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Aktuelle Ernährungsmedizin 2002; 27(3): 149-156
DOI: 10.1055/s-2002-32275
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Psychosoziale Aspekte der Adipositaschirurgie

Psychosocial Aspects of Obesity SurgeryS.  Herpertz1 , R.  Kielmann1 , A.  M.  Wolf2
  • 1Klinik für Psychotherapie und Psychosomatik, Rheinische Kliniken/Universitätsklinik Essen
  • 2Klinik für Viszeral- und Transplantationschirurgie, Universitätsklinikum Ulm
Manuskript nach einem Vortrag bei der 17. Jahrestagung der Deutschen Adipositasgesellschaft in Bremen, 18. - 20. 10. 2001
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Publication History

Publication Date:
18 June 2002 (online)

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Zusammenfassung

Konservative Gewichtsreduktionsmaßnahmen sind bei Menschen mit Adipositas permagna (Adipositas Grad III, BMI > 40 kg/m2) in der Regel wenig Erfolg versprechend. Die Adipositaschirurgie hat sich bei sinkendem Operationsrisiko im Hinblick auf eine deutliche und dauerhafte Gewichtsreduktion bei zumindest zwei Drittel der Patienten bewährt. Dennoch stellt sich bei 30 % der operierten Patienten der postoperative Gewichtsverlauf unbefriedigend dar, wobei die Ursachen weniger im chirurgischen als vielmehr im psychiatrisch-psychosomatischen Fachgebiet zu finden sind und unter dem Begriff „Compliancestörung” unzureichend abgebildet werden. Auch in der Adipositaschirurgie gewinnt die Frage der Lebensqualität operierter Patienten zunehmend an Bedeutung. Der Begriff der Lebensqualität gründet sich nicht nur auf medizinische, sondern auch auf psychosoziale Aspekte, die wiederum mit psychiatrischen/psychosomatischen Symptomen oder Störungen untrennbar verbunden sind. Nicht zuletzt durch die Grundsatzstellungnahme des Medizinischen Dienstes der Spitzenverbände der Krankenkassen wird die Adipositaschirurgie nicht nur unter dem Aspekt der Gewichtsabnahme und des Morbiditäts- und Mortalitätsrisikos, sondern auch im Hinblick auf Fragen der Lebensqualität kontrovers diskutiert. Die vorliegende Arbeit unternimmt den Versuch, psychosomatische Aspekte der Adipositaschirurgie kritisch zu beleuchten, um letztendlich die Notwendigkeit sowohl einer spezialisierten chirurgischen als auch psychiatrischen/psychosomatischen Diagnostik und Behandlung herauszustellen.

Abstract

Conservative weight reduction measures in people with morbid obesity (BMI > 40 kg/m2) are as a rule not very promising. Obesity surgery with an increasingly lower operation risk has proven to be successful with regard to weight reduction in at least two thirds of those patients operated on; in 30 % of the operated patients, however, the postoperative course of weight is unsatisfactory. The reasons for this may not necessarily be found in the surgical but rather in the psychiatric/psychosomatic field and are described inadequately by the term „compliance disorder”. In obesity surgery, the question regarding the quality of life in operated patients has increasingly gained importance. The term quality of life is not only based on medical but also on psychosocial aspects; these in turn are inseparately connected to psychiatric/psychosomatic symptoms or disorders. It is lastly not only due to the basic principles set up by the medical services of the insurance companies that obesity surgery is discussed quite controversially with regard to weight reduction, morbidity and mortality risks as well as with regard to quality of life. The aim of the present paper is to illuminate the psychosomatic aspects of obesity surgery in order to expose and emphasize the necessity for both a specialized surgery as well as psychiatric/psychosomatic diagnostics and treatment.

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PD Dr. med. Stephan Herpertz

Klinik für Psychotherapie und Psychosomatik, Rheinische Kliniken Essen · Universitätsklinik Essen

Virchowstraße 174

45147 Essen

Email: stephan.herpertz@uni-essen.de

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