Das ZEPmax-Programm – effektive, leitliniengerechte multimodale Therapie von Adipositas und Folgeerkrankungen

 

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Zusammenfassung

Hintergrund Adipositas und die assoziierten Folgeerkrankungen führen nicht nur zu einer erhöhten Morbidität und Mortalität, sondern auch zu einer Reduktion der Lebensqualität. Obwohl ein multimodaler Therapieansatz die leitliniengerechte Therapie der Wahl für die meisten Patienten ist, fehlen in Deutschland flächendeckend geeignete Programme und die Ansprechraten unstrukturierter Interventionen sind unzureichend.

Material und Methodik Das ZEPmax-Programm ist ein konservatives, multimodales, 1-jähriges Therapieprogramm mit initialer Formuladiätphase für Erwachsene mit Adipositas. Die Patienten treffen sich jede Woche für 3,5 Stunden am Zentrum. Die Daten der ersten 136 konsekutiv eingeschlossenen Patienten wurden hier als Intention-to-treat-Analyse ausgewertet. Neben Gewicht und BMI wurden Faktoren des metabolischen Syndroms untersucht.

Ergebnisse Die Teilnehmer hatten einen durchschnittlichen BMI von 43,0 kg/m². 11,8 % brachen das Programm im ersten Jahr ab. 87,5 % erreichten das primäre Therapieziel einer Gewichtsreduktion von > 10 % des Ausgangsgewichts bei einem durchschnittlichen Gewichtsverlust von 24,7 kg (19 % des Ausgangsgewichts). 72 % der Diabetespatienten (n = 18) erreichten eine vollständige Remission, d. h. einen normwertigen HbA1c ohne spezifische Diabetesmedikation. Der systolische Blutdruck der Hypertoniepatienten (n = 53) sank im Mittel um 22 mmHg. Das Gesamtcholesterin der Patienten mit Hyperlipidämie (n = 66) konnte um 23 mg/dl und das LDL-Cholesterin um 17 mg/dl gesenkt werden.

Schlussfolgerung Die vorliegende Arbeit zeigt, dass mit Hilfe des strukturierten, formuladiätbasierten, multimodalen Adipositas-Therapieprogramms ZEPmax ein nachhaltiger Gewichtsverlust mit hohen Ansprechraten erreicht werden kann. Durch erfolgreiche Therapie der Adipositas konnten die assoziierten Folgeerkrankungen Diabetes mellitus Typ 2, arterielle Hypertonie und Hyperlipidämie mit hohen Remissionsquoten behandelt werden. Die vorliegende Arbeit belegt den Stellenwert einer professionell durchgeführten konservativen Adipositastherapie in Deutschland.

Abstract

Background Obesity and related diseases are associated not only with an increased morbidity and mortality, but also with a reduced quality of life. Although a multimodal conservative therapy is recommended by guidelines, suitable programs are not offered nationwide in Germany and the response rates of unstructured interventions are insufficient.

Material and Methods The ZEPmax-Program is a conservative, multimodal, one-year therapy program with an initial formula diet for adults with obesity. The patients meet once a week for 3,5 hours at the center. In all 136 patients were included in this evaluation. Besides weight and BMI also the factors of the metabolic syndrome were assessed in an Intention-to-treat analysis.

Results The participants had an average BMI of 43,0 kg/m². 11,8 % did not complete the one-year program. The patients lost 24,7 kilograms or respectively 19 % of the initial weight and 87,5 % reached the therapeutic goal of 10 % relative weight loss. 72 % of the patients with diabetes (n = 18) achieved a complete remission with normal HbA1c and without medication. The systolic blood pressure of the patients with hypertension (n = 53) dropped by 22 mmHg. The cholesterol in patients with hyperlipidemia (n = 66) could be lowered by 23 mg/dl and the LDL-Cholesterol by 17 mg/dl.

Conclusion This survey shows that a sustained weight loss with high response rates can be achieved with a structured, formuladiet-based multimodal obesity treatment program (ZEPmax). Obesity related diseases like diabetes, hypertension and hyperlipidemia could be treated with high remission rates by an effective treatment of obesity. This evaluation demonstrates the significance of a professionally conducted conservative obesity treatment in Germany.

Publication History

Article published online:
07 December 2020

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