title: Predictors and determinants for weight reduction in overweight and obese children and adolescents.
abstract: BACKGROUND
  Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. This multicenter non-randomised trial aimed to identify parameters and determinants of long-term weight reduction.
  
  
  METHODS
  A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9±2.4 years, BMI 31.2±5.4kg/m2, BMI-SDS 2.51±0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient 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, standardized questionnaires to assess socio-demographic and socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape).
  
  
  RESULTS
  66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53±0.09mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45mm), 40% a slightly elevated (≥ 0.45 to ≤ 0.50mm) and 45% an elevated (> 0.50mm) thickness. After the inpatient treatment lasting 40.4±4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52±3.94 (0.4 to 13.3) kg (p<0.01) that was accompanied by a reduction in body fat mass. Using 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 sense of coherence (β=0.315).
  
  
  CONCLUSIONS
  The different parameters (i. e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs.
authors.affiliation: MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Ostseebad Heringsdorf, Germany. Electronic address: r.schiel@medigreif-inselklinikum.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Schiel
authors.affiliation: MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Ostseebad Heringsdorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaps
authors.affiliation: Friedrich-Schiller-University, Internal Medicine, Jena, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Stein
authors.affiliation: Ernst-Moritz-Arndt-University, Internal Medicine A, Greifswald, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Steveling
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D059168:Carotid Intima-Media Thickness; D002648:Child; D005858:Germany; D006801:Humans; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D015431:Weight Loss
keywords: Adipositas; BMI; Kohärenzsinn; Lebensqualität; Resilienz; Wohlbefinden; body mass index; obesity; quality of life; resilience; sense of coherence; well-being