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Interventiestrategieën bij overgewicht

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Bijblijven

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Overgewicht komt bij 40% van de Nederlandse volwassen bevolking voor, obesitas bij 10%. Obesitas is een chronische niet te genezen ziekte met aanzienlijke mortaliteit en comorbiditeit die door langdurig en relatief gering (5-15%) gewichtsverlies aanzienlijk te verbeteren zijn. De huisarts moet weten welke bevolkingsgroepen at risk zijn voor gewichtstoename en welke medicijnen gewichtsaanwas geven.

Bij overgewicht is stabilisatie van het gewicht of een matig verlies over langere tijd het streven. Bij obesitas komen eerst dieetadviezen, gedragsverandering en verhoging van de lichamelijke activiteiten. Deze adviezen liggen ook ten grondslag aan eventueel erop volgende behandelingen met geneesmiddelen of chirurgie. Geneesmiddelen zijn alleen geïndiceerd bij mensen met een bmi ≥ 30 kg/m2 of een bmi ≥ 27 kg/m2 met comorbiditeit en mogen alleen langdurig worden voorgeschreven bij respons, gedefinieerd als een gewichtsverlies van 5% in de eerste 3 maanden. Bij zeer ernstige obesitas is chirurgie de enige reële optie met goede resultaten op de lange termijn.

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Literatuur

  • World Health Organization. Obesity: preventing and managing the global epidemic – results of a WHO consultation on obesity. Geneva: WHO/NUT/NCD/98.1 1998:1-276

  • Mathus-Vliegen EMH. Overgewicht. I. Prevalentie en trends. Ned Tijdschr Geneeskd 1998;142(43):1982-8

    CAS  PubMed  Google Scholar 

  • Mathus-Vliegen EMH. Overgewicht II. Determinanten van overgewicht en strategieën voor preventie. Ned Tijdschr Geneeskd 1998;142(36):1989-95

    CAS  PubMed  Google Scholar 

  • Gezondheidsraad. Overgewicht en obesitas. Den Haag: Gezondheidsraad 2003; publicatie 2003/07

  • Lean MEJ, Han TS, Morrison ME. Waist circumference as a measure for indicating need for weight management. BMJ 1995;311:58-61

    Google Scholar 

  • National Institutes of Health, National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – the evidence report. Obes Res 1998;6 Suppl 2: S51-S210

  • Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diab Med 1998;15:539-53

    Article  CAS  Google Scholar 

  • Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report. Circulation 2002;106:3143-3421

    Google Scholar 

  • Mathus-Vliegen EMH. Voeding en gezondheid – streefgewicht bij obesitas niet realistisch; wel gezondheidswinst door matige stabiele gewichtsreductie. Ned Tijdschr Geneeskd 2003;147:1168-72

    CAS  PubMed  Google Scholar 

  • Goldstein DJ. Beneficial health effects of modest weight loss. Int J Obes 1992;16:397-415

    CAS  Google Scholar 

  • Dattilo AM, Kris-Etherton PM. Effects of weight loss on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992;56:320-8

    CAS  PubMed  Google Scholar 

  • Lean MEJ, Powrie JH, Anderson AS, Garthwaite PH. Obesity, weight loss and prognosis in type 2 diabetes. Diab Med 1990;7:228-33

    Article  CAS  Google Scholar 

  • Staessen J, Fagard R, Amery A. The relationship between body weight and blood pressure. J Hum Hypertension 1988;2:207-17

    CAS  Google Scholar 

  • Knowler WC, Barrett-Conner E, Fowler SE, et al. Diabetes Prevention Program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403

    Article  CAS  PubMed  Google Scholar 

  • Tuomilehto J, Lindstrom J, Eriksson JG, et al. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-50

    Article  CAS  PubMed  Google Scholar 

  • Torgerson JS, Boldrin MN, Hauptman J, Sjöström L. Xenical in the prevention of diabetes in obese subjects (XENDOS) study. A randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diab Care 2004;27:155-61

    Article  CAS  Google Scholar 

  • Karlsson J, Sjöström L, Sullivan M. Swedish Obese Subjects (SOS) – an intervention study of obesity. Two year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes 1998;22:113-26

    Article  CAS  Google Scholar 

  • Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differential long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36:20-5

    PubMed  Google Scholar 

  • Williamson DF, Pamuk E, Thun M, et al. Prospective study of intentional weight loss and mortality in overweight white women aged 40-64 years. Am J Epidemiol 1999;149:491-503

    CAS  PubMed  Google Scholar 

  • MacDonald Jr KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin dependent diabetes mellitus. J Gastrointest Surg 1997;1:213-20

    Article  PubMed  Google Scholar 

  • Nederlandse Hartstichting. Over gewicht en hart- en vaatziekten. Den Haag: Nederlandse Hartstichting 1995

  • Saris WHM, Blair SN, Baak MA van, et al. How much physical activity is enough to prevent unhealthy weight gain? Outcome of the IASO 1st Stock conference and consensus statement. Obes Rev 2003;4:101-14

    Article  CAS  PubMed  Google Scholar 

  • Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr 1995;49:1-10

    CAS  PubMed  Google Scholar 

  • Fogelholm M, Kukkonen-Harjula K. Does physical activity prevent weight gain – a systematic review. Obes Rev 2000;1:95-111

    Article  CAS  PubMed  Google Scholar 

  • Flechtner-Mors M, Ditschuneit HH, Johnson TD, et al. Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res 2000;8:399-402

    Article  CAS  PubMed  Google Scholar 

  • Rothacker DQ. Five-year self-management of weight using meal replacements: comparison with matched controls in rural Wisconsin. Nutrition 2000;16:344-8

    Article  Google Scholar 

  • Heymsfield SB, Mierlo CAJ van, Knaap HCM van der, et al. Weight management using meal replacement strategy: meta and pooling analysis from six studies. Int J Obes 2003;27:537-49

    Article  CAS  Google Scholar 

  • Ashley JM, St Jeor ST, Schrage JP, et al. Weight control in the physician's office. Arch Int Med 2001;161:1599-1604

    Article  CAS  Google Scholar 

  • Samaha FF, Iqbal N, Seshadri P, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 2003;348:2074-81

    Article  CAS  PubMed  Google Scholar 

  • Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003;348:2082-90

    Article  CAS  PubMed  Google Scholar 

  • Yancy WS, Olsen MK, Guyton JR, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. A randomized, controlled trial. Ann Intern Med 2004;140:769-77

    PubMed  Google Scholar 

  • Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one year follow-up of a randomized trial. Ann Intern Med 2004;140:778-85

    PubMed  Google Scholar 

  • Donelly JE, Hill JO, Jacobsen DJ, et al. Effects of a 16-month randomized controlled exercise trial on body weight and composition in young overweight men and women. Arch Int Med 2003;163:1343-50

    Article  Google Scholar 

  • Westerterp KR. Patterns and intensity of physical activity. Nature 2001;410:539

    Article  CAS  PubMed  Google Scholar 

  • Yanovski SZ, Yanovski JA. Obesity. N Engl J Med 2002;346:591-601

    Article  CAS  PubMed  Google Scholar 

  • Haddock CK, Poston WSC, Dill PL, et al. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes 2002;26:262-73

    Article  CAS  Google Scholar 

  • Padwal R, Li SK, Lau DCW. Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes 2003;27:1437-46

    Article  CAS  Google Scholar 

  • Wadden TA, Berkowitz RI, Sarwer DB, et al. Benefits of lifestyle modification in the pharmacological treatment of obesity. Arch Intern Med 2001;161:218-27

    Article  CAS  PubMed  Google Scholar 

  • Wirth A, Krause J. Long-term weight loss with sibutramine, a randomized controlled trial. JAMA 2001;286:1331-9

    Article  CAS  PubMed  Google Scholar 

  • Mathus-Vliegen EMH, Tytgat GNJ. Intragastric balloons in treatment-resistant obesity: safety, tolerance and efficacy of one-year balloon treatment followed by one-year balloon-free follow-up. (Submitted.) Gastrointestinal Endoscopy

  • Wit L de, Mathus-Vliegen L, Hey C, et al. Open versus laparoscopic adjustable silicone gastric banding. Ann Surg 1999;230:800-7

    Article  PubMed  Google Scholar 

  • Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med 2004;350:2549-57

    Article  CAS  PubMed  Google Scholar 

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    E. M. H. Mathus-Vliegen

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maag-, darm- en leverarts, bijzonder hoogleraar Klinische Voeding, Academisch Medisch Centrum, Universiteit van Amsterdam

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Mathus-Vliegen, E.M.H. Interventiestrategieën bij overgewicht. BIJB 20, 361 (2004). https://doi.org/10.1007/BF03059809

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