Download PDF
Psychother Psychosom Med Psychol 2007; 57(11): 420-427
DOI: 10.1055/s-2007-986202
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Psychotherapie bei Adipositas - Ein systematischer Überlick

Psychotherapy in Obesity - A Systematic ReviewSandra  Becker1 , Nora  Rapps1 , Stephan  Zipfel1
  • 1Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen
Further Information

Publication History

eingereicht 4. Sept. 2007

akzeptiert 11. Sept. 2007

Publication Date:
19 October 2007 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Adipositas ist eine schwerwiegende und chronische Erkrankung, die zu ausgeprägten gesundheitlichen Folgeerkrankungen sowie einer erhöhten Mortalität führt und deshalb Therapiestrategien langfristiger Natur sein sollten. In diesem Beitrag wird ein Überblick über den Forschungsstand zur Psychotherapie bei Adipositas gegeben. Verhaltenstherapeutische Ansätze finden dabei die größte Beachtung. Zu humanistischen und psychodynamischen Therapien gibt es keine systematischen und gut kontrollierten Untersuchungen. Wenige Studien zu psychotherapieverwandten Verfahren wie Entspannungstraining oder Hypnose konnten keine durchschlagenden Erfolge nachweisen. Verhaltenstherapeutische, auch mit kognitiven Elementen kombinierte Gewichtsreduktionsprogramme und Lifestyleinterventionen führen kurzfristig zu einer Gewichtabnahme von durchschnittlich 10 % des Ausgangsgewichtes. Die langfristigen Erfolge solcher Programme hingegen sind enttäuschend. Die Forschungsergebnisse sprechen überwiegend dafür, dass längerfristig angelegte Nachsorgeprogramme zu einer dauerhaften Verhaltensänderung der Patienten im Alltag beitragen und einer erneuten Gewichtszunahme entgegen treten können. Weitere Untersuchungen zur effektiven Nachsorge sind deshalb notwendig, um die Versorgung von adipösen Patienten zu optimieren. Dabei sollte dem Nutzen neuer Medien, insbesondere dem Einsatz internetgestützter Nachsorgeprogramme, eine größere Bedeutung zukommen.

Abstract

Obesity is a serious chronic disease, associated with severe sequelae and increased mortality rates, and therefore requires long-term care. This article gives an overview of the current state of research on psychotherapeutic treatment of obesity, focusing on behavioral approaches. Systematic well-controlled studies on humanistic and psychodynamic therapies are not available. A small number of studies on psychotherapy-related approaches, e. g. relaxation therapy or hypnotherapy, failed to demonstrate any decisive positive outcomes. While weight loss programs using methods of behavior therapy and lifestyle modification approaches result, on the average, in a short-term weight loss of 10 % of the initial weight, long-term effects of such programs are disappointing. Further evidence suggests, however, that long-term maintenance programs may facilitate lasting behavioral changes of patients in their daily lives and work against weight regain. More research on effective maintenance programs is called for to further improve care of obese patients; it should lay stronger emphasis on internet-based weight maintenance programs.

Key words

obesity - psychotherapy - treatment - randomized-controlled-trial - maintenance

Literatur

  • 1 World Health Organisation .Obesity: preventing and managing the global epidemic. Geneva; World Health Organisation 1998
    Google Scholar
  • 2 Bergmann K E, Mensik G MB. Körpermaße und Übergewicht.  Das Gesundheitswesen. 1999;  61 (2) 115-120
    PubMedGoogle Scholar
  • 3 Wirth A. Adipositas-Fibel. 2. Auflage. Berlin; Springer 2003: 65-91
    Google Scholar
  • 4 Hauner H, Hamann A, Husemann B. et al .Prävention und Therapie der Adipositas - Evidenzbasierte Leitlinie Adipositas der Deutschen Adipositas Gesellschaft, Deutschen Diabetes Gesellschaft und der Deutschen Gesellschaft für Ernährung. Stand 2007
    Google Scholar
  • 5 Shaw K, O'Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity.  The Cochrane Library. 2007;  2
    PubMedGoogle Scholar
  • 6 Wadden T A, Butryn M L. Behavioral treatment of obesity.  Endocrinol Metab Clin North Am. 2003;  32 981-1003
    CrossrefPubMedGoogle Scholar
  • 7 Stevens V, Obarzanek E, Cook N. et al . Long-term weight loss and changes in blood pressure: results of the trial of hypertension prevention, phase II.  Ann Intern Med. 2001;  134 1-11
    CrossrefPubMedGoogle Scholar
  • 8 Stahre L, Hällström T. A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment. A randomized controlled trial.  Eat Weight Disord. 2005;  10 (1) 51-58
    PubMedGoogle Scholar
  • 9 Stahre L, Tärnell B, Hakanson C E, Hällström T. A randomized controlled trial of two weight-reducing short-term group treatment programs for obesity with an 18-month follow-up.  Int J Behav Med. 2007;  14 (1) 48-55
    PubMedGoogle Scholar
  • 10 Foreyt J, Hagen R. Covert sensitization: conditioning or suggestion?.  J Abnorm Psychol. 1973;  82 (1) 17-23
    CrossrefPubMedGoogle Scholar
  • 11 Goodrick G, Poston W, Kimball K. et al . Nondieting versus dieting treatment for overweight binge-eating woman.  J Consult Clin Psychol. 1998;  66 (2) 363-368
    PubMedGoogle Scholar
  • 12 Hagen R. Group therapy versus bibliotherapy in weight reduction.  Behav Ther. 1974;  5 222-234
    CrossrefPubMedGoogle Scholar
  • 13 Israel A, Saccone A. Follow-up of effects of choice of mediator and target of reinforcement on weight loss.  Behav Ther. 1979;  10 260-265
    CrossrefPubMedGoogle Scholar
  • 14 Jeffery R, Gerber W, Rosenthal B, Lindquist R. Monetary contracts in weight control: Effectiveness of group and individual contracts of varying size.  J Consult Clin Psychol. 1983;  51 (2) 242-248
    PubMedGoogle Scholar
  • 15 Oldroyd J, Unwin N, White M. et al . Randomised controlled trial evaluating the effectiveness of behavioral interventions to modify cardiovascular risk factors in men and women with impaired glucose tolerance: outcomes at 6 months.  Diabetes Res Clin Pract. 2001;  52 29-43
    CrossrefPubMedGoogle Scholar
  • 16 Rozensky R, Bellack A. Individual differences in self-reinforcement style and performance in self- and therapist-controlled weight reduction programs.  Behav Res Ther. 1976;  14 357-364
    CrossrefPubMedGoogle Scholar
  • 17 Saccone A, Israel A. Effects of experimenter versus significant other-controlled reinforcement and choice of target behavior on weight loss.  Behav Ther. 1978;  9 271-278
    CrossrefPubMedGoogle Scholar
  • 18 Wollersheim J. Effectiveness of group therapy based upon learning principles in the treatment of overweight woman.  J Abnorm Psychol. 1970;  76 (3) 462-474
    CrossrefPubMedGoogle Scholar
  • 19 Black D, Coe W, Friesen J, Wurzmann A. Minimal interventions for weight control: a cost-effective alternative.  Addict Behav. 1984;  9 279-285
    CrossrefPubMedGoogle Scholar
  • 20 Calle-Pascual A, Rodriguez C, Camacho F. et al . Behaviour modification in obese subjects with type 2 diabetes mellitus.  Diabetes Res Clin Pract. 1992;  15 157-162
    CrossrefPubMedGoogle Scholar
  • 21 Gormally J, Rardin D. Weight loss and maintenance and changes in diet and exercise for behavioral counseling and nutrition education.  J Couns Psychol. 1981;  28 (4) 295-304
    CrossrefPubMedGoogle Scholar
  • 22 Jeffery R, Forster J, Snell M. Promoting weight control at the worksite: A pilot program of self-motivation using payroll-based incentives.  Prev Med. 1985;  14 187-194
    CrossrefPubMedGoogle Scholar
  • 23 Lindahl B, Nilsson T, Jansson J. et al . Improved fibrinolysis by intense lifestyle intervention. A randomized trial in subjects with impaired glucose tolerance.  J Intern Med. 1999;  246 105-112
    CrossrefPubMedGoogle Scholar
  • 24 Stuart R. A three-dimensional program for the treatment of obesity.  Behav Res Ther. 1971;  9 177-186
    CrossrefPubMedGoogle Scholar
  • 25 Wing R, Epstein L, Marcus M, Koeske R. Intermittent low-calorie regimen and booster sessions in the treatment of obesity.  Behav Res Ther. 1984;  22 (4) 445-449
    CrossrefPubMedGoogle Scholar
  • 26 Wing R, Epstein L, Nowalk M. et al . Behavior change, weight loss, and physiological improvements in type II diabetic patients.  J Consult Clin Psychol. 1985;  53 (1) 111-122
    PubMedGoogle Scholar
  • 27 Block J. Effects of rational emotive therapy an overweights adults.  Psychotherapy: Theory Research and Practice. 1980;  17 (3) 277-280
    PubMedGoogle Scholar
  • 28 Dennis K, Pane K, Adams B, Bing Bing Q. The impact of a shipboard weight control program.  Obes Res. 1999;  7 (1) 60-67
    PubMedGoogle Scholar
  • 29 Agras W, Telch C, Arnow B. et al . Does interpersonal therapy help patients with binge eating disorder who fail to respond to cognitive-behavioral therapy?.  J Consult Clin Psychol. 1995;  63 (3) 356-360
    PubMedGoogle Scholar
  • 30 Sbrocco T, Nedegaard R, Stone J, Lewis E. Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioral decision-based treatment for obesity.  J Consult Clin Psychol. 1999;  67 260-266
    PubMedGoogle Scholar
  • 31 Nauta H, Hospers H, Kok G, Jansen A. A comparison between a cognitive and a behavioral treatment for obese binge eaters and obese non-binge eaters.  Behav Ther. 2000;  31 441-461
    CrossrefPubMedGoogle Scholar
  • 32 Fabricatore A N. Behavior therapy and cognitive-behavioral therapy of obesity: Is there a difference?.  J Am Diet Assoc. 2007;  107 92-99
    CrossrefPubMedGoogle Scholar
  • 33 Black D, Scherba D. Contracting to problem solve versus contracting to practice behavioral weight loss skills.  Behav Ther. 1983;  14 100-109
    CrossrefPubMedGoogle Scholar
  • 34 Brownell K, Heckerman C, Westlake R, Hayes S, Monti P. The effect of couples training and partner co-operativness in the behavioral treatment of obesity.  Behav Res Ther. 1978;  16 323-333
    CrossrefPubMedGoogle Scholar
  • 35 Burnett K, Barr Taylor C, Agras W. Ambulatory computer-assisted therapy for obesity: a new frontier for behavior therapy.  J Consult Clin Psychol. 1985;  53 (5) 698-703
    PubMedGoogle Scholar
  • 36 Carroll L, Yates B. Further evidence for the role of stimulus control training in facilitating weight reduction after behavioral therapy.  Behav Ther. 1981;  12 287-291
    CrossrefPubMedGoogle Scholar
  • 37 Castro L, de Perez G, Albanchez D, de Leon E. Feedback properties of „self-reinforcement”: further evidence.  Behav Ther. 1983;  14 672-681
    CrossrefPubMedGoogle Scholar
  • 38 Chapman S, Jefferey D. Situational management, standard setting, and self-reward in a behavior modification weight loss program.  J Consult Clin Psychol. 1978;  46 (6) 1588-1589
    PubMedGoogle Scholar
  • 39 Jeffery R, Wing R. Long-term effects of interventions for weight loss using food provision and monetary incentives.  J Consult Clin Psychol. 1995;  63 (5) 793-796
    PubMedGoogle Scholar
  • 40 Johnson W, Stalonas P, Christ M, Pock S. The development and evaluation of a behavioral weight-reduction program.  Int J Obes. 1979;  3 229-238
    PubMedGoogle Scholar
  • 41 Kirschenbaum D, Stalonas P, Zastowny T, Tomarken A. Behavioral treatment of adult obesity: Attentional controls and a 2-year follow-up.  Behav Res Ther. 1985;  23 (6) 675-682
    CrossrefPubMedGoogle Scholar
  • 42 Wing R, Marcus M, Epstein L, Jawad A. A „family-based” approach to the treatment of obese type II diabetic patients.  J Couns Clin Psychol. 1991;  59 (1) 156-162
    PubMedGoogle Scholar
  • 43 Wing R, Jeffery R, Burton L. et al . Food provision vs structured meal plans in the behavioral treatment of obesity.  Int J Obes. 1996;  20 56-62
    PubMedGoogle Scholar
  • 44 Baron R. Psychology. 4. Boston; Allyn and Bacon 1998
    Google Scholar
  • 45 Allison D B, Faith M S. Hypnosis as an adjunct to cognitive-behavioral psychotherapy for obesity: a meta-analytical reappraisal.  J Consult Clin Psychol. 1996;  64 513-516
    PubMedGoogle Scholar
  • 46 Kirsch I, Montgomery G, Sapirstein G. Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis.  J Consult Clin Psychol. 1995;  63 214-220
    CrossrefPubMedGoogle Scholar
  • 47 McLean N, Griffin S, Toney K, Hardeman W. Family involvement in weight control, weight maintenance and weight-loss interventions: a systemic review of randomised trials.  Int J Obes. 2003;  27 987-1005
    PubMedGoogle Scholar
  • 48 Pearce J W, Le Bow M D, Orchard J. Role of spouse involvement in the behavioral treatment of overweight woman.  J Consult Clin Psychol. 1981;  49 236-244
    PubMedGoogle Scholar
  • 49 Murphy J K. The long-term effects of spouse involvement upon weight loss and maintenance.  Behav Ther. 1982;  13 681-693
    CrossrefPubMedGoogle Scholar
  • 50 Brownell K D, Stunkard A J. Couples training, pharmacotherapy, and behavior therapy in treatment of obesity.  Arch Gen Psychiatry. 1981;  38 1224-1229
    PubMedGoogle Scholar
  • 51 Rosenthal B, Allen G J, Winter C. Husband involvement in the behavioral treatment of overweight woman: initial effects and long-term follow-up.  Int J Obes Relat Metab Disord. 1980;  4 165-173
    PubMedGoogle Scholar
  • 52 Black D R, Lantz C E. Spouse involvement and a possible long-term follow-up trap in weight loss.  Behav Res Ther. 1984;  22 557-562
    CrossrefPubMedGoogle Scholar
  • 53 Dubbert P M, Wilson G T. Goal-setting and spouse involvement in the treatment of obesity.  Behav Res Ther. 1984;  22 227-242
    CrossrefPubMedGoogle Scholar
  • 54 Wing R R, Marcus M D, Epstein L H, Jawad A. A „family-based” approach to the treatment of obese Type II diabetic patients.  J Consult Clin Psychol. 1991;  59 156-162
    PubMedGoogle Scholar
  • 55 Wadden T A, Butryn M L, Byrne K J. Efficacy of lifestyle modification for long-term weight control.  Obes Res. 2004;  12 151-162
    PubMedGoogle Scholar
  • 56 Marston A R, Marston M R, Ross J. A correspondence course behavioral program for weight reduction.  Obes Bariatric Med. 1977;  6 140-147
    PubMedGoogle Scholar
  • 57 Wing R R, Venditti E M, Jakicic J M. et al . Lifestyle intervention in overweight individuals with a family history of diabetes.  Diabetes Care. 1998;  21 350-359
    CrossrefPubMedGoogle Scholar
  • 58 Perri M G. The maintenance of treatment effects in the long-term management of obesity.  Clin Psychol. 1998;  5 526-543
    PubMedGoogle Scholar
  • 59 Wadden T A, Foster G D. Behavioral treatment of obesity.  Med Clin North Am. 2000;  84 441-462
    CrossrefPubMedGoogle Scholar
  • 60 Kramer F M, Jeffery R W, Forster J L, Snell M K. Long-term follow-up of behavioral treatment for obesity: Patterns of weight regain in men and woman.  Int J Obes Relat Metab Disord. 1989;  13 123-136
    PubMedGoogle Scholar
  • 61 Douketis J D, Macie C, Thabane L, Williamson D F. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice.  Int J Obes. 2005;  29 1153-1167
    CrossrefPubMedGoogle Scholar
  • 62 Perri M G, Corsica J A. Improving the maintenance of weight lost in behavioral treatment of obesity. In: Wadden TA, Stunkard AJ (eds) Handbook of Obesity Treatment. New York; Guilford Press 2002: 357-379
    Google Scholar
  • 63 Phelan S, Wadden T A. Combining behavioral and pharmacological treatment for obesity.  Obes Res. 2002;  10 560-574
    PubMedGoogle Scholar
  • 64 Torp-Pedersen C. and the SCOUT Investigators . Cardiovascular responses to weight management and sibutramine in high-risk subjects: an analysis from the SCOUT trial.  Eur Heart J. 2007;  26 1-9
    PubMedGoogle Scholar
  • 65 Tate D F, Wing R R, Winett R A. Using Internet technology to deliver a behavioral weight loss program.  JAMA. 2001;  285 1172-1177
    CrossrefPubMedGoogle Scholar
  • 66 Harvey-Berino J, Pintauro S, Buzzell P. et al . Does using the Internet facilitate the maintenance of weight loss?.  Int J Obes. 2002;  26 1254-1260
    CrossrefPubMedGoogle Scholar
  • 67 Harvey-Berino J, Pintauro S, Buzzell P. Gold EC. Effect of Internet support on the long-term maintenance of weight loss.  Obes Res. 2004;  12 320-329
    PubMedGoogle Scholar
  • 68 Wing R R, Tate D F, Goring A A. et al . A self-regulation program for maintenance of weight loss.  N Engl J Med. 2006;  355 1563-1571
    CrossrefPubMedGoogle Scholar
  • 69 Micco N, Gold B, Buzzell P. et al . Minimal in-person as an adjunct to Internet obesity treatment.  Ann Behav Med. 2007;  33 (1) 49-56
    CrossrefPubMedGoogle Scholar
  • 70 Tate D F, Jackvony E H, Wing R R. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes.  JAMA. 2003;  289 1833-1836
    CrossrefPubMedGoogle Scholar
  • 71 Thabane L, Chu R, Cuddy K, Douketis J. What is the quality of reporting in weight loss intervention studies? A systematic review of randomized controlled trials.  Int J Obes. 2007, advanced online publication;  1-6
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Stephan Zipfel

Universitätsklinikum Tübingen, Medizinische Klinik VI, Psychosomatische Medizin und Psychotherapie

Osianderstraße 5

72070 Tübingen

Email: stephan.zipfel@med.uni-tuebingen.de