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. 2023 Nov;135(Suppl 6):743-750.
doi: 10.1007/s00508-023-02273-6. Epub 2023 Oct 11.

[Prevention and management of postinterventional weight regain]

[Article in German]
Renate Kruschitz  1 , Markus Fahrnberger  2 , Daniel Moritz Felsenreich  3 , Claudia Ress  4 , Barbara Andersen  5 , Kadriye Aydinkoc-Tuzcu  6 , Christian Ciardi  7 , Simone Leonore Huber  8 , Florian W Kiefer  9
Affiliations

[Prevention and management of postinterventional weight regain]

[Article in German]
Renate Kruschitz et al. Wien Klin Wochenschr. 2023 Nov.

Abstract
in English, German

Decreasing levels of patient motivation or compliance are far from being the only causes of postinterventional weight regain after lifestyle, psychological, pharmacological and surgical interventions. Weight regain originates from a complex and individually varying set of central and peripheral mechanisms, with the overall purpose of increasing food intake by both stimulating hunger and reducing satiety (mediated by gastrointestinal hormones) and decreasing the body's energy demands (via metabolic adaption). These mechanisms counteract any attempts to reduce or maintain body weight in today's increasingly prevalent adipogenic environments. The knowledge about the biological mechanisms of body weight regulation should be taken into consideration when planning treatment programs for long-term weight reduction, including follow-up treatment for the prevention and individualized treatment of postinterventional weight regain. Therapeutic measures as well as the frequency of medical follow-ups should be based on the extent of weight regain.

Die Ursachen der postinterventionellen Gewichtszunahme nach Lebensstiländerung, psychologischer Therapie, Pharmakotherapie oder chirurgischen Maßnahmen gehen weit über einen Motivations- oder Compliance-Verlust der Betroffenen hinaus. Der Gewichtszunahme liegen komplexe periphere und zentrale Mechanismen zugrunde, deren Ausmaß individuell unterschiedlich zu sein scheint und die darauf ausgerichtet sind, die Nahrungszufuhr durch reduziertes Sättigungs- und vermehrtes Hungergefühl zu erhöhen (gastrointestinale Hormone) und den Energieverbrauch zu reduzieren (metabolische Adaptierung). Diese Mechanismen erschweren das Abnehmen und Gewichthalten in einem „adipogenen“ Lebensraum, wie wir in weltweit immer häufiger vorfinden, ungemein. Das Verständnis dieser molekularen Mechanismen sollte in die Planung von Therapieprogrammen zur langfristigen Gewichtsreduktion, welche eine entsprechende Nachsorge zur Prävention und individualisierten Therapie einer postinterventionellen Gewichtszunahme beinhalten sollten, miteinbezogen werden. Dabei empfiehlt es sich, die therapeutischen Maßnahmen und Kontrollintervalle nach dem Ausmaß der Gewichtszunahme pro Zeitintervall auszurichten.

Keywords: Energy expenditure; Hunger and satiety; Lifestyle; Metabolic adaptation; Obesity.

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