Zusammenfassung
Die Adipositas nimmt weltweit rapide zu. Therapieempfehlungen wurden in der aktuellen „Evidenzbasierten Leitlinie zur Prävention und Therapie der Adipositas” gegeben: Die Basistherapie umfasst drei miteinander kombinierte Prinzipien: die Verhaltens-, Bewegungs- und Ernährungstherapie. Die Ernährungstherapie wird in vier Stufen zunehmend reduzierter Energiezufuhr unterteilt. Eine medikamentöse Therapie durch Orlistat, Sibutramin oder möglicherweise Rimonabant ist als ergänzende Maßnahme unter bestimmten Voraussetzungen und Beachtung von Kontraindikationen über begrenzte Zeiträume möglich. Chirurgische Interventionen kommen für Personen mit einer höhergradigen Adipositas (BMI > 35 - 40 kg/m2) in Betracht, die mit konservativen Maßnahmen keine befriedigende Gewichtsreduktion erzielen konnten. Bei allen Therapieformen ist eine langfristige Begleitung durch verschiedene Fachdisziplinen und unter Beachtung individueller Besonderheiten erforderlich. Eine Ernährungsumstellung ist wesentliche Voraussetzung jedes dauerhaft erfolgreichen Gewichtsmanagements, und der vor allem in den ersten Monaten zu erreichender Gewichtsabnahme sollte sich immer eine Phase der Gewichtsstabilisierung anschließen. Schon aufgrund von Komorbiditäten und Folgekosten ist eine Anerkennung der Adipositas als Erkrankung im Sinne des deutschen Sozialgesetzbuches überfällig. Dem Erreichen einer Bündelung aller Kräfte der Berufsgruppen und Kostenträger im Gesundheitssystem sowie in der Gesellschaft hinsichtlich des Erreichens realistischer Ziele bei der Prävention der Adipositas sollte auch aus langfristigen gesundheitsökonomischen Gesichtspunkten alle nur mögliche Aufmerksamkeit zukommen.
Summary
Obesity is growing rapidly the world over. The recently published German „Evidence-based Guideline for Prevention and Therapy of Obesity” specifies three combined principles of management, namely behavioural therapy, kinesitherapy and nutritional therapy. The latter indicates four phases of reducing uptake of energy for limited periods, possibly supplemented by drugs such as Orlistat, Sibutramin and/or Rimonabant, strictly observing contraindications. If conservative treatment does not achieve desirable results, persons afflicted by high-grade obesity (body-mass index 35 - 40) without adequate weight reduction may need surgical intervention. All kinds of therapy will require long-term professional control. An essential component of successful weight management is a change of diets, with a subsequent phase of weight stabilisation. Approving obesity as a disease in the sense of German social legislation is overdue, in particular in view of a possible comorbidity and of potential sequential costs. All professional groups and cost units in the public health system ought to co-operate in the objective of achieving realistic results in combating obesity under health-economic aspects.
Schlüsselwörter
Adipositas - Gewichtsmanagement - evidenzbasierte Leitlinie - Ernährungstherapie - Reduktionskost - low-carb diet - Bewegungstherapie - Verhaltenstherapie - Antiadiposita - Bariatrische Chirurgie
Key words
Obesity - weight management - evidence-based guidelines - nutritional therapy - weight-reducing diet - low-carb diet - kinesitherapy - behaviour therapy - antiadiposita - bariatric surgery
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Priv.-Doz. Dr. med. Elmar Siewert
Medizinische Klinik III
Universitätsklinikum Aachen
Pauwelsstr. 30
52074 Aachen
