[Current Guidelines to Prevent Obesity in Childhood and Adolescence]. / Aktuelle Empfehlungen zur Prävention der Adipositas im Kindes- und Jugendalter.

BACKGROUND: Current guidelines for the prevention of obesity in childhood and adolescence are presented. METHODS: A literature search was performed in Medline via PubMed, and appropriate studies were analysed. RESULTS: Programs to prevent childhood obesity were to date mainly school-based. Effects were limited to date. Analyses tailored to different age groups show that prevention programs have the best effects in younger children (< 12 years). Evidence based recommendations for preschool- and early school age imply the need for interventions addressing parents and teachers alike. During adolescence, school-based interventions were most effective when adolescents were directly addressed. To date, obesity prevention programs have mainly focused on behavior oriented prevention. Recommendations for condition oriented prevention have been suggested by the German Alliance of Non-communicable Diseases and include one hour of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory quality standards for meals at kindergarten and schools as well as a ban on unhealthy food advertisement addressing children. CONCLUSION: Behavior oriented prevention programs showed hardly any or only limited effects in the long term. Certain risk groups for the development of obesity are not reached effectively by available programs. Due to the heterogeneity of available studies, universally valid conclusions cannot be drawn. The combination with condition oriented prevention, which has to counteract on an obesogenic environment, is crucial for sustainable success of future obesity prevention programs.

Introducing excess body weight in childhood and adolescence and comparison with body mass index and waist-to-height ratio.

BACKGROUND: Weight status in children and adolescents is commonly defined using age- and gender-corrected standard deviation scores for body mass index (BMI-SDS, also called z-scores). Values are not reliable for the extremely obese however. Moreover, paediatricians and parents may have difficulties understanding z-scores, and while percentiles are easier to gauge, the very obese have values above the 99th percentile, making distinction difficult. The notion of excess body weight (EBW) is increasingly applied in adult patients, mainly in the context of bariatric surgery. However, a clear definition is not available to date for the paediatric population. METHODS: A simple definition of EBW for children and adolescents is introduced, with median weight as a function of height, age and gender (characterized by an asterisk): EBW (%) = 100x(weight-median weight*)/median weight*. EBW is compared with BMI-SDS and waist-to-height ratio (WHtR). Using two data sources (APV registry and German Health Interview and Examination Survey for Children and Adolescents (KiGGS)) including more than 14,000 children, the relationships between these anthropometric and various metabolic parameters are analysed for a group of overweight/obese children who have sought obesity therapy (APV), for the general paediatric population and for the subset of overweight/obese children from the general population (KiGGS). RESULTS: The three anthropometric parameters are strongly correlated, with the linear correlation coefficients exceeding 0.8 in the general population and 0.75 in those seeking obesity therapy. Moreover, their relationship to metabolic parameters is quite similar regarding correlations and area under the curve from receiver operating characteristic analyses. CONCLUSIONS: EBW has similar predictive value for metabolic or cardiovascular comorbidities compared with BMI and WHtR. As it is reliable at the extreme end of the obesity spectrum, easily communicable and simple to use in daily practice, it would make a very useful addition to existing tools for working with obese children and adolescents. Its usefulness in assessing weight change needs to be studied however.

[Certification of therapy institutions, obesity trainers, and obesity trainer academies by the German Working Group on Obesity in Children and Adolescents (AGA)]. / Was hat die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter durch die Zertifizierung von Behandlungseinrichtungen, Adipositas-Trainern und Adipositas-Trainer-Akademien erreicht?

There is a vast choice of behavioral therapy for obesity in children and adolescents, with wide differences in quality. In order to provide orientation for families, physicians, and health insurance companies, the German Working Group on Obesity in Children and Adolescents (AGA), which is affiliated with the German Obesity Society (DAG) and the German Pediatric Society (DGKJ), offers to certify institutions providing patient education programs for obese children and adolescents, obesity trainers, and academies for obesity trainers. Currently, 60 institutions offer obesity care, while 81 obesity trainers and 8 trainer academies are certified. This article summarizes requirements for certification and preliminary experience.

Epidermal growth factor receptor kinase domain mutations are rare in salivary gland carcinomas.

Activating mutations within the epidermal growth factor (EGFR) tyrosine kinase domain identify non-small cell lung cancer patients with improved clinical response to tyrosine kinase inhibitor therapy. Recently, we identified two EGFR mutations in a cohort of 25 salivary gland carcinomas (SGCs) by screening the tumour samples for the both most common hotspot mutations in exons 19 and 21 by allele-specific PCR. Here, we present a comprehensive sequencing analysis of the entire critical EGFR tyrosine kinase domain in 65 SGC of the main histopathological types. We found EGFR mutations in the tyrosine kinase domain to be a rare event in SGCs. No additional mutations other than the two known exon 19 deletions (c.2235_2249del15) in a mucoepidermoid carcinoma and an adenoid cystic carcinoma have been detected. Other putative predictive markers for EGFR-targeted therapy in SGCs might be relevant and should be investigated.

The role of taste and appetite regulation in the understanding of overweight and obesity. Proceedings of the 16th Aschauer Soiree, 26th April 2008.

Overweight and obesity have developed into major illnesses in most Western societies and significantly contribute to the financial burden of modern public health systems. Almost daily, new therapeutic proposals are published in the lay press, and also the scientific literature has increased dramatically in recent years. E.g., when searching MEDLINE (1966 - May 2008 (1)), the key word "obesity" meanwhile appears in more than 108,000 articles. Primary focus however, is put upon aspects of treatment, neglecting the role of taste and appetite regulation. Combining keywords like "obesity + treatment" results in over 50.000 citations, "obesity + diet" in over 23.000, "obesity + energy + expenditure" in over 13.000 citations (even "obesity + gastric + bypass" still evoke 2.600 citations), whereas "obesity + appetite + regulation" result in some 3.000, "obesity + NPY" - neuropeptid Y being one of the major chemical stimulators of appetite - evoke some 500 and "obesity + Arc + nucleus" - the arcuate nucleus being the anatomical centre of appetite regulation - no more than 370 scientific publications. The apparent scarcity of literature about taste and appetite regulation and the amazing lack of interest in neuronal information processing in overweight and obesity, has prompted the authors to brainstorm new aspects of the world-wide derailment of weight control.

Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany.

OBJECTIVE: Data of Jena children (Germany) show increases in the prevalence estimates of overweight and obesity between 1975 and 2001. Our objective was to determine if these increases contribute to changes in the distribution of body mass index (BMI) in the entire population of children. The decade 1985-1995, which includes the time of German reunification, is of particular interest because of the significant socio-economic changes in East Germany, in which Jena is located. DESIGN AND SUBJECTS: The analyses were based on data from four cross-sectional growth studies in 7- to 14-year-old children performed in Jena, Germany, in 1975 (n=2013), 1985 (n=1534), 1995 (n=1906) and 2001 (n=1918). Overweight and obesity were estimated by German reference data and the reference of Cole et al. Mean difference plots were used to investigate the changes in the BMI distributions within sexes between the studies. RESULTS: Between 1985 and 1995, the prevalence of overweight and obesity increased significantly in both sexes, whereas nonsignificant changes were found between 1975 and 1985. Although there is a tendency towards increased overweight between 1995 and 2001, the differences were nonsignificant. Comparing data from 1975 and 1985, the mean difference plots showed virtually no changes in the BMI distribution. In the plots comparing the BMI distribution for 1985 data and 1995 data, the whole distribution tended to shift upwards with a greater shift in the upper BMI range. The entire population of children in Jena gained weight during this period of time. This increase may be linked to a transition towards a more Western lifestyle, that is, usually by lower energy expenditure and nutritional transitions, caused by the process of reunification of Germany in 1989. CONCLUSIONS: Weight gain appears to be a characteristic feature of the entire population studied and does not seem to be a separate problem of the obese children. This suggests that reported changes in the prevalence may be underestimating the looming public health crisis.

[Long-term inpatient treatment of extreme juvenile obesity: an 18-month catamnestic study]. / Studie zur stationären Langzeittherapie der extremen juvenilen Adipositas. Jeder Zweite nimmt langfristig ab.

Eighteen months after completion of long-term treatment of 98 extremely overweight juveniles in the rehabilitation center Insula, this study revealed an improvement in the age-specific body mass index (BMI-SDS) in 55.1% of the cases, when all the non-responders (approx. 22%) were evaluated as failures. An improvement of at least 0.2 or 0.5 BMI SDS points was achieved in 41.8% and 21.4%, respectively.

Dental enamel defects in German medieval and early-modern-age populations.

SUMMARY: Aim of this study was to investigate the frequency and type of developmental defects of enamel (DDE) in a medieval and an early-modern-age population from Thuringia, Germany. Sixty-six skeletons subdivided into 31 single burials (12th/13th c.) and 35 individuals buried in groups (15th/16th c.) were examined. DDE were classified on 1,246 teeth according to the DDE index. Molar-incisor-hypomineralisation (MIH), a special type of DDE, was recorded according to the European Academy of Paediatric Dentistry (EAPD) criteria. DDE was found in 89.4% of the individuals (single burials 90.3% and group burials 88.6%). Hypoplastic pits were the most frequent defect in primary teeth and linear enamel hypoplasia (LEH) in permanent teeth. 13 individuals (24.1%) showed at least one hypomineralised permanent tooth, 12.2% had MIH on at least one first permanent molar and 10.0% in permanent incisors. Second primary molars were affected in 8.0% of the children and juveniles. No individual suffered from affected molars and incisors in combination. Endogenous factors like nutritional deficiencies and health problems in early childhood could have been aetiological reasons of DDE and MIH. The frequency of DDE and MIH might have been masked by extended carious lesions, dental wear and ante-mortem tooth loss.

[Freiburg intervention program for ambulatory therapy of obesity in childhood (FITOC)]. / Freiburger Interventionsprogramm zur ambulanten Therapie der Adipositas im Kindesalter (FITOC).

In this study we first try to answer the question, whether it is possible to make a successful treatment for obese children in an interdisciplinary program. Second it is asked whether a transfer of this program to further regions in Germany leads to comparable results. In FITOC children from the age of 8-11 years and over the 97. BMI-percentile are integrated in this program. The goals weight management, increased physical fitness and improvement of the cardiac risk profile are checked by weight, height, fasting blood serum, a standardized cycle ergometry and a medical measurement at the beginning, after treatment and at all check-ups. The recorded medical data show clearly that the intervention leads to a significant improvement in almost all checked parts. The successful treatment can be recorded after 8 months, likewise after 2.5 years as a long-term result. The further cornerstones of FITOC nutrition and psychology are not subject of this publication. In future the psychological part in FITOC will be evaluated by standardized inventories. The group from Düren has a success in therapy according to the definition of the program. Thereby it is shown that FITOC is extendable, if teams are trained intensively and the conditions are comparable. FITOC is able to treat obese children successfully over a long period of time. In consideration of the rising prevalence of obesity in childhood and the limited financial resources in health care this outpatient interdisciplinary program is an effective choice of treatment.

[Ever more children and adolescents are overweight. How can the obesity epidemic be stopped?]. / Immer mehr Kinder und Jugendliche zu dick. Wie lässt sich die Adipositas-Epidemie stoppen?

In Germany, the number of overweight children and adolescents is increasing. The increase in the prevalence of obesity shows considerable regional differences. Related to recent German reference data with an expected prevalence of 3%, we find today in some regions a prevalence of 7% in 5- to 6-year-olds and 8% in 13- to 15-year-olds. While the reasons for this development are not fully clear, it may be assumed that the increase in physical inactivity, together with the ready availability of an abundance of high-energy foods are significant contributing factors. A large percentage of children and adolescents suffering from obesity also have considerable co-morbidity. It is to be expected that this will in the future considerably increase the financial burden on public health care and society as a whole. Effective prevention and therapeutic countermeasures are necessary to deal with this problem.

"Obese equals lazy?" analysis of the association between weight status and physical activity in children.

INTRODUCTION: Literature provides evidence that overweight children are more sedentary. To verify this generalized statement behavior patterns of overweight and nonoverweight children needs to be understood. Therefore, we investigated the distribution of sedentary and activity levels in a quantitative and qualitative way. METHODS: Data was collected from 37 randomly selected nonoverweight and 55 overweight children. They were 8 to 11 years of age. Height and weight were measured and weight status was characterized by BMI (BMI-percentile, BMI-SDS). Daily PA (physical activity) was measured by direct accelerometry. Spare time and screen time entertainment were obtained by questionnaires. RESULTS: The amount of time spent "passive" was significantly higher in overweight children, while nonoverweight children were more "active." The multiple regression model shows a significant association between weight status (BMI-SDS) and activity parameters. Additionally, screen time entertainment was significantly related to BMI-SDS. CONCLUSION: The results support the statement that overweight children are less active than nonoverweight children. The high amount of PA seems to be an important factor to prevent overweight in children given that PA shows the highest correlation to weight status. Quantitative and qualitative measurements are needed for further analysis.

Adiposity rebound is misclassified by BMI rebound.

BACKGROUND/OBJECTIVES: Adiposity rebound (AR) is defined as the nadir or the inflexion point of body mass index (BMI) percentiles between the age of 3 and 7 years. An early rebound is seen as a risk of obesity and, thus, AR is considered as a suitable time period for prevention. As BMI does not reflect body composition, we aimed to examine the rebounds of fat mass index (FMI) and fat-free mass index (FFMI) together with BMI. SUBJECTS/METHODS: Cross-sectional data of 19 264 children aged 3-11 years were pooled from three German studies (Kiel Obesity Prevention Study, the project 'Better diet. More exercise. KINDERLEICHT-REGIONS' and regular examinations of Jena children). Height and weight were measured. Fat mass (FM) and fat-free mass (FFM) were obtained from bioelectrical impedance analysis and analysed using a population-specific algorithm. Percentiles of BMI, FMI and FFMI were constructed by the LMS method. RESULTS: Both BMI and FMI percentiles showed a rebound, whereas FFMI percentiles steadily increased with age. On P90, FMI rebound was about 1.6-1.8 years later compared with that of BMI, that is, at ages 4.2 years (BMI) and 5.8 years (FMI) in boys and at 4.2 years (BMI) and 6.0 years (FMI) in girls. At AR, the slope of the BMI-P90 was explained by increases in FFMI rather than FMI. By contrast, at FMI rebound, the slope of BMI was strongly related to FMI. CONCLUSIONS: BMI rebound does not equal the rebound of FM. At AR, the slope in BMI is determined by the increase in FFMI. AR should be defined as FMI rebound rather than BMI rebound.

Percentile curves for skinfold thickness in 7- to 14-year-old children and adolescents from Jena, Germany.

OBJECTIVE: To present age- and sex-specific percentile curves for triceps and subscapular skinfold thickness, and to investigate long-term changes in skinfold thickness in children. SUBJECTS/METHODS: A cross-sectional study of children and adolescents was conducted in Jena/Germany in 2005/2006. The sample consisted of 2132 children (1018 girls and 1114 boys) aged 7-14 years and equated to the anthropometric characteristics of the German sample included in the reference values for body mass index (BMI). Height, weight and triceps and subscapular skinfold measurements were obtained using standardized methods. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived by the LMS method. Data were compared with historical data of Jena schoolchildren from 1975. RESULTS: In both sexes, skinfold thickness increased between 7 and 14 years of age in a sex-specific pattern, with generally higher median values for triceps and subscapular skinfold in girls than boys. A comparison with skinfold thickness measured in Jena schoolchildren three decades ago showed a significant increase in subcutaneous fat. The changes in the lower range (below the tenth percentile) of the distribution exceed those in the upper range (above the 90th percentile) for both triceps and subscapular skinfold in both sexes. Furthermore, this gain in subcutaneous fat mainly occurred in underweight and normal-weight subjects, whereas skinfold thickness remained nearly unchanged in overweight subjects. CONCLUSIONS: The up-to-date percentile curves for skinfold thickness provide a basis for monitoring of individuals and evaluation of long-term trends in German children and adolescents. The changes in skinfold thickness indicate an unfavourable increase in adiposity, as well as an unfavourable change in the relationship between BMI and body fat in children and adolescents over time.

Validity of body mass index and waist circumference to detect excess fat mass in children aged 7-14 years.

BACKGROUND/OBJECTIVES: To evaluate the screening performance of body mass index (BMI) and waist circumference (WC) for excess adiposity. In addition, the diagnostic accuracy of cutoffs from different international and national reference systems based on BMI and WC was investigated. SUBJECTS/METHODS: Data from 2132 Jena children aged 7-14 years conducted in 2005/2006 were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess BMI and WC, as screening measures for excess adiposity (derived from skinfolds). Sensitivity, specificity and positive predictive values (PPVs) were calculated for two BMI-based classification systems (IOTF and German reference) and sample-based WC cutoffs. RESULTS: The BMI as well as the WC performed well in detecting excess fat mass, indicated by areas under the ROC curve (AUC) close to 1.0, with slightly greater AUCs for BMI than for WC in both sexes. The specificity of all reference systems was high for both sexes (95 to 98%). However, their sensitivities were low (53-67% in boys; 51-67% in girls). PPV were higher for the German reference and the sample-based WC cutoffs than for the IOTF reference, and higher in girls than in boys. CONCLUSIONS: The setting in which the reference system should be used is important for the selection of the reference system. The results support the use of the BMI-based references for monitoring in epidemiological studies. The sample-based cutoffs for WC should be refined for clinical use on national level.

The psychosocial situation of obese children: Psychological factors and quality of life.

The psychosocial situation of obese children at the beginning of the Freiburg Intervention Trial for Obese Children (FITOC) program influences the course and outcome of intervention therapy. At the beginning of FITOC, mothers of 30 children (12 ♂ age 10.5 ± 1.4, 18 ♀; 10.2 ± 1.3) rated the psychopathological symptoms using the Child Behavior Checklist (CBCL) and the quality of life of their children (Inventar zur Erfassung der Lebensqualität [ILK]). 46.6% of mothers rated their children to be disturbed (normal population group, 2% disturbed). There was no correlation between the body mass index of the child and the CBCL score. On the ILK, the obese children themselves selected "good" while the mother's view of their childrens' quality of life varied around "poor". The stress on the mother increased with the degree of the child's obesity and number of critical life events (p = 0.030). The CBCL and the ILK at the beginning of treatment serve as a good screening instrument for psychopathology and distress in children with obesity.

Motor abilities and aerobic fitness of obese children.

Obesity is considered to be epidemic worldwide. Stopping further progression interdisciplinary, outpatient intervention therapy programs for obese children have become increasingly important. FITOC (Freiburg Intervention Trial for Obese Children) consists of a combination of organized sports, behavioral therapy and nutritional advice. The effectiveness of the therapy is determined on the basis of anthropometrical and physical performance data. The purpose of this report is to give a differentiated view of the motor abilities of obese children and to describe changes in the course of the therapy program FITOC. Data were collected on n = 49 obese children (BMI > 97th percentile) aged 8 - 12 in a pretest at the beginning and posttest at the end of the intensive phase of the therapy. These data were compared with an age-matched German reference group. Besides the General Sports-Motor Test (Allgemeiner Sportmotorischer Test [AST]), the BMI-SDS values, the body fat mass (FM %) and the aerobic capacity (Watt/kg body weight) were recorded. In the pretest, the running exercise results and the aerobic capacity checked ranged significantly below the values of the reference group. The performance in the coordinative tests of the AST was differentiated. The medicine-ball toss was significantly above average of the reference group. In the posttest, the BMI-SDS values and the body fat mass (% FM) decreased (p < 0.001) and the aerobic capacity improved (p < 0.001). Performance in all motor abilities tests improved and the difference between the strength of the obese children and the strength of the reference group decreased. This study demonstrates that in obese children weight-bearing activities are below average but not all motor abilities.

Freiburg Intervention Trial for Obese Children (FITOC): results of a clinical observation study.

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 lipoprotein-cholesterol (HDL-C) and physical performance were measured initially and after 8.5 months. A group of n = 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/m2) as well as BMI deviation scores (BMI-SDS) decreased in both sexes (P<0.001). In the controls, BMI increased (P<0.001) and BMI-SDS remained constant. Whereas CH was only significantly lower (P<0.01) 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 (P<0.001), 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.

[Results of the study of selected head measurements of Jena children]. / Ergebnisse der Untersuchung ausgewählter Kopfmasse bei Jenaer Kindern.

Secular changes of head measurements (frontal breadth, bizygomatic breadth, bigonial breadth, auricular height, morphological facial height, lower face height) are analysed. The data are based on the Jena anthropological investigations of school children from 1975 and 1985. The inclusion of the data of the Jena longitudinal study carried out since 1985 allows an analysis of the further secular trend. Noticeable changes are proved in most of the analysed traits (frontal breadth, bigonial breadth, auricular height, morphological facial height, lower face height) between 1975 and 1985. The vertical measurements show greater percentage differences than the horizontal measurements, which, among other things, results in a relative narrowing of the face. In some head measurements (frontal breadth, bigonial breadth, auricular height) the trends continue after 1985. The secular trends show no obvious connection with the temporal acceleration of the dentition in the probands of the longitudinal study. However, a connection seems to be possible between the accelerated puberal growth spurt of the body height and the puberal growth spurt in some head dimensions.

[The phenomenon of debrachycephalization in Jena school children]. / Das Phänomen der Debrachykephalisation bei Jenaer Schulkindern.

Head measurements are performed within the anthropological investigations of school children from Jena (Germany) since more than 5 decades (1944-1995). Here we report on secular changes of the head length, the head breadth and the cephalic index. The head circumference, measured in 1985 and in 1995, is included in the analysis. Head length and head breadth show a contrary development over the whole period: the average length of the head increases between the consecutive investigations, whereas the breadth of the head decreases continuously between the separate investigations. As a consequence the cephalic index decreases in boys and girls for about 8 units since 1944. In this way a secular change of the shape of the head in the sense of debrachycephalisation can be proved in Jena school children. The head circumference, however, remains nearly constant between 1985 and 1995. Possible causes of this process of debrachycephalisation are focussed in this article.

Prevalence of overweight and obesity among school children in Jena (Germany).

OBJECTIVES: To examine the prevalence and changes in the prevalence of overweight and obesity among school children in Jena (Germany) in the last twenty years and to identify factors associated with childhood overweight. DESIGN: Cross-sectional surveys in 1975, 1985, 1995 and a household questionnaire in 1995. SUBJECTS: Children from schools in Jena, aged 7-14 y, participated (1975 : 1002 boys and 1000 girls; 1985 : 781 boys and 753 girls; 1995 : 989 boys and 912 girls). MEASUREMENTS: Prevalence of overweight or obesity based on the 90th or 97th age- and sex-specific percentile of the body mass index (BMI) developed for French children. In 1995 factors examined in relation to overweight included birth weight, birth length, age-class, number of children in household, occupation of the father, education of the mother and size of flat (apartment). RESULTS: In boys the prevalence of overweight increased from 10.0 to 16.3% and in girls from 11.7 to 20.7% between 1975 and 1995. The prevalence of obesity increased from 5.3 to 8.2% in boys and from 4.7 to 9.9% in girls between 1975 and 1995. However, the peak in the increase of overweight as well as of obesity lie for both sexes between 1985 and 1995. Using logistic regression, statistically significant associations with overweight were found for occupation of the father, birth weight in both sexes and additionally, for size of flat in girls. CONCLUSIONS: Overweight and obesity are increasing health problems among Jena children. Further investigations are needed to explore the influence of factors such as feeding pattern, food habits and physical activity on overweight. Special attention should be paid to the further social development in the society and to the link between low social class and overweight. Through such investigations effective preventive strategies could be developed.