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Aktuelle Ernährungsmedizin 2015; 40(03): 147-178
DOI: 10.1055/s-0034-1387650
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© Georg Thieme Verlag KG Stuttgart · New York

Adipositas im Erwachsenenalter

Obesity in Adulthood
S. C. Bischoff
Institut für Ernährungsmedizin, Universität Hohenheim
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Publication Date:
11 May 2015 (online)

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Zusammenfassung

Adipositas im Erwachsenenalter betrifft ca. 20 % der Bevölkerung in Deutschland, wobei altersabhängige Unterschiede zu beachten sind. Im Erwachsenenalter steigt die Prävalenz von 15 auf über 30 % an, dennoch gibt es kaum Präventionskonzepte für diese Altersgruppe. Die Entwicklung der Epidemie Adipositas mit zahlreichen wichtigen Folgeerkrankungen in den letzten wenigen Jahrzehnten ist multifaktoriell. Sie umfasst genetische, epigenetische und mikrobielle Ursachen, aber auch Umweltfaktoren wie Überernährung, mangelnde Bewegung und psychosozialer Stress spielen eine zentrale Rolle. Während die Mechanismen der Adipositas gut untersucht sind, gibt es erhebliche Defizite in der bevölkerungsbezogenen Versorgungsforschung. Des Weiteren ist die Zuständigkeit für die Adipositasprävention und -therapie unzureichend geregelt, geeignete Infrastrukturen fehlen weitgehend und die Finanzierung bzw. finanzielle Unterstützung ist ungenügend. Aufgrund dieser und anderer Barrieren ist es bislang nicht gelungen, die Adipositasepidemie erfolgreich zu bekämpfen. Auf der anderen Seite ist Adipositas im Erwachsenenalter auf der Individualebene durchaus behandelbar, wenn die richtigen Maßnahmen ergriffen und geeignete Fachkräfte konsultiert werden. Während die Adipositas Grad I mittels verschiedener Ernährungs-, Bewegungs- und Verhaltensstrategien recht erfolgreich behandelt werden kann, gibt es für die Adipositas Grad II und III nur 2 wissenschaftlich belegte Therapieoptionen: validierte multimodale Gewichtsreduktionsprogramme über 6 – 12 Monate oder – im Fall unzureichenden Erfolgs – die Adipositaschirurgie. Dabei sind neben der Effektivität Sicherheitsaspekte ebenso zu beachten wie die Vermeidung von Muskelschwund, d. h. es geht um die möglichst selektive Reduktion von Fettgewebe und den weitgehenden Erhalt der Muskelmasse. Alle erfolgreichen Adipositastherapien benötigen eine in der Regel lebenslange Anschlussbehandlung, die die Gewichtserhaltung zum Ziel hat. Die Maßnahmen und Konzepte zur Gewichtserhaltung unterscheiden sich z. T. deutlich – sowohl, was die Ernährungs- als auch was die Bewegungstherapie angeht – von den Maßnahmen der Gewichtsreduktion.

Abstract

Obesity affects approximately 20 % of the adult population in Germany, with age-related differences being observed. In adults, the prevalence of obesity increases from 15 to more than 30 %, yet there are few prevention programs for this age group available. The evolution of the epidemic of obesity and most relevant associated diseases in the last few decades is multifactorial. It includes genetic, epigenetic and microbial causes, but also environmental factors such as diet, lack of exercise and psycho-social stress play a central role. While the mechanisms of obesity has been well studied, there are significant deficits in the population-based research on public health services. Furthermore, the responsibility for obesity prevention and treatment is inadequately regulated, appropriate infrastructure is largely absent and financing or financial assistance is insufficient. Because of these and other barriers, we have so far not been able to combat the obesity epidemic successfully. On the other hand, obesity in adulthood is at the individual level treatable, if the right measures are taken and appropriate professionals are consulted. While obesity grade I can be treated quite successfully by various nutritional, exercise and behavioral strategies, there are only two scientifically proven therapeutic options for obesity grade II and III, (1) validated multimodal weight loss programs for 6 – 12 months, or – in case of lack of success – (2) bariatric surgery. In addition to effectiveness, safety aspects and the prevention of muscle loss, i. e. the highly selective reduction of adipose tissue together with extensive preservation of muscle mass, has to be considered as well. All successful obesity therapies need usually life-long follow-up treatment. The measures and concepts for weight maintenance differ in some respect clearly from the measures of weight reduction – both regarding nutritional therapy and exercise coaching.

Schlüsselwörter

Adipositas - metabolisches Syndrom - nicht alkoholische Fettlebererkrankung (NAFLD) - sehr kalorienarme Diät (VLCD) - Gewichtsreduktionsprogramm - Gewichtsstabilisierung

Keywords

obesity - metabolic syndrome - non-alcoholic fatty liver disease (NAFLD) - very low calorie diet (VLCD) - weight reduction program - weight maintenance
 

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