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Medikamentöse Therapie der Adipositas – Konkurrenz zur bariatrischen Chirurgie oder sinnvolle Ergänzung?

Pharmacotherapy of obesity—Competition to bariatric surgery or a meaningful supplement?

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Zusammenfassung

Adipositas ist eine komplexe chronische Erkrankung, die eine langfristige multimodale Therapie erfordert. Der aktuelle Therapiealgorithmus der Adipositastherapie besteht meist aus einem Stufenkonzept beginnend mit einer Lebensstilintervention, gefolgt von oder kombiniert mit einer medikamentösen Behandlung, während die bariatrische Chirurgie häufig am Ende der Therapiekaskade steht. In diesem Übersichtsartikel möchten wir einen Überblick über die aktuell verfügbaren konservativ-medikamentöse Therapieregime geben und die aktuell zugelassenen Medikamente sowie aktuell in Zulassungsstudien befindliche Medikamente bezüglich ihres Wirkungsgrades und ihrer möglichen Nebenwirkungen vorstellen. Besonderer Fokus wird auf die Bedeutung der Kombinationstherapie von Chirurgie und Pharmakotherapie im Sinne einer multimodalen Therapie gelegt. Bisherige Daten zeigen, dass durch einen multimodalen Ansatz ein verbesserter langfristiger Gewichtsverlust und metabolischer Nutzen für die Patienten erreichbar sind.

Abstract

Obesity is a complex chronic disease and requires a long-term multimodal approach. The current treatment algorithm for treatment of obesity mainly consists of a stepwise approach, which starts with a lifestyle intervention followed by or combined with medication treatment, whereas bariatric surgery is often reserved for the last option. This article provides an overview of the currently available conservative medicinal treatment regimens and the currently approved medications as well as medications currently undergoing approval studies with respect to the efficacy and possible side effects. Special attention is paid to the importance of combination treatment of pharmacotherapy and surgery in the sense of a multimodal treatment. The data so far show that using a multimodal approach an improvement in the long-term weight loss and metabolic benefits can be achieved for the patients.

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Authors and Affiliations

  1. Department of Metabolism, Digestion and Reproduction, Imperial College London, London, Großbritannien

    Tina Mazaheri, Saleem Ansari, Madhavi Nallagonda & Alexander Dimitri Miras

  2. Klinik für Allgemein‑, Viszeral‑, Transplantation‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    Lars Kollmann &  Florian Seyfried MD

  3. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland

    Felix Nickel

  4. Head Upper Gastrointestinal and Bariatric Surgery, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery; Center of Operative Medicine (ZOM), University Hospital of Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Deutschland

    Florian Seyfried MD

  5. School of Medicine, Ulster University, Londonderry, Ulster, Großbritannien

    Alexander Dimitri Miras

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T. Mazaheri, S. Ansari, M. Nallagonda, L. Kollmann, F. Nickel, F. Seyfried und A.D. Miras geben an, dass kein Interessenkonflikt besteht.

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Mazaheri, T., Ansari, S., Nallagonda, M. et al. Medikamentöse Therapie der Adipositas – Konkurrenz zur bariatrischen Chirurgie oder sinnvolle Ergänzung?. Chirurgie 94, 497–505 (2023). https://doi.org/10.1007/s00104-023-01830-z

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  • DOI: https://doi.org/10.1007/s00104-023-01830-z

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