Psychosomatische Aspekte der Adipositas

Zusammenfassung

Übergewicht und Adipositas sind in allen Industrienationen weit verbreitet und zählen in diesen Ländern zu den wichtigsten Gesundheitsproblemen. Bevölkerungsbasierte Studien in Deutschland haben ergeben, dass zwischen 12 und 18 % der erwachsenen Bevölkerung adipös ist. Übergewicht und Adipositas gehen mit einem Spektrum von Gesundheitsstörungen und massiven psychosozialen Belastungen einher. Neben den Erbanlagen wird die komplexe Ätiologie der Adipositas vornehmlich bestimmt durch den Lebensstil, in den u. a. intra- und interindividuelle Aspekte einfließen. Innerhalb des Gesamtkollektivs adipöser Menschen stellt die „psychogene Adipositas” eine Subgruppe dar, bei der psychiatrische Störungen zu einer Veränderung des Ess- und Bewegungsverhaltens führen, deren Folge eine anhaltende positive Energiebilanz mit Übergewicht und Adipositas ist. Die Arbeit beschreibt die psychosozialen Probleme von adipösen Menschen, wobei insbesondere die kontrovers diskutierte Frage der psychiatrischen Komorbidität im Allgemeinen und der Essstörungen im Besonderen herausgestellt wird. Die Ergebnisse bisheriger vornehmlich verhaltenstherapeutisch orientierter Behandlungskonzepte werden dargestellt und schulenübergreifende Konzepte diskutiert. Schließlich wird die Problematik psychiatrischer/psychologischer Diagnostik bei adipösen Patienten mit dem Anliegen einer operativen Gewichtsreduktion im Spannungsfeld von Kostenträgern und Chirurgen aufgezeigt.

Psychosomatic Aspects of Obesity

Overweight and obesity are widespread in industrial countries and are considered to be serious health problems in these countries. Population-based studies in Germany have shown that between 12 and 18 % of the adult population is obese. Overweight and obesity are accompanied by a large spectrum of health disorders and extreme psychosocial burdens. Besides the hereditary disposition, the life style including both intra- and inter-individual aspects determines the complex etiology of obesity. Within the collective sample of the obese, one sub-sample is the „psychogenic obese” i. e. in which psychiatric disorders lead to a change in both eating and exercise behavior, the result then being a continuous positive energy reserve in the form of overweight and obesity. The paper describes the psychosocial problems of obese persons; especially the controverse question with regard to psychiatric morbidity in general and eating disorders in particular are emphasized. The results of past, mainly behavioral oriented treatment concepts are presented and various concepts beyond single school orientation are discussed. Finally, the problems with psychiatric psychological diagnostics in those obese patients with the request for surgical weight reduction within the context of insurance coverage and the surgeons are presented.

Key words

Obesity - Epidemiology - Etiology - Risk factors - Psychiatric comorbidity - Obesity surgery

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