95: 177-192
• 29 Schirmer M, Brandt S, Zorn S. et al. Effekte einer Therapie mit Liraglutid bei Jugendlichen mit extremer Adipositas unter Real-Life-Bedingungen. Adipositas - Ursachen, Folgeerkrankungen. Therapie 2023; 17: 115-125
• 30 Kelly AS, Auerbach P, Barrientos-Perez M. et al. A Randomized, Controlled Trial of Liraglutide for Adolescents with Obesity. The. New England journal of medicine 2020; 382: 2117-2128
• 31 Weghuber D, Barrett T, Barrientos-Pérez M. et al. Once-Weekly Semaglutide in Adolescents with Obesity. The. New England journal of medicine 2022; 387: 2245-2257
• 32 Iepsen EW, Have CT, Veedfald S. et al. GLP-1 Receptor Agonist Treatment in Morbid Obesity and Type 2 Diabetes Due to Pathogenic Homozygous Melanocortin-4 Receptor Mutation: A Case Report. Cell reports Medicine 2020; 1: 100006
• 33 Welling MS, de Groot CJ, Kleinendorst L. et al. Effects of glucagon-like peptide-1 analogue treatment in genetic obesity: A case series. Clinical obesity 2021; 11: e12481
• 34 Iepsen EW, Zhang J, Thomsen HS. et al. Patients with Obesity Caused by Melanocortin-4 Receptor Mutations Can Be Treated with a Glucagon-like Peptide-1 Receptor Agonist. Cell metabolism 2018; 28: 23-32.e23
• 35 Jastreboff AM, Aronne LJ, Ahmad N. et al. Tirzepatide Once Weekly for the Treatment of Obesity. The. New England journal of medicine 2022; 387: 205-216
• 36 Farooqi IS, Matarese G, Lord GM. et al. Beneficial effects of leptin on obesity, T cell hyporesponsiveness, and neuroendocrine/metabolic dysfunction of human congenital leptin deficiency. The Journal of clinical investigation 2002; 110: 1093-1103
• 37 Clément K, van den Akker E, Argente J. et al. Efficacy and safety of setmelanotide, an MC4R agonist, in individuals with severe obesity due to LEPR or POMC deficiency: single-arm, open-label, multicentre, phase 3 trials. The lancet Diabetes & endocrinology 2020; 8: 960-970
• 38 Inge TH, Courcoulas AP, Jenkins TM. et al. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. The. New England journal of medicine 2016; 374: 113-123
• 39 Olbers T, Beamish AJ, Gronowitz E. et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. The lancet Diabetes & endocrinology 2017; 5: 174-183
• 40 Brandt S, Lennerz BS, Wiegand S. et al. Twelve-Month Outcomes after Metabolic and Bariatric Surgery among Youths Participating in a Structured Preparation and Follow-Up Program: Results of the Youth with Extreme Obesity Study. Obesity Facts 2023; 17: 59-71
• 41 Cooiman MI, Kleinendorst L, Aarts EO. et al. Genetic Obesity and Bariatric Surgery Outcome in 1014 Patients with Morbid Obesity. Obesity surgery 2020; 30: 470-477