The epidemic of lifestyle-dependent diseases and the failure of previous interventions to combat the main causes demand an alternative approach. Abdominal obesity is associated with most of these diseases and is a good target for therapeutic and preventive measures. Time-restricted feeding (TRF) offers a low-threshold, easy-to-implement lifestyle-modification concept with promising results from animal testing. Here, we describe a pilot study of TRF with abdominally obese participants (waist-to-height ratio, WHtR ≥0.5) in a general practitioner’s office. Participants (n = 40, aged 49.1 ± 12.4, 31 females) were asked to restrict their daily eating time to 8–9 hours in order to prolong their overnight fasting period to 15–16 hours. Questionnaires, anthropometrics, and blood samples were used at baseline and at follow-up. After three months of TRF, participants had reached the fasting target, on average, on 85.5 ± 15.2% of all days recorded. Waist circumference (WC) was reduced by −5.3 ± 3.1cm (p < 0.001), and three participants reached a WHtR <0.5. HbA1c was diminished by −1.4 ± 3.5 mmol/mol (p = 0.003). TRF may be an easily understandable and readily adoptable lifestyle change with the potential to reduce abdominal obesity and lower the risk for cardiometabolic diseases. Further well-designed studies are necessary to investigate the applicability and usefulness of TRF for public health.

AimTo evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany.MethodsCluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated.ResultsThe final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.ConclusionThis study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.Trial registrationGerman Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.

Background Therapeutic fasting may improve health-related quality of life (HRQoL) and sleep but is not applicable for everyone. Time-restricted eating (TRE) offers a low threshold alternative but research on associations with HRQoL and sleep is rare. Methods We conducted a secondary analysis of two pilot studies in a pre-post design, which examined TRE in healthy employees at the Ulm University and in abdominal obese patients in a general practitioners office. Participants reported their HRQoL (EQ-5D visual analogue scale) before and after 3 months of restricting their daily eating to 8–9 h. They kept a diary to protocol timing of first and last meal, sleep quality (analogue scale) and duration. Pearson’s correlation coefficient was applied to test bivariate correlations between continuous variables and linear regression analyses were conducted to identify associated factors with the pre-post differences in HRQoL and the differences in sleep quality. Results Ninety-nine participants (aged aged 48.9 ± 1.1, 83.8% female) reached the fasting target of 15–16 h on average on 77.2 ± 18.7% of all recorded days. HRQoL increased by 7.8 ± 12.6 and sleep quality by 9.6 ± 13.9 points, but sleep duration was not extended. Regression analysis revealed mean fasting duration and baseline sleep quality as significant factors associated with changes in HRQoL. Improvements in sleep quality correlated with baseline sleep quality and HRQoL at follow-up but not with fasting. Changes in anthropometry did not correlate with the HRQoL or sleep quality. Conclusions TRE correlates with increased HRQoL and sleep quality independent from weight loss. TRE is easily applicable with or without medical supervision. The potential effects of TRE on health and sleep should be further investigated in larger randomized trials. Trial registration German Register for Clinical Trials (DRKS), DRKS-ID: DRKS00015057. Registered 4 July 2018.

BackgroundRegular breakfast and well-balanced soft drink, and screen media consumption are associated with a lower risk of overweight and obesity in schoolchildren. The aim of this research is the combined examination of these three parameters as influencing factors for longitudinal weight development in schoolchildren in order to adapt targeted preventive measures.MethodsIn the course of the Baden-Württemberg Study, Germany, data from direct measurements (baseline (2010) and follow-up (2011)) at schools was available for 1733 primary schoolchildren aged 7.08 ± 0.6 years (50.8% boys). Anthropometric measurements of the children were taken according to ISAK-standards (International Standard for Anthropometric Assessment) by trained staff. Health and lifestyle characteristics of the children and their parents were assessed in questionnaires. A linear mixed effects regression analysis was conducted to examine influences on changes in waist-to-height-ratio (WHtR), weight, and body mass index (BMI) measures. A generalised linear mixed effects regression analysis was performed to identify the relationship between breakfast, soft drink and screen media consumption with the prevalence of overweight, obesity and abdominal obesity at follow-up.ResultsAccording to the regression analyses, skipping breakfast led to increased changes in WHtR, weight and BMI measures. Skipping breakfast and the overconsumption of screen media at baseline led to higher odds of abdominal obesity and overweight at follow-up. No significant association between soft drink consumption and weight development was found.ConclusionTargeted prevention for healthy weight status and development in primary schoolchildren should aim towards promoting balanced breakfast habits and a reduction in screen media consumption. Future research on soft drink consumption is needed. Health promoting interventions should synergistically involve children, parents, and schools.Trial registrationThe Baden-Württemberg Study is registered at the German Clinical Trials Register (DRKS) under the DRKS-ID: DRKS00000494.

BackgroundSkipping breakfast was found to be associated with abdominal obesity in primary school children. The aim of this research was to examine factors associated with skipping breakfast in primary school children in order to develop targeted preventive measures.MethodsBaseline data assessment (2010) of a cluster-randomized controlled trial for the evaluation of a school-based health promotion program in primary school children in the state of Baden-Württemberg, Germany. Anthropometric measures of 1,943 primary school children aged 7.1 ± 0.6 years (51.2% boys) were conducted according to ISAK-standards (International Standard for Anthropometric Assessment) by trained staff. Further information on the health and living conditions of the children and their parents were assessed in parental questionnaires. Generalized linear mixed regression analysis was calculated to define correlates for skipping breakfast in terms of odds ratios (OR) and 95% confidence intervals (CI).ResultsAccording to the final regression models, significant correlates of skipping breakfast can be divided into modifiable behavioral components (high consumption of soft drinks (OR 2.49, 95% CI 1.81; 3.43), screen media (OR 2.48, 95% CI 1.77; 3.46) and high levels of physical activity (OR 0.64, 95% CI 0.44; 0.93)) on the one hand, and more or less static socio-economic factors (migration background (OR 2.81, 95% CI 2.02; 3.91), single parenting (OR 2.13, 95% CI 1.34; 3.40), and high family education level (OR 0.42, 95% CI 0.28; 0.64)) on the other hand, and finally individual factors (female gender (OR 1.43, 95% CI 1.03; 1.99) and having a percentage of body fat at or above the 95th percentile (OR 1.47, 95% CI 1.00; 2.17)).ConclusionTargeted prevention should aim at health-related behaviors accompanying the habit of skipping breakfast. Focusing on vulnerable groups, characterized by not so easily modifiable socio-economic as well as individual factors, may improve results. Interventions should synergistically promote children’s health and involve their parents in order to be successful. To reach all children and to avoid skipping breakfast, schools should offer regular breakfast at the start of a school day. Policy makers should support healthy eating habits at all times.

ObjectiveTo determine parental willingness-to-pay (WTP) for childhood obesity prevention.MethodsCross-sectional data from the follow-up measurements (2011) of a health promotion programme in German primary schools. Data collection included anthropometric measurements of children and self-administered questionnaires for parents, including WTP assessment. Mann-Whitney U-Test was used for differences between groups, and regression analysis to identify factors associated with general WTP and amount of WTP.ResultsFrom 1 534 parents, 97.8% considered overweight/obesity to be serious public health problems. A general WTP to reduce the incidence of childhood overweight/obesity by half, was declared by 48.8%. Parents of overweight/obese children showed with 61.4%, significantly more frequently, their general WTP than the others with 47.2% (p = 0.001). Mean WTP was €23.04 (99% confidence interval (CI) [22.45; 23.75]) per month. Parents of centrally obese children showed significantly higher WTP than parents of the other children (p = 0.001). General WTP and the amount of WTP were associated with the central obesity of the child, migration status and household income. Additionally, general WTP was associated with maternal obesity.ConclusionsNearly half of the parents were willing to invest in prevention of obesity. The general WTP significantly occurs more often and with higher amount in affected parents.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0020-8) contains supplementary material, which is available to authorized users.

Overall, the identified interventions showed a moderate effect on WC. One reason may be that in most studies WC was a secondary outcome parameter, while only a small number of interventions primarily targeted abdominal obesity. Further research regarding the treatment of abdominal obesity is urgently needed.

ObjectiveTo investigate correlates of changes in waist-to-height ratio (WHtR) in primary school children in order to identify modifiable factors usable for prevention.MethodsOutcome evaluation of a statewide health promotion program in Baden-Württemberg, Germany. Baseline (2010) and follow-up (2011) measurements provided data for the calculation of changes in WHtR. Further information on the health and living conditions of the children were assessed in parental questionnaires. Anthropometric measures were taken in 1733 (50.8% male) first and second grade children (age at baseline 7.1 ± 0.6 years) by staff trained according to ISAK-standards. Stepwise linear regression analysis was applied to identify variables with influence on changes in WHtR.ResultsAccording to the resulting regression model, changes in WHtR towards an increase were influenced by at least one parent being overweight/obese, at least one parent who smoked, low household income, higher age of the child and the skipping of breakfast. There was no clustering effect in schools observed.ConclusionA promising target for prevention of gain in WHtR in primary school children is to ensure the regularity of breakfast. Smoking cessation as well as dietary improvements would not only help children's health but also the health of their parents. The socioeconomic influence on the development of an unhealthy weight status has already been acknowledged and should be extensively targeted by all of society and policy makers.