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Comorbidities in overweight children and adolescents: do we treat them effectively?

International Journal of Obesity volume 37, pages 493–499 (2013)Cite this article

Subjects

Abstract

OBJECTIVE:

The aim was to analyze the effectiveness of treatment concerning obesity-associated comorbidities in clinical practice.

METHODS:

A total of 11 681 overweight children with ⩾6-month follow-up treated at 175 centers specialized in pediatric obesity care in Central Europe were included in this analysis (mean body mass index (BMI) 29.0±5.6 kg m−2, standard deviation score body mass index (SDS-BMI) 2.48±0.54, 45% boys, age 11.4±2.8 years). The changes of weight status, blood pressure, fasting lipids and glucose, and oral glucose tolerance tests were documented by standardized prospective quality documentation software (APV).

RESULTS:

After follow-up of in median 1.2 (interquartile range 0.9–2.2) years, a mean reduction of −0.15 SDS-BMI was achieved. The prevalence of prehypertension (37–>33%) and hypertension (17–>12%) decreased, while prevalences of triglycerides >150 mg dl−1 (22–>21%), low-density-lipoprotein-cholesterol >130 mg dl−1 (15–>14%), impaired fasting glucose (6–>6%) and impaired glucose tolerance (9–>8%) remained stable. Drug treatment according to cutoffs recommended in European obesity guidelines were not frequently indicated (hypertension: 10%; dyslipidemia: 1%, type 2 diabetes <1%). None of the children with dyslipidemia received lipid-lowering drugs and only 1.4% of the children with hypertension were treated with antihypertensive drugs.

CONCLUSIONS:

Achieving sufficient weight loss to improve obesity associated comorbidities was difficult in clinical practice. Drug treatment of hypertension, dyslipidemia and type 2 diabetes was rarely performed even if it was indicated only in a minority of the overweight children. Future analyses should identify reasons for this insufficient drug treatment of comorbidities and analyze whether the benchmarking processes of APV improve medical care of childhood obesity.

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References

  1. Han JC, Lawlor DA, Kimm SY . Childhood obesity. Lancet 2010; 375: 1737–1748.

    Article  PubMed  PubMed Central  Google Scholar 

  2. I'Allemand D, Wiegand S, Reinehr T, Muller J, Wabitsch M, Widhalm K et al. Cardiovascular risk in 26 008 European overweight children as established by a multicenter database. Obesity (Silver Spring) 2008; 16: 1672–1679.

    Article  Google Scholar 

  3. Ebbeling CB, Pawlak DB, Ludwig DS . Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360: 473–482.

    Article  PubMed  Google Scholar 

  4. Arslanian S, Suprasongsin C . Insulin sensitivity, lipids, and body composition in childhood: is ‘syndrome X’ present? J Clin Endocrinol Metab 1996; 81: 1058–1062.

    Article  CAS  PubMed  Google Scholar 

  5. Barlow SE, Dietz WH . Management of child and adolescent obesity: summary and recommendations based on reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics 2002; 110: 236–238.

    PubMed  Google Scholar 

  6. http:www.a-g-a.de/Leitlinie.pdf . Guidelines of the German working group on obese children and adolescents 2012.

  7. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 23: 381–389.

    Article  Google Scholar 

  8. Barlow SE, Dietz WH, Klish WJ, Trowbridge FL . Medical evaluation of overweight children and adolescents: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics 2002; 110: 222–228.

    PubMed  Google Scholar 

  9. Barlow SE, Trowbridge FL, Klish WJ, Dietz WH . Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics 2002; 110: 229–235.

    PubMed  Google Scholar 

  10. Reinehr T, Wabitsch M, Andler W, Beyer P, Bottner 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 Pediatr 2004; 163: 308–312.

    Article  PubMed  Google Scholar 

  11. Reinehr T, Hoffmeister U, Mann R, Goldapp C, Westenhofer J, Egmond-Froehlich A et al. Medical care of overweight children under real-life conditions: the German BZgA observation study. Int J Obes (Lond) 2009; 33: 418–423.

    Article  CAS  Google Scholar 

  12. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiss 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.

    Article  Google Scholar 

  14. Cole TJ . The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.

    CAS  PubMed  Google Scholar 

  15. http:www.aps.de . Guidelines of the German paediatric working group on metabolic disorders 2012.

  16. National high blood pressure education program working group on high blood pressure in children and adolescents.. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.

  17. Kurth BM, Kamtsiuris P, Holling H, Schlaud M, Dolle R, Ellert U et al. The challenge of comprehensively mapping children's health in a nation-wide health survey: design of the German KiGGS-Study. BMC Public Health 2008; 8: 196.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chu NF, Rimm EB, Wang DJ, Liou HS, Shieh SM . Clustering of cardiovascular disease risk factors among obese schoolchildren: the Taipei Children Heart Study. Am J Clin Nutr 1998; 67: 1141–1146.

    Article  CAS  PubMed  Google Scholar 

  19. Csabi G, Torok K, Jeges S, Molnar D . Presence of metabolic cardiovascular syndrome in obese children. Eur J Pediatr 2000; 159: 91–94.

    Article  CAS  PubMed  Google Scholar 

  20. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103: 1175–1182.

    Article  CAS  PubMed  Google Scholar 

  21. Reinehr T, Kiess W, Kapellen T, Wiegand S, Holl RW . Children with diabetes mellitus type 2 in Europe: an underserved population. Arch Dis Child 2010; 95: 954.

    Article  CAS  PubMed  Google Scholar 

  22. Malecka-Tendera E, Mazur A . Childhood obesity: a pandemic of the twenty-first century. Int J Obes (Lond) 2006; 30 (Suppl 2): S1–S3.

    Article  Google Scholar 

  23. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002; 346: 802–810.

    Article  CAS  PubMed  Google Scholar 

  24. Denzer C, Reithofer E, Wabitsch M, Widhalm K . The outcome of childhood obesity management depends highly upon patient compliance. Eur J Pediatr 2004; 163: 99–104.

    Article  PubMed  Google Scholar 

  25. Pinelli L, Elerdini N, Faith MS, Agnello D, Ambruzzi A, De SM et al. Childhood obesity: results of a multicenter study of obesity treatment in Italy. J Pediatr Endocrinol Metab 1999; 12 (Suppl 3): 795–799.

    PubMed  Google Scholar 

  26. Reinehr T, Widhalm K, l'Allemand D, Wiegand S, Wabitsch M, Holl RW . Two-year follow-up in 21 784 overweight children and adolescents with lifestyle intervention. Obesity (Silver Spring) 2009; 17: 1196–1199.

    Article  Google Scholar 

  27. Grinstein G, Muzumdar R, Aponte L, Vuguin P, Saenger P, DiMartino-Nardi J . Presentation and 5-year follow-up of type 2 diabetes mellitus in African-American and Caribbean-Hispanic adolescents. Horm Res 2003; 60: 121–126.

    CAS  PubMed  Google Scholar 

  28. Reinehr T, Schober E, Roth CL, Wiegand S, Holl R . Type 2 diabetes in children and adolescents in a 2-year follow-up: insufficient adherence to diabetes centers. Horm Res 2008; 69: 107–113.

    CAS  PubMed  Google Scholar 

  29. Oude LH, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009; 21: CD001872.

    Google Scholar 

  30. Reinehr T, Kersting M, Alexy U, Andler W . Long-term follow-up of overweight children: after training, after a single consultation session, and without treatment. J Pediatr Gastroenterol Nutr 2003; 37: 72–74.

    Article  PubMed  Google Scholar 

  31. Reinehr T, Schaefer A, Winkel K, Finne E, Toschke AM, Kolip P . An effective lifestyle intervention in overweight children: findings from a randomized controlled trial on ‘Obeldicks light’. Clin Nutr 2010; 29: 331–336.

    Article  CAS  PubMed  Google Scholar 

  32. Wunsch R, de Sousa G, Reinehr T . Intima-media thickness in obesity: relation to hypertension and dyslipidaemia. Arch Dis Child 2005; 90: 1097.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS . Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics 2001; 108: 712–718.

    Article  CAS  PubMed  Google Scholar 

  34. Biro FM, Wien M . Childhood obesity and adult morbidities. Am J Clin Nutr 2010; 91: 1499S–1505S.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Reinehr T, Kleber M, Toschke AM . Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis 2009; 207: 174–180.

    Article  CAS  PubMed  Google Scholar 

  36. Reinehr T, de Sousa G, Andler W . Longitudinal analyses among overweight, insulin resistance, and cardiovascular risk factors in children. Obes Res 2005; 13: 1824–1833.

    Article  CAS  PubMed  Google Scholar 

  37. August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008; 93: 4576–4599.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Holl RW, Grabert M . The quality circle: how to improve the outcome of paediatric diabetes care. Horm Res 2002; 57 (Suppl 1): 105–109.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The APV standardized documentation was supported by grants of the Bundesministerium für Bildung und Forschung (Obesity network: LARGE, FKZ 01GI0824 and FKZ 01GI1130), the German Obesity Society (DAG) and German Federal Centre for Health Education (BzGA). We are indebted to all health professionals of the APV Study Group taking care of overweight children and contributing to the APV database. We thank the following obesity treatment centers for participating in the study: Amrum Satteldüne Kinder-Reha, Augsburg Bunter Kreis, Bad Bodenteich Moby Dick Seeparkklinik, Bad Fallingbostel Gesundheitszentrum, Bad Frankenhausen Kinder-Reha, Bad Hersfeld Kinderklinik, Bad Kreuznach Viktoriastift, Bad Kösen Kinder-Reha, Bad Lippspringe, Bad Mergentheim Kinderklinik, Bad Neuenahr—DRK Institutsambulanz, Bad Orb Spessartklinik—Kinder-Reha, Bad Rothenfelde Kinder-Reha, Bad Salzungen Reha-Klinik Charlottenhall, Bad Segeberg/Neumünster junior marvelesse, Bensheim Ernährungspraxis, Berchtesgaden CJD, Berchtesgaden Klinik Schönsicht Kinder-Reha, Berlin Charite Kinderklinik, Berlin DRK Ausbildungszentrum, Berlin DRK Moby Dick, Berlin Lichtenberg Kinderklinik, Berlin Vivantes Beh.Zentrum SPZ, Bischofswiesen/Strub, INSULA, Blaubeuren Ernährungspraxis, Bonn Ernährungsberatung KIDS Schulung, Braunschweig ernährungsmed. Zentrum, Bregenz—Landeskrankenhaus Kinderklinik, Bremen Zentralkrankenhaus Kinderklinik, Bremen-Nord Kinderklinik, Bruchweiler Kinder-Reha, Brügge, Fördekids, Buchholz Ernährungsberatung, Böblingen Kinderarztpraxis, Bühl—Praxis Ernährungsberatung, Darmstadt Kinderklinik, Datteln Vestische Kinderklinik, Detmold Kinderklinik, Dieburg Ernährungsberatung KIDS Schulung, Dornbirn Kinderklinik, Dorsten St. Elisabethkrhs., Dresden Moby Dick, Düren Gesundheitsamt, Düren sozialpäd. Zentrum Marienhospital, Düsseldorf Ernährungsberatung ‘richtig essen’, Düsseldorf Ernährungspraxis ‘iss gut’, Eppingen Kinderarztpraxis Schulze, Erlangen Uni-Kinderklinik, Eschede Adipositastraining KIDS, Ettenheim Kinderarztpraxis, Feldberg ITZ Caritas-Haus, Feldkirch Landeskrankenhaus Kinderklinik, Flensburg Fördekids, Frankfurt Päd. Endokrinologie, Freiburg—Fitoc, Freiburg Uni-Kinderklinik, Friedrichsdorf Ernährungspraxis, Fürth Kinderklinik, Gaissach Fachklinik Deutsche Rentenversicherung Bayern-Süd, Garz Fachklinik CJD, Gauting, Kinderarztpraxis, Gelnhausen Ernährungsberatung, Giffers, Ausbildungszentrum Guglera, Gittelde am Harz—Ernährungsberatung, Gotha Helios Kinderklinik, Gröbenzell Ernährungsberatung, Göttingen Uni-Kinderklinik, Göttingen, KIDS Schulungsprogramm, Hagen Allgemeines Krankenhaus, Hagen Kinderarztpraxis, Hagen Kinderklinik, Hamburg Moby Dick, Hamburg Moby Dick Partner Konopka, Hamburg Rallye Energy, Hamburg Wilhelmstift, Hannover BKK Essanelle, Hannover Kinderklinik Bult, Haßfurt Adipositasschulung Haßberge, Herdecke Kinderklinik, Herne Praxis Ernährungsmedizin, Hirschberg Praxis Maurer, Homburg CJD, Homburg Uni-Kinderklinik, Kiel städt. Krankenhaus Fördekids, Korbach Ernährungsberatung, Kreischa Klinikum Bavaria Zscheckwitz, Köln—Amsterdamerstrasse, Power Pänz, Köln—Prävention UniReha GmbH, Köln MeLo KIDS Schulungsprogramm, Köln Sporthochschule, Kölpinsee, Seebad Klaus Störtebecker Kinder-Reha, Leipzig Sportmedizin, Leipzig Uni-Kinderklinik, Lindau Forum Adipositas, Lindenberg/Lindau Adipositasschulung, Lingen Bonifatius-Hospital, Luhe Ernährungsberatung/LuheVitalConcept, Lörrach Kinderklinik VPS, Lübeck Uni-Kinderklinik, Magdeburg—Städtische Kinderklinik, Magdeburg Uni-Kinderklinik, Mahlow Ernährungspraxis, Menden BIG, Munster Ernährungsberatung Moby Dick, Murnau Kinder-Reha, Mönchengladbach Städt. Kinderklinik, Mühlhausen Präventionspraxis Scherf, München Adieupositas, Münster Arztpraxis, Nagold Ernährungsberatung, Neumünster Präventionszentrum, Neunkirchen Kinderklinik, Neuss Lukaskrankenhaus, Niederkassel Kinderarztpraxis Sprenker, Norden—Klinik Nordendeich, Nürnberg PEP, Oberhausen Adipositaszentrum, Oberhausen EKO Kinderklinik, Oberstaufen Ernährungsmedizin, Oldenburg Kids-Schulungsprogramm, Oldendorf Ernährungspraxis KiloKids, Osnabrück Kinderhospital, Overath KIDS-Schulungsprogramm, Oy-Mittelberg Reha, Paderborn Ernährungspraxis Kinderleicht, Passau Kinderklinik, Pforzheim Adipositas Training, Pocking Kinderarztpraxis, Poppenricht Ernährungsberatung, Potsdam Patienten Trainings Zentrum, Pönitz FiFaFu KIDS-Programm, Ravensburg Ernährung und Diät, Reiskirchen Ernährungspraxis, Rendsburg Villa Schwensen Praxisgemeinschaft KJPP, Ronneburg Ernährungsberatung, Rosenheim Lufti-Team, Rüsselsheim Gesundheits- und Pflegezentrum, Saalfeld Kinderklinik, Saarbrücken Moby Dick, Salzburg Kinderklinik, Scheidegg Prinzregent Luitpold Reha, Schliengen Ernährungsberatung, Schliengen Erwachsene, Seebad Heringsdorf—Kinder-Reha, Senden Ernährungsberatung, Siegburg KIDS Schulungsprogramm, Siegen DRK Kinderklinik, Simonswald Klinik Eichhof, Solingen Ernährungsberatung, Sonneberg KIDS Ernährungspraxis, St. Augustin Kinderklinik, St. Gallen Ostschweiz Kinderklinik, St. Pölten Landesklinikum Kinderklinik, Straubing Praxis, Tholey/ SPZ Neunkirchen, Tübingen Universitäts-Kinderklinik, Ulm Uni-Kinderklinik, Untergruppenbach Ernährungsberatung, Viersen Kinderklinik Nikolaus, Villingen-Schwenningen Kiarztpraxis, Waldbröl Gemeinschaftspraxis, Waltrop Ernährungsberatung, Wangen Kinder-Rehaklinik, Westerland/Sylt, Haus Quickborn, Westerland/Sylt, Kinder-Reha, Wien Uni-Kinderklinik, Wiesbaden DKD Kinderklinik, Wiesmoor KIDS Schulungsprogramm, Windach Psychosomatik—Sportverein Triathlon, Wustrow Ostseebad Fischland, Wyk auf Föhr—AOK Kinderkurheim, Würzburg ambulantes Schulungszentrum, Zwickau—Praxis Ernährungsberatung

Author contributions

All authors contributed substantially to conception and design, acquisition of data, or analysis and interpretation of data. The first draft of the article was performed by Thomas Reinehr. All authors revised the paper critically for important intellectual content and all authors approved the final version.

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The authors had full access to all the data in the study and the corresponding author had final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany

    T Reinehr

  2. Department of Pediatric Endocrinology and Diabetology, Charité Universitätsmedizin Berlin, Berlin, Germany

    S Wiegand

  3. Insula Berchtesgarden, Berchtesgarden, Germany

    W Siegfried

  4. Department of Pediatrics, German Center for Diagnostics, Wiesbaden, Germany

    K M Keller

  5. Department of Pediatrics, University of Vienna, Vienna, Austria

    K Widhalm

  6. Children’s Hospital of Eastern Switzerland, St Gallen, Switzerland

    D l'Allemand

  7. Department of Pediatrics, Childreńs Clinic St Pölten, St Pölten, Austria

    K Zwiauer

  8. Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany

    R W Holl

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  1. T Reinehr
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  2. S Wiegand
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Correspondence to T Reinehr.

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Reinehr, T., Wiegand, S., Siegfried, W. et al. Comorbidities in overweight children and adolescents: do we treat them effectively?. Int J Obes 37, 493–499 (2013). https://doi.org/10.1038/ijo.2012.184

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