title: Comorbidities in overweight children and adolescents: do we treat them effectively?
abstract: OBJECTIVE
  The aim was to analyze the effectiveness of treatment concerning obesity-associated comorbidities in clinical practice.
  
  
  METHODS
  A total of 11,681 overweight children with ≥ 6-month follow-up treated at 175 centers specialized in pediatric obesity care in Central Europe were included in this analysis (mean body mass index (BMI) 29.0 ± 5.6 kg m(-)(2), standard deviation score body mass index (SDS-BMI) 2.48 ± 0.54, 45% boys, age 11.4 ± 2.8 years). The changes of weight status, blood pressure, fasting lipids and glucose, and oral glucose tolerance tests were documented by standardized prospective quality documentation software (APV).
  
  
  RESULTS
  After follow-up of in median 1.2 (interquartile range 0.9-2.2) years, a mean reduction of -0.15 SDS-BMI was achieved. The prevalence of prehypertension (37->33%) and hypertension (17->12%) decreased, while prevalences of triglycerides >150 mg dl(-1) (22->21%), low-density-lipoprotein-cholesterol >130 mg dl(-1) (15->14%), impaired fasting glucose (6->6%) and impaired glucose tolerance (9->8%) remained stable. Drug treatment according to cutoffs recommended in European obesity guidelines were not frequently indicated (hypertension: 10%; dyslipidemia: 1%, type 2 diabetes <1%). None of the children with dyslipidemia received lipid-lowering drugs and only 1.4% of the children with hypertension were treated with antihypertensive drugs.
  
  
  CONCLUSIONS
  Achieving sufficient weight loss to improve obesity associated comorbidities was difficult in clinical practice. Drug treatment of hypertension, dyslipidemia and type 2 diabetes was rarely performed even if it was indicated only in a minority of the overweight children. Future analyses should identify reasons for this insufficient drug treatment of comorbidities and analyze whether the benchmarking processes of APV improve medical care of childhood obesity.
authors.affiliation: Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany. T.Reinehr@kinderklinik-datteln.de
authors.forename: T
authors.initials: T
authors.lastname: Reinehr
authors.forename: S
authors.initials: S
authors.lastname: Wiegand
authors.forename: W
authors.initials: W
authors.lastname: Siegfried
authors.forename: K M
authors.initials: KM
authors.lastname: Keller
authors.forename: K
authors.initials: K
authors.lastname: Widhalm
authors.forename: D
authors.initials: D
authors.lastname: l'Allemand
authors.forename: K
authors.initials: K
authors.lastname: Zwiauer
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000328:Adult; D001317:Austria / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D015897:Comorbidity; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology
chemical_list: D008055:Lipids