Psychotherapie bei Adipositas - Ein systematischer Überlick

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

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