title: Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey).
abstract: BACKGROUND
  Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction.
  
  
  METHODS
  In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 ± 2.4 years, BMI 31.2 ± 5.4 kg/m², BMI-SDS 2.51 ± 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape).
  
  
  RESULTS
  66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 ± 0.09 mm (range, 0.40-0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45-0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 ± 4.1 (range, 28-49) days, children and adolescents reached a mean weight reduction of 5.52 ± 3.94 (0.4-13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being (β = -0.543), resilience (β = 0.434) and intrafamilial conflicts (β = 0.315).
  
  
  CONCLUSIONS
  The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.
authors.affiliation: MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik f&#252;r Kinder und Jugendliche, D-17424 Heringsdorf, Germany. r.schiel@medigreif-inselklinikum.de.|Mathias-Hochschule, University of Applied Sciences, D-48431 Rheine, Germany. r.schiel@medigreif-inselklinikum.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schiel
authors.affiliation: MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik f&#252;r Kinder und Jugendliche, D-17424 Heringsdorf, Germany. alexander_kaps@yahoo.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaps
authors.affiliation: Internal Medicine, Friedrich-Schiller-University, D-07745 Jena, Germany. stein.guenter37@gmail.com.
authors.forename: Günter
authors.initials: G
authors.lastname: Stein
authors.affiliation: Internal Medicine A, Ernst-Moritz-Arndt-University, D-17489 Greifswald, Germany. antje.steveling@uni-greifswald.de.
authors.forename: Antje
authors.initials: A
authors.lastname: Steveling
keywords: body-mass index; carotid intima-media thickness; quality of life; resilience