[Prevention and therapy of obesity with diet and sports, an ambulatory therapy program for overweight children].

Dietary restriction together with ongoing power-orientated training provide best results in the therapy and prevention of obesity. Diet can reduce the resting metabolic rate by up to 20% within 14 days. Physical activity stimulates the resting metabolic rate and counteracts this energy saving effect, but is especially important for maintaining a steady state after weight reduction. Exercise reduces the risk factors accompanying obesity by favorable adaptation of the sympathoadrenergic system to physical activity. This can be seen in the effects on heart rate, stroke volume, blood pressure, as well as glycogenolytic and lipolytic activities. Body fat especially in the abdominal area, which is particularly connected with atherogenic risk, is diminished. Weight reduction is accompanied by a decrease of the cardioprotective cholesterol fraction. Diets high in unsaturated fatty acids combined with a staying power training have a synergistic effect: they reduce a decrease of HDL. It is difficult to demonstrate risk factors connected with overweight children. However, from the preventive medicine point of view it is advisable to start with therapeutic measures during childhood. In an out-patient pilot project we surveyed 18 obese children aged 9 to 13 years. The therapy plan consisted of dietary restriction (1200 kcal/d), an exercise program performed 3 times a week, and psychological assistance. All children of 12 to 13 years arrived at an overweight level less than 20%, the younger ones displayed a lower weight reduction effect. All 18 improved their aerobic capacity. In the 1st months of treatment, HDL-cholesterol decreased slightly, but increased above pre-treatment level, later on. We did not see any vitamin deficiencies during the therapeutic regimen.