[Obesity treatment in rehabilitation clinics--explanations and remarks on implementing clinical practice guideline]

This paper focuses on the improvement of obesity treatment during in-patient rehabilitation.

The diagnosis of obesity rarely is in the foreground of assignment to rehabilitation. Obesity is the primary diagnosis in only about 1 % of all adipose patients; the term is also non-specific with respect to the causal role in the Metabolic Syndrome. The effects of obesity (diabetes, hypertension, myocardial infarction, arthrosis) are treated but not the underlying cause.

Treatment of obesity can be the primary focus or take place as an adjunct to the treatment of other diseases; it therefore requires different structures and a sufficient number of patients. Life style change is an essential aspect of obesity-specific behavior therapy and requires closed groups. Different modular therapeutic offerings are more suitable in physiotherapy and sports. In general, 85 - 90 % of all patients meet the prerequisites for group settings (i. e., ability to communicate, discipline). A generally accepted uniform pattern of motivational assessment appears to be important to treatment success but has to be postulated as yet. Pre-assessment interviews and subjects' response to proposed therapy settings are useful means of identifying motivated patients.

Setting down rehabilitative goals in writing facilitates patients' achieving therapeutic targets. Medical discharge summaries should reflect the process state (motivation, therapeutic modules, concomitant illnesses, target agreements, subjective and somatic changes in quality of life). Ongoing ambulatory care seems important but can rarely be implemented. Accepted indicators of the quality of rehabilitative obesity treatment need to be determined.