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Essstörungen bei Adipositas und Diabetes mellitus

Eating disorders associated with obesity and diabetes

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Zusammenfassung

Die häufigste Essstörung bei Adipositas ist die Binge-Eating-Störung (BES). Die Kernsymptomatik dieser Essstörung stellen subjektiv unkontrollierbare Essanfälle dar. Ähnlich wie bei anderen Essstörungen sind häufiger Frauen betroffen; der Anteil an Männern ist jedoch erstaunlich hoch. Mit dem Krankheitsverlauf gehen eine erhöhte Komorbidität mit anderen psychischen Störungen sowie ein kontinuierlicher Gewichtsanstieg einher.

Adoleszente und junge Frauen mit Diabetes mellitus Typ 1 zeigen eine überzufällige Koinzidenz mit der Bulimia nervosa. Die bewusste Reduktion der Insulindosis zwecks Gewichtsreduktion mittels Glukosurie stellt eine charakteristische gegenregulatorische Maßnahme dar. Die Komorbidität von Typ-1-Diabetes-mellitus und einer Essstörung stellt einen Risikofaktor für die Entwicklung späterer diabetischer Folgeerkrankungen dar. So zeichnen sich essgestörte Patientinnen mit Typ-1-Diabetes-mellitus durch eine unzureichende Stoffwechselkontrolle und die frühzeitigere Entwicklung von diabetischen Spätschäden aus. Auch wenn die BES bei Menschen mit Typ-2-Diabetes-mellitus im Vergleich zu stoffwechselgesunden Menschen nicht häufiger aufzutreten scheint, stellt sie doch einen Risikofaktor für eine beschleunigte Gewichtszunahme dar, welche in der Regel mit einer Zunahme der Insulinresistenz einhergeht. Insbesondere bei jungen Patientinnen mit Diabetes mellitus erscheint ein diagnostisches Screeningverfahren notwendig. Patientinnen mit Diabetes mellitus und einer Essstörung sollte eine Psychotherapie angeboten werden.

Summary

Binge eating disorder is one of the most frequent comorbid mental disorders associated with overweight and obesity. Binge eating disorder patients often suffer from other mental disorders and longitudinal studies indicate a continuous weight gain during the long-term course. As in other eating disorders gender is a risk factor, but the proportion of male binge eating disorder patients is surprisingly high.

In young women with type 1 diabetes the prevalence of subclinical types of bulimia nervosa is increased. In addition, insulin purging as a characteristic compensatory behavior in young diabetic women poses a considerable problem. In patients with type 1 diabetes, disturbed eating and eating disorders are characterized by insufficient metabolic control and early development of late diabetic sequelae. Patients with type 2 diabetes are often overweight or obese. Binge eating disorder does not occur more frequently in patients with type 2 diabetes compared to healthy persons. However, the comorbidity of binge eating disorder and diabetes type 2 is associated with weight gain and insulin resistance. Especially in young diabetic patients a screening procedure for disturbed eating or eating disorders seems to be necessary. Comorbid patients should be offered psychotherapy.

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Notes

  1. Personenbezeichnung: An der Anorexia nervosa und der Bulimia nervosa erkranken vorwiegend Frauen. Die Autoren entschieden sich von daher für die durchgehende Verwendung der weiblichen Personenbezeichnung, obwohl bei der BES auch eine große Zahl von Männern betroffen ist.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Seminartätigkeit für Lundbeck, Lilly, Sanofi-Aventis.

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Authors and Affiliations

  1. Institute of Psychology, Clinical Child and Adolescent Psychology, University of Lausanne, Lausanne, Schweiz

    S. Munsch

  2. Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum der Ruhr-Universität Bochum, Alexandrinenstr. 1-3, 44791, Bochum, Deutschland

    S. Herpertz

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Munsch, S., Herpertz, S. Essstörungen bei Adipositas und Diabetes mellitus. Nervenarzt 82, 1125–1132 (2011). https://doi.org/10.1007/s00115-010-3227-x

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