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Consensus BASO 2020 Een Praktische Gids Voor De Evaluatie En Behandeling Van Overgewicht En Obesitas

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Consensus BASO 2020 Een Praktische Gids Voor De Evaluatie En Behandeling Van Overgewicht En Obesitas Consensus BASO 2020 Een praktische gids voor de evaluatie en behandeling van overgewicht en obesitas Belgian Association for the Study of Obesity 1 BASO - Redactiecomité Prof. Dr. Bart Van der Schueren (endocrinoloog, KUL) Prof. Dr. Jean-Paul Thissen (endocrinoloog, UCL) Marie Barea (diëtist, ULB) Prof. Dr. Matthias Lannoo (chirurgien, KUL) Prof. Dr. Inge Gies (pediatrische endocrinoloog, VUB) Prof. Dr. Roland Devlieger (gynaecoloog, KUL) Prof. Dr. Veronique Beauloye (pediatrische endocrinoloog, UCL) Barbara Lembo (psycholoog, Clairs Vallons, Ottignies-Louvain-la-Neuve) Dr. Eveline Dirinck (endocrinoloog, UZA, UAntwerpen) An Verrijken (diëtist, UZA, UAntwerpen) Prof. Dr. Dirk Vissers (kinesitherapeut, UAntwerpen). Professionele Medische schrijfondersteuning werd geboden door Sara Rubio, PhD (Modis Life Sciences). SA Novo Nordisk NV nam alle kosten voor zijn rekening die verband houden met de update van deze consensus. We danken ook alle eXperts die hun bijdrage hebben geleverd tijdens het bijwerken van deze consensus. 2 Inhoudstafel 0. Afkortingenlijst .................................................................................................................. 4 1. Hoofdstuk: “Inleiding” ....................................................................................................... 8 2. Hoofdstuk “Voedingsinterventies” .................................................................................. 33 3. Hoofdstuk: “Psychologische zorg bij de behandeling van obesitas” ............................... 46 4. Hoofdstuk: “Interventies op het gebied van fysieke activiteit” ...................................... 73 5. Hoofdstuk: “FarMacotherapeutische interventies” ........................................................ 82 6. Hoofdstuk: “Chirurgische ingrepen” ............................................................................. 101 7. Hoofdstuk: “Obesitas en zwangerschap” ...................................................................... 116 8. Hoofdstuk: “Obesitas bij kinderen” ............................................................................... 129 9. Hoofdstuk: “Genetische vorMen van obesitas” ............................................................ 186 10. Hoofdstuk: “Preventie van obesitas” ........................................................................ 210 11. Referenties ................................................................................................................ 216 3 0. Afkortingenlijst 5HT2CR serotonine-2C-receptor α-MSH α-melanocyte stimulating hormone β-MSH β-melanocyte stimulating hormone AAP American Academy of Pediatrics ACT acceptance and comMitment therapy ACTH adrenocorticotropic hormone ADHD aandachtstekort-hyperactiviteitsstoornis AGB adjustable gastric banding (verstelbare Maagband) AGRP agouti-gerelateerde peptide ALT alanine-aminotransferase AST aspartaat-aminotransferase AUDIT Alcohol Use Disorders Identification Test BASO Belgian Association for the Study of Obesity BDNF brain-derived neurotrophic factor BED binge eating disorder BMI body Mass indeX BPD-DS bilio-pancreatische bypass Met duodenale ‘switch’ CB1 cannabinoïde-1 CDC Centers for Disease Control and Prevention CGT cognitieve gedragstherapie CHMP ComMittee for Medicinal Products for Human Use CZS centraal zenuwstelsel DASH dietary approaches to stop hypertension DPP-4 dipeptidylpeptidase-4 DSM Diagnostic and Statistical Manual of Mental Disorders 4 EASO European Association for the Study of Obesity ECOG European Childhood Obesity Group EDE-Q Eating Disorders Examination - Questionnaire ForM EMA Europees geneesMiddelenbureau EOSS Edmonton Obesity Score Staging FDA Food and Drug Administration FISH fluorescence in situ hybridization GABA gamMa-aminoboterzuur GHR ghreline receptor GIP glucoseafhankelijk insulinotroop polypeptide GLP-1 glucagonachtig peptide-1 GNAS GNAS coMplex locus GORZ gastro-oesofageale refluxziekte HADS Hospital AnXiety and Depression Scale HDL ‘high-density’ lipoproteïne HIIT high-intensity interval training ICD International Classification of Diseases IDF International Diabetes Federation IE international eenheden IGF insulin growth factor INR internationale genorMaliseerde ratio IOM Institute of Medicine IOTF International Obesity Taskforce KCE Federaal kenniscentrum voor de gezondheidszorg KSR2 kinase suppressor of Ras 2 LDL “low-density” lipoproteïne LEP leptine LEPR leptinereceptor 5 MC4R melanocortine-4 receptor MGO metabool gezond obees MNGO metabool niet-gezonde obese MSH melanocytenstimulerend hormoon NAFLD niet-alcoholische leververvetting (non-alcoholic fatty liver disease) NEO-FFI NEO Five Factor Inventory NPY neuropeptide Y NVE Nederlandse Vragenlijst voor Eetgedrag OGTT orale glucosetolerantietest OSAS obstructief slaapapneusyndroom PCSK1 proprotein convertase subtilisin/kexin type 1 PC1 proconvertase 1 PC2 proconvertase 2 PCOS polycysteus-ovariumsyndroom PHP pseudohypoparathyroidism POMC pro-opiomelanocortine PWS Prader-Willi-syndroom RYGB RouX-en-Y gastric bypass SADI-S single anastomose duodenale switch SCL-90 SyMptom Checklist SG sleeve gastrectomy (maagverkleining) SGLT2 natriumglucose-cotransporter-2 SH2B1 SH2B adaptor protein 1 SIM1 single-minded 1 SPE Studiecentrum Perinatale Epidemiologie SSRI selectieve serotonine-heropnamereMMers TrkB tropomyosin-related kinase B (BDNF receptor) TSH thyroïdstiMulerend hormoon 6 TUB tubby bipartite transcription factor VLCD zeer laag calorische voeding (very low calorie diet) WAGR WilMs’ tuMor, aniridia, genitourinary anoMalies, and Mental retardation WGO (WHO) Wereldgezondheidsorganisatie (World Health Organization) 7 1. Hoofdstuk: “Inleiding” 1.1. Definitie van overgewicht en obesitas Obesitas is een ziekte die wordt gekenmerkt door een overmatige ophoping van lichaamsvet, die een risico vormt voor de gezondheid1. De hoeveelheid en de verspreiding van het vet, alsook de gevolgen voor de gezondheid kunnen bij verschillende Mensen Met obesitas enorm variëren. Om het percentage vetMassa (of ‘adipositas’) in iemands lichaaM nauwkeurig te berekenen, zijn geavanceerde hulpmiddelen nodig. De body Mass index (BMI) is een antropometrische meting die in de klinische praktijk vaak wordt gebruikt als Maatstaf voor adipositas. De BMI drukt lichaamsgewicht in kg uit in relatie tot de lengte in M2 (BMI = gewicht [in kg]/lengte [in M2]). Volgens de Wereldgezondheidsorganisatie (WGO) wordt obesitas bij personen ouder dan 18 jaar gedefinieerd als een BMI gelijk aan of hoger dan 30 kg/M2 en overgewicht (ook ‘pre-obesitas’ genoeMd) als een BMI tussen 25 en 29,9 kg/M2 (zie Tabel 1.1)1. Bij kinderen en adolescenten worden deze termen anders gedefinieerd (zie hoofdstuk “Obesitas bij kinderen”). Obesitas is een coMplexe ziekte Met verscheidene oorzaken en risicofactoren (International Classification of Diseases [ICD]-10 code E66; zie Hebebrand et al. voor een discussie over de nieuwe codering volgens ICD-112). Overgewicht en obesitas hebben een toenaMe van de morbiditeit en mortaliteit tot gevolg en verMinderen de levenskwaliteit van de getroffen personen. Daarnaast is obesitas een chronische ziekte, die door de WGO en andere relevante medische instellingen ook als dusdanig wordt erkend, zowel bij volwassenen als bij kinderen1, 3, 4. DaaroM zijn voor de preventie en het behanden van obesitas interventies op de lange termijn nodig. 1.2. Prevalentie De afgelopen tientallen jaren is obesitas uitgegroeid tot een zorgwekkende pandeMie, die wereldwijd alle leeftijdscategorieën en etnische groepen treft. De aandoening wordt tegenwoordig beschouwd als het belangrijkste chronische gezondheidsprobleeM bij volwassenen ter wereld en neeMt ook bij kinderen en adolescenten alarMerend toe. 8 In 2008 had naar schatting de helft van alle volwassenen in de Europese regio overgewicht of obesitas (BMI ≥ 25 kg/M2)5. In 2015 waren 21,5% van alle Mannen en 24,5% van alle vrouwen in de Europese regio obees (de Meest recente gegevens toen deze consensus werd geschreven)6. In België is het obesitaspercentage 25% bij Mannen en 24% bij vrouwen (gegevens uit 2016)7. Gezien de stijgende tendens die de laatste tientallen jaren werd waargenomen (het percentage overgewicht en obesitas is tussen 1980 en 2008 verdubbeld), zullen deze cijfers de volgende decennia nog verder toeneMen. Dit zal gepaard gaan Met een toeneMende Maatschappelijke en economische last in verband Met overgewicht en obesitas, tenzij effectieve behandelingen en preventieMaatregelen worden ingezet. 1.3. Indelingscriteria voor obesitas De eerste stap in het aanpakken van overgewicht of obesitas, is de ernst van het probleeM te evalueren. Er zijn verschillende systeMen voorgesteld om obesitas in te delen, waaronder antropometrische Metingen (BMI, vetverdeling in het lichaam) en een klinisch classificatiesysteeM (Edmonton Obesity Staging SysteM [EOSS]). 1.3.1. BMI-indeling Zoals eerder vermeld, is de BMI een antropometrische Meting die vaak wordt gebruikt in de klinische praktijk als vervangende Marker voor adipositas. De BMI wordt berekend Met behulp van de volgende forMule: BMI = gewicht (in kg)/lengte (in M2). De WGO heeft gradaties van overgewicht en obesitas bij volwassenen bepaald volgens BMI-waarden (Tabel 1.1)1. Tabel 1.1. BMI-categorieën voor personen van 18 jaar of ouder, ongeacht leeftijd en geslacht. Categorie BMI (kg/m2) Ondergewicht < 18,5 Normaal gewicht 18,5–24,9 Overgewicht (of ‘pre-obesitas’) 25,0–29,9 Obesitas ≥ 30,0 9 Klasse 1 30,0–34,9 Klasse 2 35,0–39,9 Klasse 3 (Morbide obesitas)* ≥ 40,0 *Morbide obesitas wordt soms onderverdeeld in obesitas klasse 3 (40,0– 49,9),
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