Zusammenfassung
Übergewicht geht mit einer erhöhten somatischen Morbidität und Mortalität einher. Diese Arbeit geht der bisher strittigen Frage der psychischen Komorbidität in verschiedenen Populationen Übergewichtiger und Adipöser sowie dem Zusammenhang zu medizinischer Inanspruchnahme und Gesundheitsverhalten nach. In einer eigenen Erhebung wurde das Hauptaugenmerk auf Inanspruchnahme- und Gesundheitsverhalten bei Übergewichtigen/Adipösen mit psychischer Komorbidität gerichtet. In der repräsentativen Befragung an 1281 Personen aus der Allgemeinbevölkerung wurden anhand validierter Selbstbeschreibungsinstrumente wichtige komorbide psychische Störungen (Depression, Angststörungen) erhoben und mithilfe bewährter Cut-off-Werte solche Personen identifiziert, die neben dem Übergewicht/der Adipositas mindestens eine psychische Komorbidität aufwiesen. Diese 61 Personen zeigten vor allem ein im Vergleich zu den Übergewichtigen/Adipösen ohne psychische Komorbidität erhöhtes Inanspruchnahmeverhalten von psychiatrischen und psychotherapeutischen Leistungen und rauchten häufiger. Psychische Komorbidität erwies sich neben der Anzahl somatischer Probleme, Alter, BMI, weiblichem Geschlecht und einem Wohnsitz in den neuen Bundesländern als zusätzlicher Prädiktor für einen geringeren subjektiven Gesundheitszustand bei Übergewichtigen/Adipösen. Die Ergebnisse implizieren die Notwendigkeit, in Gewichtsreduktionsprogrammen das Augenmerk auf die psychotherapeutische Behandlung bei psychischer Komorbidität zu richten.
Abstract
Obesity is associated with an increased somatic morbidity and mortality. This paper focuses on the controversial issue of mental co-morbidity in various populations of overweight and obese persons and the relationship to the utilization of medical care and health behaviour. Therefore, this paper focuses on health care utilization and health behaviour in overweight/obese with mental co-morbidity. In a representative German community sample with n = 1281 we administered valid self-rating scales on depression and anxiety. Using established cut-off scores we identified 61 subjects with both overweight/obesity and at least one mental disorder. Compared to the overweight/obese without mental co-morbidity, those subjects showed a more extensive health care utilization of psychiatric and psychotherapeutic services and reported more smoking. Beside the number of somatic problems, age, BMI, female gender and residence in Eastern-Germany a lower subjective health in overweight/obese subjects could be predicted by the occurrence of at least one mental disorder. Our results implicate the need to focus on psychotherapy in weight reduction programmes for participants with mental co-morbidity.
Key words
obesity - overweight - health care utilization - health behaviour - subjective health
Literatur
1
Mensink G B, Lampert T, Bergmann E.
Übergewicht und Adipositas in Deutschland 1984 - 2003.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz.
2005;
48
1348-1356
2
Hach I, Ruhl U E, Klose M. et al .
Obesity and the risk for mental disorders in a representative German adult sample.
Eur J Public Health.
2007;
17
297-305
3
Hilbert A, Rief W, Brähler E.
Problembewusstsein und Einstellung zur Adipositasprävention: Eine repräsentative Surveyuntersuchung.
Psychother Psych Med.
2007;
57
242-247
4
Barnow S, Stopsack M, Bernheim D. et al .
Ergebnisse einer ambulanten Interventionsstudie bei adipösen Kindern und Jugendlichen.
Psychother Psych Med.
2007 (Epub 2007 Jul 6);
5 Stunkard A J, Pudel V. Adipositas. In: Adler RH, Herrmann JM, Köhle K, Schonecke OW, Uexküll T von, Wesiack W (Hrsg) Psychosomatische Medizin. München, Wien, Baltimore; Urban und Schwarzenberg 1997: 581-598
6
Heitmann B L, Erikson H, Ellsinger B M, Larsson B.
Mortality associated with body fat, fat-free mass and body mass index amoung 60-year-old Swedish men - a 22-year follow-up. The study of men born in 1913.
Int J Obes.
2000;
22
33-37
7
Higgins M, Kannel W, Garrison R. et al .
Hazards of obesity - the Framingham experience.
Acta Med Scand.
1988;
723, Suppl
23-36
8
Manson J E, Colditz G A, Stampfer M J. et al .
A prospective study of obesity and risk of coronary heart disease in women.
NEJM.
1990;
322
882-889
9
Felson D T, Abdersib H, Naunark A. et al .
Obesity and knee-osteoarthritis. The Framingham Study.
Ann Intern Med.
1988;
109
18
10
Strobel R J, Rosen R C.
Obesity and weight loss in obstructive sleep apnea: A critical review.
Sleep.
1996;
19
104-122
11
Després J P, Lemieux I, Prud'homme D.
Treatment of obesity: need to focus on high risk abdominal obese patients.
BMJ.
2001;
322
716-720
12
Venditti E M, Wing R R, Jakici J M. et al .
Weight cycling, psychological health, and binge eating in obese women.
J Consult Clin Psychol.
1996;
64
400-405
13 Stunkard A J, Wadden T A. Psychological aspects of human obesity. In: Björntorp P, Brodoff BN (eds) Obesity. Philadelphia; Lippincott 1992: 97-135
14
McElroy S L, Kotwal R, Malhotra S. et al .
Are mood disorders and obesity related? A review for the mental health professional.
J Clin Psychiatry.
2004;
65
634-651
15
Roberts R E, Kaplan G A, Shema S J, Strawbridge W J.
Are the obese at greater risk for depression?.
Am J Epidemiol.
2000;
152
163-170
16
Carpenter K M, Hasin D S, Allison D B, Faith M S.
Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study.
Am J Public Health.
2000;
90
251-257
17
Becker E S, Margraf J, Turke V. et al .
Obesity and mental illness in a representative sample of young women.
Int J Obes Relat Metab Disord.
2001;
25, Suppl 1
S5-9
18
Onyike C U, Crum R M, Lee H B. et al .
Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey.
Am J Epidemiol.
2003;
158
1139-1147
19
Herva A, Laitinen J, Miettunen J. et al .
Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study.
Int J Obes.
2006;
30
520-527
20
Heo M, Pietrobelli A, Fontaine K R. et al .
Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race.
Int J Obes.
2006;
30
513-519
21
Baumeister H, Härter M.
Mental disorders in patients with obesity in comparison with healthy probands.
Int J Obes.
2007;
31
1155-1164
22
Lamertz C M, Jacobi C, Yassouridis A. et al .
Are obese adolescents and young adults at higher risk for mental disorders? A community survey.
Obes Res.
2002;
10
1152-1160
23
John U, Meyer C, Rumpf H J, Hapke U.
Relationships of psychiatric disorders with overweight and obesity in an adult general population.
Obes Res.
2005;
13
101-119
24
Fitzgibbon M L, Stolley M R, Kirschenbaum D S.
Obese people who seek treatment have different characteristics than those who do not seek treatment.
Health Psychol.
1993;
12
342-345
25
Saunders R.
Post-surgery group therapy for gastric bypass patients.
Obes Surg.
2004;
14
1128-1131
26
Friedman M A, Brownell K D.
Psychological correlates of obesity: moving to the next research generation.
Psychol Bull.
1995;
117
3-20
27
Black D W, Goldstein R B, Mason E E.
Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients.
Am J Psychiatry.
1992;
149
227-234
28
Herpertz S, Burgmer R, Stang A. et al .
Prevalence of mental disorders in normal-weight and obese individuals with and without weight loss treatment in a German urban population.
J Psychosom Res.
2006;
61
95-103
29
Beutel M E, Dippel A, Szczepanski M. et al .
Mid-term effectiveness of behavioural and psychodynamic inpatient treatments of severe obesity based on a randomized study.
Psychother Psychosom.
2006;
75
337-345
30
Wiltink J, Dippel A, Szczepanski M. et al .
Long-term weight loss maintenance after inpatient psychotherapy of severe obesity based on a randomized study - predictors and maintaining factors of health behaviour.
J Psychosom Res.
2007;
62
691-698
31
Löwe B, Kroenke K, Grafe K.
Detecting and monitoring depression with a two-item questionnaire (PHQ-2).
J Psychosom Res.
2005;
58
163-171
32
Löwe B, Grafe K, Zipfel S. et al .
Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians' diagnosis.
J Psychosom Res.
2003;
55
515-519
33
Spitzer R L, Kroenke K, Williams J B, Löwe B.
A brief measure for assessing generalized anxiety disorder: the GAD-7.
Arch Intern Med.
2006;
166
1092-1097
34
Kroenke K, Spitzer R L, Williams J B. et al .
Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.
Ann Intern Med.
2007;
146
317-325
35
Connor K M, Kobak K A, Churchill L E. et al .
Mini-SPIN: A brief screening assessment for generalized social anxiety disorder.
Depress Anxiety.
2001;
14
137-140
36
Beutel M E, Wiltink J, Schwarz R. et al .
Complaints of the ageing male based on a representative community sample.
European Urology.
2002;
41
5-93
37
Skilton M R, Moulin P, Terra J L, Bonnet F.
Associations between anxiety, depression, and the metabolic syndrome.
Biol Psychiatry.
2007, Epub 2007 Jun 30;
Dr. med. Dipl.-Psych. Jörg Wiltink
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
Untere Zahlbacher Straße 8
55131 Mainz
Email: wiltink@psychosomatik.klinik.uni-mainz.de