[Which Factors Affect Weight Maintenance? A Qualitative Study with Adolescents and their Parents who have Completed a Ten-months Intervention]. / Welche Faktoren beeinflussen die Gewichtsstabilisierung nachhaltig? Eine qualitative Befragung von Kindern und Jugendlichen sowie deren Eltern, nach Teilnahme an einem Gewichtsreduktionsprogramm.

BACKGROUND: The alarming increase in the prevalence of childhood obesity is recognised as a major public health concern. Currently, structured multi-modal therapy programmes present the gold standard of therapy strategies for obese children and adolescents. However, effects of these treatments are still a matter of discussion. Failure to isolate and understand the external and internal factors contributing to successful, long-term weight reduction may well be contributing to the ineffectiveness of current treatment interventions. OBJECTIVE: A qualitative approach was chosen in order to identify subjectively perceived resources and barriers to weight maintenance after previous weight reduction. The research question focused on how these resources and barriers affect success of participants. Additionally the question arose as to how and to what extent parents should and could be involved in the therapy process. The results can deliver important starting points for the development of therapy programmes and future research. METHOD: 7 participants of a weight reduction and maintenance programme and 7 of their parents were interviewed on their personal experiences during and after the treatment. The interviews were analysed based on the qualitative content analysis. RESULTS: Continuous motivation, especially after the initial weight reduction phase, was identified as the strongest predictor of successful weight maintenance. Successful weight maintainers generally showed characteristics of higher self-efficacy, internal motivation concerning physical activity and flexible self-control concerning food intake. Unsuccessful weight gainers stated a lack of motivation concerning physical activity and lost control over their eating habits. Concerning the role of parents in the therapy process, the results show that higher parental involvement does not predict greater success. The general relationship between parents and their children seems to be more significant, especially concerning the issues of responsibility. CONCLUSION: It is disputable to what extent the post treatment intervention contributed to the development of intrinsic motivation. More attention should be paid to the age (children or adolescents) of participants of therapy programmes, especially concerning the involvement of parents. It is assumed that general aspects of education should be discussed with parents.

[The influence of migration background and parental education on childhood obesity and the metabolic syndrome]. / Adipositas bei Kindern und Jugendlichen - Einfluss von Migrationshintergrund und Bildung der Eltern auf das Auftreten eines metabolischen Syndroms.

Obesity and metabolic syndrome are important risk factors for cardiovascular diseases. In this study, the influence of migration background and parental education on the degree of obesity and the presence of the metabolic syndrome (MS) in children and adolescents (N=492) requiring sociopediatric care were investigated. Two regression models were computed with the dependent variables BMI-SDS and MS, respectively. Age, gender, migration background, and parental education were used as independent variables. When controlling for age and gender, higher BMI-SDS were found among Turkish patients (ß=0.21; p=0.002) and patients with other migration backgrounds (ß=0.11; p=0.085) compared to German patients. The BMI-SDS values were also higher among patients from families with a low parental education level compared to those with a higher education level (ß=0.31; p<0.001). The key risk factor for MS is the BMI-SDS (OR: 8.9; p=0.011). No influence could be determined for migration background and parental education, when controlling for age, gender, and BMI-SDS. Obesity therapy should be increasingly tailored to the needs of identified risk groups. This will also allow for a targeted prevention of comorbidities.

Ethnicity and comorbidities in an overweight and obese multiethnic childhood cohort in Berlin.

AIM: This study aims to analyse the association between ethnicity, elevated metabolic parameters and metabolic syndrome (MS) in a multiethnic cohort of overweight to obese children and adolescents. METHODS: For 1053 patients, standard deviation of body mass index (BMI-SDS) was calculated and metabolic parameters (fasting blood glucose, fasting insulin, homeostasis model assessment-IR, lipids, blood pressure) were measured. MS was defined by WHO criteria. Bivariate and multivariate analyses were performed. Adjusted differences in BMI-SDS and metabolic parameters between different migration groups were assessed with linear regression models. The risk for MS was calculated with multiple logistic regression models. RESULTS: Forty-eight per cent of the children were German, 25% Turkish and 27% had another ethnicity. Concerning weight status, 23% are overweight, 31% obese and 46% extremely obese with higher rates among the immigrant population. Multivariable models indicate significant associations between elevated metabolic parameters and higher BMI-SDS values. Overall prevalence of MS was 32.3%. MS was detected significantly more often among Turkish patients (40.4%) compared to Germans (27.3%; p=0.02). Logistic regression analysis showed a greater risk for MS with older age (OR=1.09; p=0.003) and Turkish ethnicity (OR=1.62; p=0.02). CONCLUSION: Nearly all patients had symptoms of MS, and 40% had MS showing that this highly health-threatening condition is quite common. Therefore, effective therapy and prevention efforts must be developed for this high risk group. More migration-specific research regarding insulin resistance, MS and Type 2 DM is needed.

[Association between health-related quality of life and selected indicators for 10- to 15-year-old girls in Berlin]. / Einflussfaktoren auf die gesundheitsbezogene Lebensqualität von 10- bis 15-jährigen Mädchen in Berlin.

OBJECTIVE: The state of knowledge on health-related quality of life (HRQOL) is incomplete. The influence of social and behavioural factors on HRQOL of 10- to 15-year-old girls was investigated. METHOD: The Berlin School Children's Cohort (BSCOC-cross-sectional study 2006-2007) included 1 842 girls and their parents (n=1 683) in Berlin. Height and body weight were measured. A standardised questionnaire to capture the HRQOL of the girls (KINDL(®) questionnaire) and possible influencing factors was used. The association of the variables age, social situation, migration background, family situation, weight status, menarche status, eating behaviour and illness in the last weeks with the HRQOL and its partial scales were controlled for using the Kruskal-Wallis test. Variables which showed a statistically significant relationship with HRQOL were included as independent variables in a linear regression model with the outcome variable HRQOL to test their influence and quantify it. RESULTS: In comparison to the KINDL reference values (KiGGS), the HRQOL values of the assessed girls are lower. Quality of life is unfavourably swayed by age, low social status, two-sided migration background, sickness in the last few weeks, little physical activity, unfavourable eating behaviour, overweight and obesity and when post-menarche. With the exception of migration background and menarche status, all results were confirmed in the multivariate model. CONCLUSION: The results of the linear regression model demonstrate a higher importance of body and behaviour-related factors and places and confirm the relevance of past prevention and health promotion in the named areas also for the HRQOL of the girls.

Is there a further acceleration in the age at onset of menarche? A cross-sectional study in 1840 school children focusing on age and bodyweight at the onset of menarche.

OBJECTIVE: More than 30 years ago Frisch and Revelle proposed a body weight threshold for the onset of menarche. Based on this hypothesis, a further acceleration of age at menarche can be expected in times of childhood obesity. DESIGN: A cross-sectional study of 1840 healthy school girls (Berlin school children's cohort, BSCOC) within the age groups 10-15 years was conducted in 2006-2007. METHODS: Median age of menarche was calculated by Kaplan-Meier survival analysis. Bi- and multivariate analyses were performed to analyze the associations between menarche age and weight status. A locally weighted regression was used to analyze the relationship respectively between height, weight, and body mass index (BMI)-SDS and age stratified by menarche status. RESULTS: Nine hundred and thirty six (50.9%) girls had already experienced menarche at a median age of 12.8 years. Two hundred and thirty six of these girls reached their menarche recently. Obese/overweight girls reached menarche significantly earlier (12.5 years), than normal weight (12.9 years), and underweight girls (13.7 years). The mean total body weight was similar in all girls at menarche irrespective of age (mean 51.1 kg, s.d. 8.1) and height. BMI-SDS remained the only significant factor for onset of menarche within a multiple regression model for early menarche (OR 2.1, 95% confidence interval 1.3-3.3, P=0.002). CONCLUSIONS: Age at onset of menarche did not accelerate even in a childhood population with more than 10% obesity prevalence. Nevertheless, a negative correlation of BMI-SDS with age at onset of menarche exists.