Indikationsstellung in der Adipositastherapie – Surgeons first? // Indications in obesity therapy - surgeons first?

Zusammenfassung

Die Adipositas ist weltweit ein zunehmendes Problem. Seit dem Jahr 2010 waren erstmals mehr Menschen übergewichtig als untergewichtig. Insbesondere die adipositasassoziierten Erkrankungen, allen voran der Diabetes mellitus Typ II, stellen das Gesundheitssystem vor enorme Herausforderungen. Am 3. Juli 2020 hat der Deutsche Bundestag Adipositas als Krankheit anerkannt und die Entwicklung eines Disease-Management-Programms (DMP) angestoßen, das zurzeit ausgearbeitet wird. Bisher richtet sich die Indikation einer Behandlung der Adipositas in Deutschland nach der S3-Leitlinie „Chirurgie der Adipositas und metabolischer Erkrankungen“ der DGAV von 2018 und der S3-Leitlinie „Prävention und Therapie der Adipositas“ der Deutschen Adipositas-Gesellschaft e. V. von 2014. Dieser Artikel gibt einen Überblick über die aktuell in Deutschland verfügbaren konservativen, medikamentösen, endoskopischen und chirurgischen Therapiemethoden des Übergewichts und der Adipositas und erläutert die Indikationen. Vor dem Hintergrund der Neuausrichtung der Adipositasbehandlung im Rahmen des DMP und der anstehenden Überarbeitungen der Leitlinien sollte die bisherige Indikationsstellung kritisch diskutiert werden. Die wissenschaftlichen Erkenntnisse der letzten Jahre zeigen, dass durch eine chirurgische Behandlung der Adipositas aktuell im Langzeitverlauf nicht nur der größte Gewichtsverlust erreicht wird, sondern auch, dass adipositasassoziierte Erkrankungen effektiver behandelt werden und die Gesamtmortalität im Vergleich zur konservativen Behandlung deutlich effektiver gesenkt wird.

Abstract

Obesity is a growing problem worldwide. For the first time since 2010, more people have been overweight than underweight. In particular, obesity-associated diseases, above all type 2 diabetes mellitus, pose enormous challenges to the healthcare system. On July 3, 2020, the German Bundestag recognised obesity as a disease and initiated the development of a diseases management program (DMP), which is currently being drawn up. So far, the indication for treatment of obesity in Germany has been based on the S3 guideline “Surgery of obesity and metabolic diseases” of the DGAV from 2018 and the S3 guideline “Prevention and therapy of obesity” of the German Obesity Society e. V. from 2014. This article gives an overview of the currently available conservative, medical, endoscopic and surgical treatment methods for overweight and obesity in Germany and explains the indications. Against the background of the reorientation of obesity treatment as a part of the DMP and the forthcoming revisions of the guidelines, the previous indication should be discussed critically. The scientific findings of the last few years show that surgical treatment of obesity not only achieves the greatest weight loss in the long term, but also that obesity-associated diseases are then treated more effectively and overall mortality is reduced significantly more effectively than with conservative treatment.

Schlüsselwörter

Adipositas - Adipositastherapie - Adipositaschirurgie - Indikationsstellung - Leitlinien

Keywords

obesity - obesity therapy - obesity surgery - indication - treatment guidelines

Publication History

Received: 01 August 2022

Accepted after revision: 26 October 2022

Article published online:
07 December 2022

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