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Nutzen und Risiko der medikamentösen Adipositastherapie

Benefits and risks of pharmacotherapy of obesity

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Entsprechend den aktuellen Leitlinien sind Ernährungs-, Bewegungs- und Verhaltenstherapie Grundlage einer Behandlung von Adipositas. Wird damit innerhalb von 3–6 Monaten das angestrebte Ziel einer Gewichtsabnahme von zunächst 5% nicht erreicht, so kann zusätzlich eine adjuvante Pharmakotherapie in Erwägung gezogen werden. Dies setzt bei den zu behandelnden Patienten einen BMI ≥30 kg/m2 oder einen BMI ≥27 kg/m2 bei gleichzeitig vorhandenen Komorbiditäten, wie Typ-2-Diabetes, Dyslipidämie oder Hypertonie, voraus. Gegenwärtig stellen Orlistat, Sibutramin und Rimonabant die möglichen Optionen für eine medikamentöse Adipositastherapie dar. Diese Substanzen bewirken eine moderate Gewichtsabnahme und eine Verbesserung des kardiovaskulären Risikoprofils. Langzeitdaten zu Nutzen und Risiko existieren bisher nicht. Unterschiedliche Nebenwirkungen der einzelnen Substanzen sind von wesentlicher Bedeutung für den differenzialtherapeutischen Einsatz. Weitere neue Substanzgruppen befinden sich in klinischer oder präklinischer Entwicklung.

Abstract

According to current guidelines, diet, exercise and behavioral therapy are the basics for any treatment of obesity. If this does not result in a weight loss of 5% within 3--6 months, specific pharmacotherapy can be used in addition to lifestyle intervention. Treated patients should have a BMI ≥30 kg/m2 or at least a BMI ≥27 kg/m2 plus accompanying comorbidities, such as type 2 diabetes, dyslipidemia or hypertension. Orlistat, sibutramine and rimonabant are presently available options for the pharmacotherapy of obesity. These compounds result in moderate weight reduction and improvement of cardiovascular risk profile. No long-term data regarding benefit and risk are available to date. Different side effect profiles of the various compounds need to be considered before their use. Other potential new drugs for the pharmacotherapy of obesity are currently in clinical or preclinical development.

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Interessenkonflikt

Der korrespondierende Autor hat im Rahmen von Beratertätigkeit, Durchführung klinischer Studien und/oder Vortragstätigkeit Verbindungen zu den folgenden Firmen, deren Produkte in dieser Übersicht erwähnt werden: Sanofi-Aventis, Abbott, Lilly, Roche, MSD, Takeda, GlaxoSmithKline, Novo-Nordisk.

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Authors and Affiliations

  1. Diabetes Klinik Bad Nauheim GmbH, Kerckhoff-Campus für Herz- und Gefäßmedizin, Ludwigstraße 37–39, 61231, Bad Nauheim, Deutschland

    A. Hamann

  2. Abteilung Innere Medizin I und Klinische Chemie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    A. Hamann & J. Tafel

  3. Medizinische Klinik II, Main-Taunus-Kliniken, Bad Soden, Deutschland

    J. Tafel

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  1. A. Hamann
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  2. J. Tafel
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Correspondence to A. Hamann.

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Hamann, A., Tafel, J. Nutzen und Risiko der medikamentösen Adipositastherapie. Diabetologe 4, 266–271 (2008). https://doi.org/10.1007/s11428-008-0224-9

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  • DOI: https://doi.org/10.1007/s11428-008-0224-9

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