Zusammenfassung
Die Adipositas stellt ein zunehmendes Problem in unserem Gesundheitssystem dar. Zur Therapie kommt in erster Linie eine Lebensstiländerung in Form von Umstellung der Ernährung, vermehrter körperlicher Bewegung und Verhaltensmodifikation in Frage. Die meisten Patienten sind allerdings nicht in der Lage, langfristig einem solchen Therapieregime zu folgen. Nimmt das Gewicht weniger als 5% in 3–6 Monaten ab, ist eine pharmakologische Behandlung zu überlegen.
Orlistat, ein gastrointestinaler Lipasehemmer, erhöht die Fettexkretion und vermindert so die Energieaufnahme. In Studien bis zu 4 Jahren Dauer wurde eine Nettogewichtsabnahme von 3–5 kg nachgewiesen, auch kardiovaskuläre Risikofaktoren bessern sich. Sibutramin, ein Serotonin- und Noradrenalinwiederaufnahmehemmer, verstärkt die Sättigung und erhöht den Energieverbrauch. Innerhalb eines Jahres wird eine Nettogewichtsabnahme von 4–6 kg erreicht. Für beide Pharmaka liegen bis jetzt keine Endpunktstudien vor.
Die Antiadiposita Orlistat und Sibutramin sind eine sinnvolle Therapieergänzung zu einer Lebensstiländerung bei der Behandlung von Adipösen. In der Hand eines fachkundigen Arztes bewirkt eine Kombinationstherapie aus nichtmedikamentösen und medikamentösen Maßnahmen eine deutliche Gewichtsreduktion bei mehr als der Hälfte der Patienten und verbessert die Morbidität und Lebensqualität.
Abstract
Obesity and its associated diseases are an increasing challenge in medicine. A change in lifestyle is usually the first step with modifications in nutrition, physical activity and behavior. However, most of obese patients are not able to follow such a treatment regimen for a longer period of time. If they do not lose >5% of initial weight within 3–6 months, pharmacological intervention should be taken into account.
Orlistat, a gastro-intestinal lipase inhibitor, enhances fat excretion thereby reducing energy uptake and body fat. Studies up to 4 years document a net weight loss of 3–5 kg, all cardiovascular risk factors are reduced. Sibutramine, a serotonin- and noradrenalin reuptake inhibitor, promotes satiety and stimulates energy expenditure. Within one year a net weight reduction of 4–6 kg is achieved and morbidity as well as quality of life are improved. For both drugs no endpoint outcomes are available so far.
The anti-obesity drugs orlistat and sibutramine are useful tools for overweight and obese patients as an adjunct to lifestyle changes. Under the supervision of experienced physicians the combined treatment consisting of non-pharmacological and pharmacological methods reduces body weight in more than half of the patients and improves morbidity and quality of life.
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Wirth, A. Gewichtsreduktion mittels Pharmakotherapie. Internist 44, 359–366 (2003). https://doi.org/10.1007/s00108-003-0864-1
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DOI: https://doi.org/10.1007/s00108-003-0864-1