Objective: Current guidelines for prevention of obesity in childhood and adolescence are discussed. Methods: A literature search was performed in Medline via PubMed, and appropriate studies were analyzed. Results: Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children. Conclusion: Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an ‘obesogenic environment' is crucial for sustainable success of future obesity prevention programs.

BACKGROUND:The Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary, outpatient program for obese children consisting of regular physical exercise and comprehensive dietary and behavioral education. Parental involvement is required. The study is designed as a longitudinal, nonrandomized clinical observation study. An 8-month intensive phase preceded a follow-up phase of 1 y or longer. METHODS: Data were collected from 31 groups comprising 496 children (267 girls, 229 boys), with an average age of 10.5 y. Body height and weight, fasting total-cholesterol (CH), low-density lipoprotein-cholesterol (LDL-C), high-density lipoproteincholesterol (HDL-C) and physical performance were measured initially and after 8.5 months. A group of n ¼ 35 obese children (16 girls, 19 boys) who did not take part in this intervention program served as controls. RESULTS: After the intensive intervention phase, body mass index (BMI, kg/m 2 ) as well as BMI deviation scores (BMI-SDS) decreased in both sexes (Po0.001). In the controls, BMI increased (Po0.001) and BMI-SDS remained constant. Whereas CH was only significantly lower (Po0.01) in boys after 8.5 months, LDL-C decreased significantly in both sexes. HDL-C tended to increase in both sexes (not significant). The controls showed no significant changes in CH, LDL-C and HDL-C. The fitness levels (W/kg body weight) improved in the intervention group (Po0.001), but not in the control group. CONCLUSIONS: The results indicate that obese children can be successfully treated in such an intervention program. BMI-SDS and risk factors decreased and physical performance improved. To maintain therapeutical success, we highly recommended that these children enroll in community-based exercise programs in order to help them maintain a more active lifestyle after the follow-up phase.

Background: There is empirical evidence that the presence of a companion animal can have a positive impact on performance. The available evidence can be viewed in terms of differing hypotheses that attempt to explain the mechanisms behind the positive effects. Little attention has been given to motivation as a potential mode of action with regards to human-animal interactions. First we give an overview of evidence that animals might promote motivation. Second we present a study to examine the effect of a therapy dog on exercise performance in children with obesity.Methods: Twelve children, aged 8–12 years old, were randomly assigned to two groups in a crossover design: dog-group and human confederate group. Several types of physical activities via accelerometer and subjective ratings of wellbeing, satisfaction, and motivation were assessed. Data were analyzed using analysis of variance for repeated measures on one factor.Results: The main effect of condition was significant for all performance variables. There was less passive behavior and more physical activity for all performance variables in the presence of the dog than in that of the human confederate. Between dog- and human- condition there was no difference in the subjective rating of motivation, wellbeing, or satisfaction.Discussion: The results demonstrate that the presence of a therapy dog has the potential to increase physical activity in obese children. Task performance as a declarative measure was increased by the presence of the dog in comparison to a human confederate, but self-report measures of motivation, satisfaction or wellbeing did not differ between the two conditions. Therefore, it stands to reason that a dog could trigger implicit motives which enhance motivation for activity. The results of our study indicate the potentially beneficial effect of incorporating dogs into outpatient training for obese children.

Objective:This paper reports the frequency, type, and degree of dyslipidemia in obese children before therapeutic intervention. The relationships between lipid values and weight status, as well as lipid values and physical fitness, of these children were also investigated.Design and methods:The initial examination of the Freiburg Intervention Trial for Obese Children (FITOC) measured the values of triglycerides (TG), total cholesterol (C), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in 546 obese children aged 7–12 (body mass index [BMI] > 97th percentile), and compared these values with those of the age- and sex-specific reference group in the Lipid Research Clinics Population Studies Data Book (LRC). Four groups were selected according to the following scheme: A, Normolipidemia; B, Hyper-LDL-cholesterolemia alone; C, Hypo-HDL-C + hypertriglyceridemia; D, Combined hyperlipidemia = Hyper-LDL-C + hypertriglyceridemia. Body mass index, BMI-SDS (corrected BMI), and physical performance in watt/kg body weight were measured.Results:A total of 45.8% of the overweight children showed an abnormal lipid profile. Ten percent of the children had high LDL-C levels (group B), while 15% had increased LDL-C and increased TG (group D) (higher prevalence in boys). In 18.9% we found increased TG, combined with decreased HDL-C values (group C).Conclusion:Obese children are at risk of dyslipoproteinemia and related diseases. Children with the highest BMI-SDS and lowest physical fitness have the lowest HDL-C values and increased TG, indicating a higher risk for the metabolic syndrome.