Welke interventies zijn effectief? · Welke interventies zijn effectief? •Bevolking Bevolking...
Transcript of Welke interventies zijn effectief? · Welke interventies zijn effectief? •Bevolking Bevolking...
Gewichtsreductie
Welke interventies zijn effectief?
Victor Gerdes
Internist
Disclosure belangen
Voor bijeenkomst mogelijk Bedrijfsnamen
relevante relaties
• Sponsoring of onderzoeksgeld AstraZeneca (investigator initiated study)
• Honorarium of andere (financiële) Sprekervergoedingen: Sanofi, Bayer, Lilly
vergoeding
• Aandeelhouder nvt
• Andere relatie, namelijk team bariatrische chirurgie
Spaarne Gasthuis
Welke interventies zijn effectief?
• Bevolking Bevolking
• Eerste lijn BMI > 25
• Gespecialiseerde centra BMI > 35
Myths, presumptions and facts about obesity
Provision of meals and use of meal-replacement products promote greater weight loss
A bout of sexual activity burns 100 to 300 kcal for each person involved
The built environment, in terms of sidewalk and park availability, influences obesity
N Engl J Med 2013;368:446-54.
Myths, presumptions and facts about obesity
Provision of meals and use of meal-replacement products promote greater weight loss
A bout of sexual activity burns 100 to 300 kcal for each person involved
The built environment, in terms of sidewalk and park availability, influences obesity
N Engl J Med 2013;368:446-54.
Myths, presumptions and facts about obesity
Regularly eating (vs. skipping) breakfast is protective against obesity
Regardless of body weight or weight loss, an increased level of exercise increases health
Setting realistic goals in obesity treatment is important because otherwise patients will become frustrated and lose less weight
N Engl J Med 2013;368:446-54.
Myths, presumptions and facts about obesity
Regularly eating (vs. skipping) breakfast is protective against obesity
Regardless of body weight or weight loss, an increased level of exercise increases health
Setting realistic goals in obesity treatment is important because otherwise patients will become frustrated and lose less weight
N Engl J Med 2013;368:446-54.
Bevolking
• Scholing
• Belasting
• Aanleg van gebouwen en steden
• Werkgevers
• Producenten
• Winkels
Dieet
• Restrictie energie inname
• Samenstelling• Vet• Koolhydraat• Eiwit
• Verdeling over de dag
• Afgepaste hoeveelheid / voorverpakt
Med Clin North Am . 2018 January ; 102(1): 107–124
Med Clin North Am . 2018 January ; 102(1): 107–124
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
N Engl J Med 2009;360:859-73.
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
Physical activity vs basal metabolic rate
Lichaamsbeweging
RCT 12 maanden beweegprogramma: gemiddeld – intensief
• Interventiegroep 298 min/wk vs controlegroep 68 min/wk
• Gewichtsverlies 2,1 kg (vrouwen) en 1.7 kg (mannen)
Systematic review over aerobic exercise
• 14 trials, 1847 pt
• -1.7 (-2.29 to -1.11) kg Taille omtrek -1.95 (-3.62 to -0.29) cm
Lichaamsbeweging
• Afvallen: in principe risico voor spierkracht en skelet• Gezondheid en aantal uren zitten er dag / habitual exercise
• Ook bij gelijk gewicht voldoende bewegen gunstig• Vetpercentage > metabole effecten• Behoud spiermassa
Welk advies te geven?• Bij ernstig overgewicht oppassen voor blessure
• Lopen• Zwemmen• Fietsen
Gedragstherapie obesitas
• Aannames• Aangeleerde patronen maladaptief• Gedrag kan veranderen
Met verschillende methoden
• Aanpassen en monitoren intake
• Aanpassen en monitoren beweging
• Controleren omgeving en stimuli
• Groep of individueel
• Welk programma: voorkeur patiënt van belang
• Internet, telefoon
JAMA.2018;320(11):1172-1191
JAMA.2018;320(11):1172-1191
−2.39kg [95%CI,−2.86 to −1.93]
67 studies
n=22065
Behavioral and Psychological Strategies of Long-Term Weight Loss Maintainers in a Widely Available Weight Management Program
Obesity (2020) 28, 421-428
Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients
• N=743
• Orlistat 120 mg 3dd
• Hypocaloric (-600)
• Weight loss 10.2% vs 6.1% at 1 yr
Mean percentage change in bodyweight from start of single-blind lead-in until 2-year examination in orlistatand placebo groups
THE LANCET • Vol 352 • July 18, 1998
Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity
• N=224
• Interventions• Sibutramine 15 mg alone
• 30 group sessions
• 30 group sessions icmsibutramine
• Brief therapy icm sibutramine
• 1200-1500 kcal
• 1 year follow-up
N Engl J Med 2005;353:2111-20
Phentermin / topiramate
Am J Clin Nutr 2012;95:297–308.
A Randomized, Controlled Trial of 3.0 mg of Liraglutidein Weight Management
N Engl J Med 2015;373:11-22
Weight Loss at 1 Year with High-Intensity Lifestyle Interventions or Pharmacotherapy Combined with
Low-to-Moderate-Intensity Lifestyle Counseling.
N Engl J Med 2017;376:254-66.
A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice
• Primary care
• N=390
• Follow-up 2 yrs
• Intervention• Quarterly visit• Quarterly visit + lifestyle coach every
month• Quarterly visit + lifestyle coach +
meal replacement / medication
N Engl J Med 2011; 365: 1969–1979
A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice
Figure 3. Categorical Weight Loss at 12 and 24 Months. Panel A shows the percentage of participants in each group in the intention-to-treat population who were at or below their baseline weight at months 12 and 24. (Participants for whom data on weight were missing were assumed to have a weight above the baseline weight.) Panel B shows the percentage of participants who lost 5% ormore of their baseline weight, and Panel C shows the percentage of participants who lost 10% or more of their baseline weight. (The percentage of participants who lost 5% or more of their baseline weight includes the percentage who lost 10% or more.
Nieuwe middelen
• Semaglutide
• Thermogenese
• Eetlust / verzadiging
• Micro RNA mimetica
• Microbiota / metabolieten
Combinatietherapie?
Bariatrische chirurgie
BMI > 35 icm comorbiditeit of
BMI > 40
Verschillende ingrepen
Grote spreiding effect op korte en lange termijn
N Engl J Med 2017;377:1143-55.
Endoscopic and minimally invasive technologies
Obesity Surgery (2020) 30:736–752
Endoscopic and minimally invasive technologies
Obesity Surgery (2020) 30:736–752
Pacemaker
Endoluminaal restrictief
Endoluminale bypass of sleeve
Magnetische anastomose
Endoscopische aspiratie
Welke interventies zijn effectief?
• Preventie
• Gecombineerde aanpak
• Focus op lange termijn
• Medicatie
• Bariatrische chirurgie
Toekomst?
Verbeteren bestaande mogelijkheden
Voorspellen respons
Nieuwe medicatie
Gastroscopisch en / of minimaal invasief