Abstract
Objective:
Current care for overweight children is controversial, and only few data are available concerning the process of care, as well as the outcome under real-life conditions.
Methods:
A nationwide survey of treatment programs for overweight children and adolescents in Germany identified 480 treatment centers. From 135 institutions that had agreed to participate in this study of process of care and outcome, 48 randomly chosen institutions were included in the study. All 1916 overweight children (mean age 12.6 years, 57% female, mean body mass index 30.0 kg/m2), who presented at these institutions for lifestyle interventions, were included in this study. Diagnostic procedures according to guidelines and effect of lifestyle interventions on weight status at end of treatment were analyzed.
Results:
Children treated <3 months were older and more obese, whereas children with >3 months treatment duration demonstrated more cardiovascular risk factors at baseline. On the basis of an intention-to-treat analysis, 75% of the children reduced their overweight. The reduction of overweight varied widely between the treatment institutions (intracluster correlation coefficient 0.15 in the multiple regression model reflecting the intracenter correlation). Screening for hypertension, disturbed glucose metabolism and dyslipidemia was performed in 52% of the children at baseline and in 10% at the end of intervention.
Conclusion:
Overweight reduction is achievable with lifestyle intervention in clinical practice. However, because the clientele, treatment approach and outcome varied widely between different institutions, and screening for comorbidities was seldomly performed as recommended, quality criteria for institutions have to be implemented to improve medical care of overweight children under real-life conditions.
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References
Kunze D, Wabitsch M . Guidelines of the German Obesity Working Group. available at www.a-g-a.de.
Wabitsch M . Overweight and obesity in European children: definition and diagnostic procedures, risk factors and consequences for later health outcome. Eur J Pediatr 2000; 159 (Suppl 1): S8–13.
Barlow SE . Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 (Suppl 1): S164–S192.
Reinehr T, Wabitsch M, Andler W, Beyer P, Böttner A, Chen-Stute A et al. Medical care of obese children and adolescents—APV: a standardised multicentre documentation derived to study initial presentation and cardiovascular risk factors in patients transferred to specialised treatment institutions. Eur J Ped 2004; 163: 308–312.
Campbell K, Waters E, ÓMeara S, Summerbell C . Interventions for preventing obesity in childhood. A systematic review. Obes Rev 2001; 2: 149–157.
Reinehr T, Wabitsch M . Strukturierte Erfassung der Therapieangebote für adipöse Kinder und Jugendliche—ein Projekt der Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA). Monatsschr Kinderheilkd 2003; 151: 757–761.
BzgA . Die Versorgung übergewichtiger und adipöser Kinder und Jugendlicher in Deutschland. Quantität und Qualität von Angeboten im Zeitraum 2004–2005. Gesundheitsförderung konkret 2007. Band 8.
L'Allemand D, Wiegand S, Müller J, Reinehr T, Wabitsch M, Widhalm K et al. Cardiovascular risk in 26008 European overweight children as established by a multicenter database. Obesity 2008; 16: 1672–1679.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1–6.
Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiβ HC, Hesse V et al. Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001; 149: 807–818.
Cole TJ . The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.
de Man SA, Andre JL, Bachmann H, Grobbee DE, Ibsen KK, Laaser U et al. Blood pressure in childhood: pooled findings of six European studies. J Hypertens 1991; 9: 109–114.
Kavey REW, Daniels SR, Lauer RM, Atins DL, Hayman LL, Taubert K . American Heart Association Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood. Circulation 2003; 107: 1562–1566.
Dmitrienko A, Molenberghs G, Chuiang-Stein C, Offen W . Analysis of Clinical Trials using SAS Multiple Comparisons and Multiple Endpoints. SAS Publishing: Carey, NJ, USA, 2005. pp 67–128.
Shoukri MM, Chaudhary MA . Analysis of correlated data with SAS and R. 3rd edn 2007. Chapman and Hall/CRC, Boca Raton: London, New York.
Littell RC, Milliken GW, Stroup WW, Wolfinger RD, Schabenberger O . SAS for Mixed Models. SAS Press: Carey, NJ, USA, 2006.
Reinehr T, Temmesfeld M, Kersting M, de Sousa G, Toschke AM . Four-year follow-up of children and adolescents participating in an obesity intervention program. Int J Obes 2007; 31: 1074–1077.
Sawicki PT, Bastian H . German health care: a bit of Bismarck plus more science. BMJ 2008; 337: a1997.
Reinehr T, Holl R, Wabitsch M . The German Working Group of Childhood and Adolescent Obesity (AGA): improving the quality of care for overweight and obese children in Germany. Obes Facts 2008; 1: 26–32.
Toschke AM Reinehr T . Different anthropometric index changes in relation to cardiovascular risk profile change. Clin Nutr 2008; 27: 457–463.
Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States 2002. Department of Health and Human Services, Centers for Disease Control and Diabetes: Atlanta, GA, US, 2003.
Acknowledgements
We thank all children and parents participating at this study as well as all treatment centers for this kind support. We are indebted to Gideon de Sousa, Vestische Youth Hospital Datteln, for his support in editing the paper.
This study was funded by the Federal Centre for Health Education (Cologne, Germany), an agency of the German Federal Ministry for Health.
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Reinehr, T., Hoffmeister, U., Mann, R. et al. Medical care of overweight children under real-life conditions: the German BZgA observation study. Int J Obes 33, 418–423 (2009). https://doi.org/10.1038/ijo.2009.50
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DOI: https://doi.org/10.1038/ijo.2009.50
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