[Quality indicators for ambulatory health education programme for overweight and obese children and adolescents].
BACKGROUND
In Germany, 9 to 12 % of all children between five and seven years of age have been shown to be overweight at school entry; 2.5 to 3.5 % of them are obese. Therapeutic intervention for obese children and adolescents is considered to be indicated especially in cases where an increased body mass index (BMI) is accompanied by a disease the effective treatment of which requires weight loss. Furthermore, the child and its family must be willing to actively change their habits.


OBJECTIVE
A multitude of health care providers have begun to offer multidisciplinary group programme for prevention and treatment of obesity to affected individuals and their families. The Medical Service of the Statutory Health Insurance (MDK) has therefore developed a list of quality and assessment criteria for such programme.


METHODS
A systematic search for information in international and national publications was performed using standard methodology of evidence-based medicine. Data were extracted and assessed according to pre-defined criteria taking into consideration previously published clinical guidelines and opinions of expert panels.


RESULTS
Nearly all available studies were of low internal validity and mostly of poor methodological quality. Therefore, no binding recommendations for the design of health education programme for overweight and obese children and adolescents can be given. Potentially successful intervention should combine the following 4 modules: nutrition, physical activity, change of eating habits, physical activity habits and life style using methods of behavioural therapy, and involvement of parents. Such combinations may have the potential to reduce or stabilise the BMI at least during a defined period of time. In younger children, the beneficial effect will be more pronounced if the parents are actively involved.


CONCLUSIONS
Up to now informative studies have not reliably shown that the effect of ambulatory health education programmes for overweight and obese children and adolescents and their parents may last for more than one or two years. Therefore, a controlled clinical trial determining the long-term effectiveness of such programme is imperative. The decision whether a defined programmes should be included in such a study could be taken on the basis of the quality indicators and assessment criteria described here.
Böhler
T
T
MDK Baden-Württemberg. t.boehler@mdkbw.de
Alex
C
C
Becker
E
E
Becker
R
R
Hoffmann
S
S
Hutzler
D
D
Jung
C
C
Laufersweiler-Lochmann
F
F
Radu
C
C
D000553:Ambulatory Care / Q000592:standards*; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003131:Combined Modality Therapy / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D006266:Health Education / Q000592:standards*; D006801:Humans; D008297:Male; D009765:Obesity / Q000534:rehabilitation*; D019984:Quality Indicators, Health Care / Q000592:standards*