Medical care of overweight children under real-life conditions: the German BZgA observation study

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/m 2 ), 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 o3 months were older and more obese, whereas children with 43 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.

The influence of familial predisposition to cardiovascular complications upon childhood obesity treatment

“…When grouped according to familial predispositions, girls with familial obesity responded better to treatment than girls with no familial obesity, though girls without familial obesity reduced their degree of obesity as well. This finding was contrary to expectations since other studies have shown that familial obesity is associated with a poorer response to treatment [9][10][11][12]14]. However, familial predispositions to obesity related cardiovascular complications were in general not associated with the changes in BMI SDS in the obese children and adolescents enrolled in the multidisciplinary treatment protocol practised in the present study.…”

“…Finally, the intervention approaches and the follow-up times during treatment varied from 12 [10,12,14] to 36 months [9] in-between these studies. Furthermore, many of the cited studies outline the effect of a familial predisposition to obesity [9][10][11][12][14][15][16][17][18] and only a few studies outline the effect of a familial predisposition to T2DM [12]. The studies concerning CVD only analyse the degree of obesity and not how these conditions influence childhood obesity treatment [20,21].…”

“…In order to treat childhood obesity effectively, an early intervention is of great importance, and a multidisciplinary approach involving the family combining counselling on diet, behaviour, and activity seems pivotal, but the response to treatment may be inadequate for some patients [8][9][10][11][12][13]. One explanation may be the metabolic state of the children and their families, since it has been shown that a familial predisposition to obesity is associated with a poorer response to treatment [9,10,12,14].…”

“…Furthermore, a familial predisposition to obesity has been associated with the development of obesity in childhood [15][16][17][18]. The influence of a familial predisposition to obesity has been described in regards to parents [9,11,12,[14][15][16] especially the weight status of the mother [9,11,15], siblings [10], and grandparents [17,18] indicating that the high prevalence of overweight and obese children is dependent upon obesity among the family members.…”

Effectiveness of lifestyle intervention in overweight children

“…For example, younger age and a lower degree of overweight were associated with greater success in many studies (20,45,47) , underlining the benefits of an early intervention in childhood obesity.…”