Wie ist Gewichtsreduktion erfolgreich möglich?

Zusammenfassung

Adipositas und Begleit- bzw. Folgeerkrankungen nehmen weltweit genauso wie in Deutschland zu.

Gewichtsabnahme und Erhalt des reduzierten Gewichts sind schwierig und diese Tatsache führte zu Studien mit der Zielstellung, Gründe für erneute Gewichtszunahme nach Gewichtsverlust zu evaluieren und Hypothesen für erfolgreichere Behandlungsoptionen zu generieren. Einige der Hauptfaktoren liegen im Energiehaushalt, insbesondere im Grundumsatz (resting metabolic rate, RMR), der non-exercise Thermogenese und der nahrungsinduzierten Thermogenese. Die hohe Rate an erneuter Gewichtszunahme nach erfolgreicher Gewichtreduktion (mehr als 80 %) ist zurückzuführen auf adaptive Vorgänge mit denen der Organismus versucht, die Energiedepots des Körpers konstant zu halten. Die so genannte „adaptive Thermogenese“ ist definiert als geringere Reduktion des Energieverbrauchs als es dem Vorhersagewert entsprechen würde. Diese verminderte Thermogenese scheint neben diätetischen Faktoren ein wesentlicher Grund für erneute Gewichtszunahme zu sein.

Hauptziel jeder Gewichtsreduktion ist der Verlust an Körperfett. Allerdings ist dies in der Regel mit einem Verlust an Muskelmasse verbunden. Diese lean body mass (LBM) ist aber die Hauptdeterminante des Grundumsatzes (RMR). Eine Reduktion der LBM bewirkt demzufolge einen Abfall des Grundumsatzes und kann so zu erneuter Gewichtszunahme führen. Somit ist es erforderlich, im Sinne einer langfristigen Gewichtsreduktion dem Abfall des Grundumsatzes und der LBM entgegen zu wirken.

In dieser Arbeit werden die Mechanismen der adaptiven Thermogenese im Hinblick auf die Entwicklung von Strategien zur Vermeidung einer erneuten Gewichtszunahme nach erfolgreicher Gewichtsreduktion diskutiert.

Abstract

The prevalence of obesity and related health problems is increasing worldwide and also in Germany. It is well known that substantial and sustained weight loss is difficult to accomplish. Therefore, a variety of studies has been performed in order to specify causes for weight gain and create hypotheses for better treatment options.

Key factors of this problem are an adaptation of energy metabolism, especially resting metabolic rate (RMR), non-exercise thermogenesis and diet induced thermogenesis.

The extremely high failure rate (> 80 %) to keep the reduced weight after successful weight loss is due to adaptation processes of the body to maintain body energy stores. This so called “adaptive thermogenesis” is defined as a smaller than predicted change of energy expenditure in response to changes in energy balance. Adaptive thermogenesis appears to be a major reason for weight regain. The foremost objective of weight-loss programs is the reduction in body fat. However, a concomitant decline in lean tissue can frequently be observed. Since lean body mass (LBM) represents a key determinant of RMR it follows that a decrease in lean tissue could counteract the progress of weight loss.

Therefore, with respect to long-term effectiveness of weight reduction programs, the loss of fat mass while maintaining LBM and RMR seems desirable.

In this paper we will discuss the mechanisms of adaptive thermogenesis and develop therapeutic strategies with respect to avoiding weight regain successful weight reduction.

Schlüsselwörter

Adipositas - Gewichtsreduktion - Gewichtserhaltung - Energieumsatz - Adaptive Thermogenese

Keywords

obesity - weight loss - weight maintenance - energy expenditure - adaptive thermogenesis

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