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Adipositas und psychische Komorbidität: therapeutische Implikationen

Obesity and mental comorbidity: therapeutic implications

  • Schwerpunkt: Adipositas – Übersichten
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Zusammenfassung

Die Adipositas geht im Erwachsenenalter oft mit psychischer Komorbidität einher, die den Gewichtsreduktionserfolg beeinflussen und eine Behandlung indizieren kann, die von Standardprogrammen der multimodalen Adipositasverhaltenstherapie (AVT) nicht abgedeckt wird. Dieser Artikel diskutiert am Beispiel der häufig komorbiden Binge-Eating-Störung (BES) aktuelle Forschungsergebnisse zu Ätiologie und Intervention bei Komorbidität mit dem Ziel, Implikationen für die weitere Forschung und Behandlung abzuleiten. Die Kognitive Verhaltenstherapie (KVT), die am besten belegte Therapieform für Erwachsene mit BES, war der AVT bei der Reduktion der Essstörungssymptomatik überlegen und bei der Gewichtsreduktion nur tendenziell und ausschließlich kurzfristig unterlegen. Daher sollte sich die weitere Interventionsentwicklung auf graduelle Anpassungen der KVT zur Verbesserung der Gewichtsreduktion bei Patienten mit Adipositas und BES konzentrieren. Hierfür kommen mit dem Ziel einer geringfügigen Gewichtsreduktion einzelne adaptierte AVT-Interventionen in Betracht, während sich gleichzeitige oder sequenzielle Kombinationen dieser beiden Therapieformen nicht eindeutig bewährt haben. Interventionen, die auf aktuellen Forschungsergebnissen für die Komorbidität beider Störungsbilder fußen, könnten individualisiert einbezogen werden, um die Wirksamkeit für Essstörungssymptomatik und Körpergewicht zu erhöhen. Neue digitale Behandlungsmodalitäten könnten den Transfer in den Lebensalltag und die Nachhaltigkeit der Effekte fördern. Diese Modifikationen hin zu einer adaptiven KVT für Erwachsene mit Adipositas und BES, basierend auf einem patientengerechten Therapierational, bedürfen der Absicherung durch weitere experimentelle Therapieforschung.

Abstract

Obesity is often associated with mental comorbidity in adults, likely impacting on weight loss success and can indicate treatment that is not covered by the standard program of multimodal behavioral weight loss (BWL) treatment. Using the example of binge-eating disorder (BED) as a frequent comorbid condition, this article discusses current research on the etiology and interventions in cases of comorbidity in order to derive implications for research and treatment. Cognitive-behavioral therapy (CBT), the best established form of treatment for adults with BED, was more efficacious than BWL treatment in improving binge-eating symptomatology, while tending to show lower weight loss effects and only in the short term. Therefore, further development of interventions should focus on gradual adaptations of CBT for improving weight loss in patients with obesity and BED. These interventions could be adapted from BWL treatment and aim at a slight weight loss. Parallel or sequential combinations of these treatments have not consistently demonstrated improved treatment effects. Interventions based on the results of current research on the comorbidity of both disorders could be included on an individual basis in order to enhance the efficacy for eating disorder symptomatology and body weight. New digital treatment modalities could support the transfer into daily life and boost the long-term sustainability of therapeutic gains. These modifications regarding adaptive CBT for adults with obesity and BED should be based on an individual treatment rationale and require confirmation by further experimental treatment research.

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  1. Integriertes Forschungs- und Behandlungszentrum AdipositasErkrankungen, Forschungsbereich Verhaltensmedizin, Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland

    Anja Hilbert

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A. Hilbert gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hilbert, A. Adipositas und psychische Komorbidität: therapeutische Implikationen. Psychotherapeut 66, 10–15 (2021). https://doi.org/10.1007/s00278-020-00480-4

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