Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany.

OBJECTIVES: Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. STUDY DESIGN: All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. METHODS: Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease. RESULTS: On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%. CONCLUSIONS: This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.

Early mother-child relationship. The Copenhagen model of early preventive intervention towards mother-infant relationship disturbances.

The development of interactive patterns in the first year of life has been studied in healthy mother-infant pairs and in infants whose mothers have psychiatric or psychosocial problems, interfering with their relation to the child. During the first 3 months a relationship develops in healthy mother-infant pairs characterized by an intimate interchange of signals and responses between mother and child. The baby develops a basic pattern of social relating. During the next months the baby begins to expect the mother to fulfil it's wishes and still the mother adapts to and supports the baby's expanding capacities and needs. A beginning sense of self and not-self develops. At 10-12 months the infant is able to move around trying to examine everything within range. At this age the infant senses that there exist other wills and minds than it's own. The child looks at the mother and reads her expressions for "yes", "no", and "maybe". The mother can stop or encourage her child by verbal and body signals. At 12-18 months the child has developed a secure attachment apt to protect the child against later adversities. The development during the first year of life may be seriously disturbed if the mother cannot adapt to and support the baby's signals and needs. Relationship disturbances in the first year of life may be related to maternal or infant problems: Low birth weight babies, irritable babies with low stimulus tolerance and babies with withdrawal reactions following maternal alcoholism or drug abuse during pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Mother-infant relationship in the first year of life.

The development of interactive patterns in the first year of life has been studied in healthy mother--baby pairs and in infants whose mothers have psychiatric or psycho-social problems which interfere with their contact with the child. During the first 2-3 months a relationship develops in healthy mother--baby pairs characterized by an intimate interchange of signals and responses between mother and infant. The baby's inborn capacity of imitation and regulation of visual/auditive stimulation gradually is patterned and supported by the mother's empathetic response. 2-3 months old the baby has developed a basic pattern of social relating. This development is not seen if the mother cannot adapt to and support the baby's signals. In cases with simple social privation the baby seems not to "know" how to use social contact. In cases with active failure in the mother's response a pattern of emotional withdrawal develops where the baby avoids eye contact, does not engage in vocal dialogue and is easily upset when offered social contact. During the next months motor development enables the baby to reach out for things in the outer world: rattles, mother's face, own feet etc. A beginning sense of self and not-self develops. The baby expects the mother to guess and fulfil it's wishes and still the mother adapts to and supports the baby's expanding capacities and needs. In contrast the baby with a non-adapting mother may, or may not show a normal interest in reaching out for inanimate things. But the social withdrawal hinders the infant in reaching out for the mother's face and body. A limited interest in handling, mouthing and examining objects is often seen, lending the baby's activities an avital and stereotype quality. The baby does not expect the mother to guess and fulfil it's wishes. It's experience with self and not-self is narrowed and deprived of the rich and varied social interaction of the healthy mother--baby pairs. At 10-12 months the infants are able to move around trying to handle and examine everything within their range. At this age healthy infants are able to sense that there exist other wills and minds than their own. The mother can encourage or stop the child by verbal and body signals. The child may compromise or protest and you will sense it's personality.(ABSTRACT TRUNCATED AT 250 WORDS)