[Evaluation of an outpatient treatment program for obese children and adolescents].
BACKGROUND
In Germany the number of children with elevated body weights has significantly increased in the last 10 to 15 years. Resulting comorbidities lead to increasing costs for the community. The quality of life of these children is reduced.


METHODS
84 children and their families have been included in the study. In addition to anthropometric data informations on eating behaviour and psychosocial data of the family have been documented. At the beginning of the intervention the children had an age of 10.36 +/- 3,27 years and a BMI-SDS of 4,78 +/- 1,16. The mean time period for follow-up has been 28,7 months (mean).


METHODS
Children have been treated within a family-based intervention program in a setting focusing on behaviour modification over 6 months (sessions every 4 th week). Patients have been treated in four different intervention groups (behaviour modification and eating counselling (a),a' plus one parent group session (b),b' plus two courses in cooking and preparing meals for parents and children, (c), the fourth group has been treated in addition within a more intensive inpatient setting for 6 weeks.


RESULTS
Drop out rate has been 37,1 %. The weight reduction during the treating period has resulted in a reduction of the BMI-SDS of 0.57 +/- 0.51 (p = 0.0001). 33.7 % of the patients investigated during follow-up (n = 30) have not changed or even reduced their achieved body weights (BMI-SDS). In a stepwise multiple regression analysis the variables age of the patient, self-control of eating behavior and weight of the father explained 70 % of the variance of weight changes during the follow-up period. There have been no differences between the changes in BMI-SDS during follow-up between patients in groups,a',b' or,c' and the group taking part in addition in the in-patient setting.


CONCLUSIONS
Treatment programs for obese children and adolescents have to focus on the specific living conditions and eating behaviours of the family especially on age, capacity for self control of the child and the eating behaviour of the father. Local networks to be established within the country for treating obese children coordinated by the paediatrician seem to be best possibilities to provide individual support. In this local networks the prevention of extreme eight increases must be a predominant task.
Weyhreter
H
H
Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin Ulm. helmut.weyhreter@medizin.uni-ulm.de
Tannhäuser
S
S
Muche
R
R
Debatin
M
M
Heinze
E
E
Strittmatter
U
U
Räkel-Rehner
S
S
Wabitsch
M
M
D000293:Adolescent; D000553:Ambulatory Care; D001521:Behavior Therapy; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D003296:Cooking / Q000379:methods; D005196:Family Therapy; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008016:Life Change Events; D008297:Male; D052756:Nutritional Sciences / Q000193:education; D009765:Obesity / Q000145:classification / Q000523:psychology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D012307:Risk Factors