Overweight and obesity in childhood and adolescence

Abstract

Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables. A total of 1,916 children aged 8-16 years from 48 (5 rehabilitation, 43 outpatient) institutions were examined. Data were collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1), and 1 year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was -0.27 and 1 year later at t2 was -0.23 (per protocol analysis; intention to treat: t1=-0.24; t2=-0.06). Psychological health and quality of life, which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations and in the weight reduction accomplished.

Association of Symptoms of Attention-Deficit/Hyperactivity Disorder with Physical Activity, Media Time, and Food Intake in Children and Adolescents

“…This corresponds with our previous results based on the same population [13], where we found a significant independent association between ADHD symptoms and overweight only in adolescent girls. The success of treatment for obesity is reduced by ADHD symptoms or impulsivity in most studies [29], [56], [57]. Girls are under stronger societal pressure to reduce weight and food intake than boys.…”

Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents

“…2a-c). Previous studies indicated that a lower BMI at the beginning of a LI is one predictor of success as measured by BMI SDS [10,11]. However, the indication to participate in an outpatient or inpatient LI depends on obesity degree and existing risk factors or comorbidities (table 4) [21,22].…”

“…In a study analyzing 1,916 children (8 to <16 years of age) from 48 institutions (5 rehabilitation, 43 outpatient centers) in Germany, the short-term success (1-year-follow-up) was as lower as more obese the children were [10]. The authors also stated a higher success rate in younger children [10]. Similar results were indicated by another study with 2-year follow-up [11].…”

Three- and Five-Year Follow-Up of a Combined Inpatient-Outpatient Treatment of Obese Children and Adolescents

“…Nevertheless, the follow-up rates in our study may be considered as somewhat satisfying compared to other studies in the field. In an observational follow-up study of different treatment programmes in Germany, loss to follow-up was already 58.6% one year after the end of treatment and 72.5% after initial inpatient treatment [65]. In an attempt to compensate for our nevertheless large and presumably biased loss to follow-up, we consequently used an intention to treat analysis with baseline values imputed for missing values at follow-up which eventually handles dropouts as a “failure.” Thus, the estimates of treatment effects are considered conservative in the sense that true effects might be slightly better than our estimates.…”