Objective: Childhood obesity is high on the global public health agenda. Although risk factors are well known, the influence of social risk on the therapeutic outcome of lifestyle intervention is poorly examined. This study aims to investigate the influence of migration background, low education, and parental unemployment. Methods: 62,147 patients participated in multidimensional lifestyle intervention programs in 179 pediatric obesity centers. Data were collected using standardized software for longitudinal multicenter documentation. 12,305 (19.8%) attended care for 6-24 months, undergoing an intensive therapy period and subsequent follow-ups for up to 3 years. A cumulative social risk score was calculated based on different risk indicators. Results: Migration background, low education, and parental employment significantly influenced the outcome of lifestyle intervention. The observed BMI-SDS reduction was significantly higher in the subgroup with low social risks factors (Δ BMI-SDS -0.19) compared to those presenting moderate (Δ BMI-SDS -0.14) and high social risk (Δ BMI-SDS -0.11). Conclusion: Our data underline the effect of children's social setting on the outcome of multidimensional lifestyle intervention. The presence of a high social risk burden is a negative predictor for successful weight loss. Specific therapeutic programs need to be developed for disadvantaged children and adolescents.

Objective: Treatment of paediatric obesity focuses on changes of nutrition and eating behaviour and physical activity. The evaluation of the patient education programme by KgAS was utilised to analyse the association of changes of portion size, eating rate and dietary habits with BMI-SDS reductions. Methods: Patients (n = 297) were examined at the beginning and at the end of treatment and after 1-year follow-up at different out-patient centres. Their parents completed questionnaires including estimation of children's portion size, eating rate and frequency of food intake. Associations of 1-and 2-year changes in BMI-SDS and behaviour were calculated for patients with complete data in BMI-SDS, portion size, eating rate, frequency of green, yellow and red food intake (n = 131) by multiple linear regression models. Results: Significant changes were found in the desired direction for BMI-SDS, portion size, eating rate and the intake of unfavourable red food items both after 1 and 2 years as well as for the consumption of favourable green food items after 1 year. Significant positive associa- tions with BMI-SDS reduction after 1 and 2 years were detected for portion size (Cohen's f 2 0.13 and 0.09) and eating rate (Cohen's f 2 0.20 and 0.10), respectively. Conclusion: Reduced portion sizes and eating rates are associated with BMI-SDS reduction after 1 and 2 years. These findings suggest to focus on appropriate portion sizes and reduced eating rates in patient education programmes.

Objective: To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade. Methods: 65,453 subjects (<21 years) from the APV database (Adiposity Patients Registry) with a BMI ≥ 90th percentile were included (years 2005-2015). Logistic regression models (confounders: age, sex, migration background) were created for overweight, obesity, extreme obesity, and obesity-related comorbidities. Comorbidities were further adjusted for weight category. Results were stratified by inpatient or outpatient care. Results: Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups. Conclusion: During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.

Objective Obesity is associated with many cardiovascular risk factors (CVRF) in childhood. There is an ongoing discussion whether there is a linear relationship between degree of overweight and deterioration of CVRFs justifying body mass index (BMI) cut-offs for treatment decisions. Methods We studied the impact of BMI-SDS on blood pressure, lipids, and glucose metabolism in 76,660 children (aged 5–25 years) subdivided in five groups: overweight (BMI-SDS 1.3 to <1.8), obesity class I (BMI-SDS 1.8 to <2.3), class II (BMI-SDS 2.3–2.8), class III (BMI-SDS > 2.8–3.3), and class IV (BMI-SDS > 3.3). Analyses were stratified by age and sex. Results We found a relationship between BMI-SDS and blood pressure, triglycerides, HDL cholesterol, liver enzymes, and the triglycerides–HDL-cholesterol ratio at any age and sex. Many of these associations lost significance when comparing children with obesity classes III and IV: In females < 14 years and males < 12 years triglycerides and glucose parameters did not differ significantly between classes IV and III obesity. Prevalence of dyslipidemia was significantly higher in class IV compared to class III obesity only in females ≥ 14 years and males ≥ 12 years but not in younger children. In girls < 14 years and in boys of any age, the prevalences of type 2 diabetes mellitus did not differ between classes III and IV obesity. Conclusions Since a BMI above the highest BMI cut-off was not associated consistently with dyslipidemia and disturbed glucose metabolism in every age group both in boys and girls, measurements of CVRFs instead of BMI cut-off seem preferable to guide different treatment approaches in obesity such as medications or bariatric surgery.

ZusammenfassungRehabilitationsmaßnahmen für Kinder und Jugendliche mit Adipositas sind kurzfristig sehr erfolgreich, die Rückfallrate ist jedoch hoch. Nachsorgeprogramme hatten in Wirksamkeitsstudien keinen nachweisbaren Erfolg oder wurden eingestellt. Die Konsensusgruppe Adipositasschulung für Kinder und Jugendliche (KgAS) hat daher ein neues Programm entwickelt, das in einer Machbarkeitsstudie evaluiert wurde. In Kooperation der Fachklinik Sylt für Kinder und Jugendliche der DRV Nord mit ambulanten Partnern wurde 25 Familien die Teilnahme ermöglicht. Während des stationären Aufenthaltes des Kindes wurden sie in eine anschließende ambulante Nachsorge am Heimatort vermittelt. Die Teilnahme wurde durch eine Fragebogenerhebung (Eltern, Kinder/Jugendliche, Nachsorgekräfte) begleitet, außerdem wurden Einzelgespräche und ein Fokusgruppeninterview mit den Nachsorgekräften ausgewertet. Die Auswertung zeigte eine gute Machbarkeit und hohe Zufriedenheitswerte bei allen beteiligten Gruppen (Kinder/Jugendliche, Eltern, Nachsorgekräfte, Rehabilitationsklinik). Somit scheint der Nachsorgeansatz der KgAS geeignet, in das Regelangebot der Behandlung überführt zu werden. Zukünftig muss jedoch eine randomisiert-kontrollierte Studie die Wirksamkeit überprüfen.

No abstract

the APV initiative and the German BMBF Competence Network Obesity (2018) Heterogeneity in sociodemographic characteristics and cardiovascular risk factors at the initiation of a lifestyle intervention for obesity within Germany: an APV multicenter study on 40,942 children and adolescents,

ZusammenfassungAdipositas im Kindes- und Jugendalter stellt auch infolge der COVID-19 Pandemie ein wachsendes Problem dar. In der Therapie wiesen verhaltensorientierte multimodale Programme mit den Schwerpunkten Ernährung, Bewegung, medizinische und psychosoziale Betreuung unter Einbezug des familiären Umfeldes bzw. der Eltern über einen Zeitraum von 6 bis 12 Monaten die beste Evidenz auf. Allerdings gibt es nach wie vor keine flächendeckende Versorgung Betroffener. Dies ist hauptsächlich auf eine uneinheitliche Kostenübernahme durch unterschiedliche Kostenträger und Verantwortlichkeiten zurückzuführen. Die vom Gesetzgeber vorgesehene Entwicklung eines Disease Management Programms Adipositas stellt einen möglichen Schritt zur adäquaten Versorgung dar. Um den Besonderheiten von Kindern und Jugendlichen gerecht zu werden, sollte neben einem DMP für Erwachsene eines für diese Altersgruppe konzipiert werden. Zusätzlich sollte dieses DMP „Adipositas im Kindes- und Jugendalter“ in ein Gesamtkonzept eingebettet werden, das patientenzentriert den Bedürfnissen der Betroffenen i.S. ambulanter und stationärer Maßnahmen gerecht wird. Um aber die Versorgungssituation zu verbessern, sind darüber hinaus sozialgesetzbuchüberschreitende innovative Absätze wie beispielsiweise kommunal verankerte Beratungsstellen wünschenswert.