Evaluation of a day clinic psychosomatic treatment for eating disorders and obesity
- 20.04.2021
- English Articles
- Britta Nimis
- Helge Fehrs
- Günter Reich
Peer Reviewed / Manuscript (original contribution) received: May 05, 2020 / Revision accepted: September 25, 2020
Introduction
The prevalence and severity of obesity in Germany have continually increased: 47% of women and 62% of men in Germany were overweight or obese in the observation period 2014–2015 [1], which has far-reaching consequences on the health system and economic sector [2]. According to the German government’s 2015 health report, being overweight (BMI ≥ 25) is a risk factor for chronic disease [3]. Obesity (BMI ≥ 30) leads to increased risk for other medical risk factors, such as type 2 diabetes mellitus, arterial hypertension, disorders of fat metabolism and coronary heart disease [4].
Obesity often goes hand in hand with an eating disorder, such as binge eating disorder (BED). This is characterised by attacks of excessive eating and treatment should focus primarily on the abnormal eating habits and the associated emotions, conflicts and disturbed patterns of physical activity [5]. BED is the most common eating disorder, carrying a risk of obesity 3 to 6 times higher than that of persons without BED [6]. The factors responsible for the strong correlation between obesity and BED are as yet unknown. The treatment of obesity should aim towards realistic therapy goals with long-term weight loss and stabilisation [7]. Particularly when there is also an eating disorder it is neither sufficient for treatment to focus solely on weight loss, nor to concentrate exclusively on the psychopathology of the eating disorder, as is clearly shown in the recent review by Agüera et al. [8]. The authors attribute the high dropout rates in the empirically effective BED treatments (cognitive behavioural therapy [CBT] and interpersonal therapy [IPT]) to the fact that weight levels remain high and the associated dissatisfaction.
Abstract
The recommended approach for the treatment of obese patients is a holistic treatment concept including not only nutrition and exercise therapy, but also psychotherapy, particularly if there is also an eating disorder. This study examined the effect of a multimodal day clinic treatment on 91 severely obese patients with disturbed eating patterns in a specific waiting group design 6 weeks before treatment, upon admission, upon discharge and 6 months later.
The average BMI was 46 upon initial contact and this, like the symptoms of the eating disorder ('Fragebogen zum Essverhalten', FEV), reduced significantly more during the treatment period than during the waiting period. In the pre/post comparison there was a significant improvement in all parameters (BMI, FEV, overall mental health, BSI) and these values remained largely stable in the follow-up examinations. The better psychological well-being and control of eating habits the patients displayed, the more benefit the patients derived. The results underline the need for holistic therapies.
Keywords: obesity, day clinic, psychosomatic, eating disorder, overweight, nutrition therapy
