Schiel Ralf, Kaps Alexander, Stein Günter, Steveling Antje
MEDIGREIF-Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, D-17424 Heringsdorf, Germany.
Mathias-Hochschule, University of Applied Sciences, D-48431 Rheine, Germany.
Healthcare (Basel). 2016 Jan 7;4(1):5. doi: 10.3390/healthcare4010005.
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.
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).
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).
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.
在全球范围内，超重和肥胖被认为会带来严重的健康风险。超重和肥胖的成功预防和治疗方法一直难以捉摸。本试验的目的是确定能够保证长期体重减轻的参数和决定因素。
共有143/159名超重和肥胖儿童及青少年（90%）完成了这项前瞻性多中心试验（年龄13.9±2.4岁，BMI 31.2±5.4 kg/m²，BMI-SDS 2.51±0.57）。在为期六周的康复期间，患者参加了结构化治疗与教学计划（STTP）。住院治疗后，对儿童和青少年进行了24个月的监测（体格检查、BMI、BMI-SDS、身体成分、颈动脉内膜中层厚度、实验室参数、血压测量，以及用于评估社会人口统计学、社会经济参数、饮食行为、幸福感、生活质量、智力、家庭内部冲突、自我效能感、心理韧性、连贯感、压力管理、社会支持和实际体型的标准化问卷）。
66%的儿童和青少年表现出异常的实验室参数以及更高的血压和/或颈动脉内膜中层厚度增加。颈动脉内膜中层的平均厚度为0.53±0.09毫米（范围0.40 - 0.80）；15%的患者处于正常范围（<0.45毫米），40%略有升高（0.45 - 0.50毫米），45%升高（>0.50毫米）。在持续40.4±4.1（范围28 - 49）天的住院治疗后，儿童和青少年的平均体重减轻了5.52±3.94（0.4 - 13.3）千克（p<0.01），同时体脂量减少。进行多变量分析后，确定了与长期体重减轻相关的最重要心理因素（R平方 = 0.53）：幸福感（β = -0.543）、心理韧性（β = 0.434）和家庭内部冲突（β = 0.315）。
不同参数（即心理韧性、家庭内部冲突、结构化日程安排）已证明其效用，应制定策略将这些参数纳入结构化治疗与教学计划，并将干预措施融入治疗环境。
