Zusammenfassung
Die Adipositas stellt einen Risikofaktor für das Auftreten einer Reihe von chronischen Erkrankungen dar. Das Risiko für Diabetes, Hypertonie und Dyslipidämie steigt schon ab einem BMI von 21 kg/m2 an. In den Industrieländern verursacht ein erhöhter BMI ein Drittel aller ischämischen Herzerkrankungen und ein Viertel aller zerebrovaskulären Erkrankungen. Die Beziehung zwischen der Höhe des BMI und dem relativen Risiko für Gesamtmortalität ist j-förmig. Als unabhängiger Risikofaktor für die Gesamtmortalität belegt Adipositas weltweit den sechsten Rang; in Deutschland steht sie an vierter Stelle. Die Prävalenz der Adipositas in Deutschland hat zwischen 1985 und 2002 konstant zugenommen, bei Männern von 16,2 % auf 22,5 % und bei Frauen von 16,2 % auf 23,3 %. Die Prävalenz des Übergewichts bzw. der Adipositas bei Kindern und Jugendlichen in Deutschland wird derzeit auf 15 % bzw. 6 % geschätzt. Der sozioökonomische Status ist eine wichtige Determinante der Adipositas, wobei der Einfluss sozialer Unterschiede auf die Prävalenz der Adipositas bei Frauen größer ist als bei Männern. Konzepte zur Eindämmung der Adipositas erfordern multiple Strategien, um sowohl auf der Individualebene, als auch auf der Populationsebene eine Trendwende in der Entwicklung dieser Epidemie herbeizuführen.
Summary
Obesity is associated with an increased risk for various chronic diseases. The risk of diabetes, hypertension and dyslipidemia is increased upwards from a body mass index (BMI) of 21 kg/m2. In industrial countries a high BMI accounts for one third of cases of ischemic heart disease and one quarter of cerebrovascular diseases. The relationship between BMI and relative risk of death is 'J'-shaped. Obesity ranks sixth as an independent risk factor for overall mortality worldwide, and fourth among the leading causes of death in Germany. The prevalence of obesity in Germany increased continuously between 1985 and 2002: in men from 16.2% to 22.5% and in women form 16.2% to 23.3%. Prevalence of overweight and obesity in children and adolescents in Germany is estimated to be 15% and 6%, respectively. Socio-economic status is an important determinant of obesity and the effect of social differences on the prevalence of obesity is stronger for women than men. Concepts to curtail obesity require multiple strategies on the individual and population level if the trend of the epidemic is to be reversed.
Schlüsselwörter
Adipositas - Epidemie - Deutschland
Key words
obesity - epidemic - Germany
Literatur
-
1
Adams K F, Schatzkin A, Harris T B. et al .
Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.
N Engl J Med.
2006;
355
763-778
-
2
Bergmann K E, Mensink G B.
Körpermaße und Übergewicht.
Gesundheitswesen.
1999;
61 Spec No
S115-S120
-
3
Chan J M, Rimm E B, Colditz G A, Stampfer M J, Willett W C.
Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men.
Diabetes Care.
1994;
17
961-969
-
4
Colditz G A, Willett W C, Rotnitzky A, Manson J E.
Weight gain as a risk factor for clinical diabetes mellitus in women.
Ann Intern Med.
1995;
122
481-486
-
5
Cole T J, Bellizzi M C, Flegal K M, Dietz W H.
Establishing a standard definition for child overweight and obesity worldwide: international survey.
BMJ.
2000;
320
1240-1243
-
6
Engeland A, Bjorge T, Sogaard A J, Tverdal A.
Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227,000 Norwegian boys and girls.
Am J Epidemiol.
2003;
157
517-523
-
7
EUROASPIRE I and II Group .
Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. European Action on Secondary Prevention by Intervention to Reduce Events.
Lancet.
2001;
357
995-1001
-
8
Ezzati M, Hoorn S V, Rodgers A, Lopez A D, Mathers C D, Murray C J.
Estimates of global and regional potential health gains from reducing multiple major risk factors.
Lancet.
2003;
362
271-280
-
9
Ezzati M, Lopez A D, Rodgers A, Vander H S, Murray C J.
Selected major risk factors and global and regional burden of disease.
Lancet.
2002;
360
1347-1360
-
10
Flegal K M, Carroll M D, Ogden C L, Johnson C L.
Prevalence and trends in obesity among US adults, 1999 - 2000.
JAMA.
2002;
288
1723-1727
-
11
Flegal K M, Troiano R P.
Changes in the distribution of body mass index of adults and children in the US population.
Int J Obes Relat Metab Disord.
2000;
24
807-818
-
12
Fontaine K R, Redden D T, Wang C, Westfall A O, Allison D B.
Years of life lost due to obesity.
JAMA.
2003;
289
187-193
-
13
Gortmaker S L, Cheung L W, Peterson K E. et al .
Impact of a school-based interdisciplinary intervention on diet and physical activity among urban primary school children: eat well and keep moving.
Arch Pediatr Adolesc Med.
1999;
153
975-983
-
14
Graf C, Koch B, Dordel S. et al .
Physical activity, leisure habits and obesity in first-grade children.
Eur J Cardiovasc Prev Rehabil.
2004;
11
284-290
-
15
Han T S, Sattar N, Lean M.
ABC of obesity. Assessment of obesity and its clinical implications.
BMJ.
2006;
333
695-698
-
16
Han T S, van Leer E M, Seidell J C, Lean M E.
Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample.
BMJ.
1995;
311
1401-1405
-
17
Haslam D, Sattar N, Lean M.
ABC of obesity. Obesity-time to wake up.
BMJ.
2006;
333
640-642
-
18
Hedley A A, Ogden C L, Johnson C L, Carroll M D, Curtin L R, Flegal K M.
Prevalence of overweight and obesity among US children, adolescents, and adults, 1999 - 2002.
JAMA.
2004;
291
2847-2850
-
19
Heidrich J, Liese A D, Kalic M. et al .
Sekundärprävention der koronaren Herzkrankheit. Ergebnisse der EuroASPIRE I- und II-Studien in der Region Münster.
Dtsch Med Wochenschr.
2002;
127
667-672
-
20
Helmert U, Strube H.
Die Entwicklung der Adipositas in Deutschland im Zeitraum von 1985 - 2002.
Gesundheitswesen.
2004;
66
409-415
-
21
Hense H W, Filipiak B, Döring A, Stieber J, Liese A, Keil U.
Ten-Year Trends of Cardiovascular Risk Factors in the MONICA Augsburg Region in Southern Germany.
CVD Prevention.
1998;
1
318-327
-
22 International Obesity Task Force, European Association for the Study of Obesity .Obesity in Europe 2002: The case for action. London 2002
-
23 James P T, Jackson-Learch R, Ni Mhurchu C. Overweight and obesity (high body mass index). Geneva: WHO In: Ezzati M, Lopez AD, Rogers A, Murray CJL, editors. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors 2004
-
24
James P T, Leach R, Kalamara E, Shayeghi M.
The worldwide obesity epidemic.
Obes Res.
2001;
9
(Suppl 4)
228S-233S
-
25
James P T, Rigby N, Leach R.
The obesity epidemic, metabolic syndrome and future prevention strategies.
Eur J Cardiovasc Prev Rehabil.
2004;
11
3-8
-
26
Janssen I, Katzmarzyk P T, Srinivasan S R. et al .
Utility of childhood BMI in the prediction of adulthood disease: comparison of national and international references.
Obes Res.
2005;
13
1106-1115
-
27
Kalies H, Lenz J, von Kries R.
Prevalence of overweight and obesity and trends in body mass index in German pre-school children, 1982 - 1997.
Int J Obes Relat Metab Disord.
2002;
26
1211-1217
-
28
Kelder S H, Perry C L, Klepp K I, Lytle L L.
Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors.
Am J Public Health.
1994;
84
1121-1126
-
29
Kuczmarski R J, Ogden C L, Grummer-Strawn L M. et al .
CDC growth charts: United States.
Adv Data.
2000;
8
1-27
-
30
Lean M, Gruer L, Alberti G, Sattar N.
ABC of obesity. Obesity - can we turn the tide?.
BMJ.
2006;
333
1261-1264
-
31
Liese A D, Doring A, Hense H W, Keil U.
Five year changes in waist circumference, body mass index and obesity in Augsburg, Germany.
Eur J Nutr.
2001;
40
282-288
-
32
Liese A D, Hirsch T, von Mutius E, Weiland S K.
Burden of overweight in Germany: prevalence differences between former East and West German children.
Eur J Public Health.
2006;
16
526-531
-
33
Manson J E, Willett W C, Stampfer M J. et al .
Body weight and mortality among women.
N Engl J Med.
1995;
333
677-685
-
34
Mokdad A H, Marks J S, Stroup D F, Gerberding J L.
Actual causes of death in the United States, 2000.
JAMA.
2004;
291
1238-1245
-
35
Mokdad A H, Marks J S, Stroup D F, Gerberding J L.
Correction: actual causes of death in the United States, 2000.
JAMA.
2005;
293
293-294
-
36
Muller M J, Koertzinger I, Mast M, Langnase K, Grund A.
Physical activity and diet in 5 to 7 year old children.
Public Health Nutr.
1999;
2
443-444
-
37
Must A, Spadano J, Coakley E H, Field A E, Colditz G, Dietz W H.
The disease burden associated with overweight and obesity.
JAMA.
1999;
282
1523-1529
-
38
Noel P H, Pugh J A.
Management of overweight and obese adults.
BMJ.
2002;
325
757-761
-
39
Olshansky S J, Passaro D J, Hershow R C. et al .
A potential decline in life expectancy in the United States in the 21st century.
N Engl J Med.
2005;
352
1138-1145
-
40
Peeters A, Barendregt J J, Willekens F, Mackenbach J P, Al Mamun A, Bonneux L.
Obesity in adulthood and its consequences for life expectancy: a life-table analysis.
Ann Intern Med.
2003;
138
24-32
-
41
Pouliot M C, Despres J P, Lemieux S. et al .
Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women.
Am J Cardiol.
1994;
73
460-468
-
42
Rose G.
Population distributions of risk and disease.
Nutr Metab Cardiovasc Dis.
1991;
1
37-40
-
43 Schaffrath-Rosario A, Kurth B M. Die Verbreitung von Übergewicht und Adipositas. Kiggs-Symposium 2006. Aufzufinden unter: http://www.kiggs.de/experten/downloads/dokumente/ppt_adipositas.pdf. Abgerufen am 16.01.2007
-
44
Summerbell C D, Waters E, Edmunds L D, Kelly S, Brown T, Campbell K J.
Interventions for preventing obesity in children.
Cochrane Database Syst Rev.
2005;
3
CD001871
-
45 Swinburn B, Bell C. A comprehensive approach to obesity prevention. Oxford: Blackwell Publishing In: Kopelman PG, Caterson ID, Dietz WH, editors. Clinical Obesity in Adults and Children 2005: 456-471
-
46
Weiland S K, Rapp K, Klenk J, Keil U.
Zunahme der Lebenserwartung: Größenordnung, Determinanten und Perspektiven.
Dtsch Ärztebl.
2006;
103
1072-1077
-
47 World Health Organisation .Obesity: preventing and managing the global epidemic. Geneva 2000
-
48 World Health Organisation .The European Health Report 2005: public health action for healthier children and populations. Statistical Tables. World Health Organisation ed. Geneva 2005
Univ.-Prof. Dr. med. Ulrich Keil
Institut für Epidemiologie und Sozialmedizin, Universität Münster
Domagkstraße 3
48149 Münster
Telefon: 0251/8355396
Fax: 0251/8355300
eMail: keilu@uni-muenster.de
