Berisha Albana, Kiess Wieland, Gausche Ruth, Beger Christoph, Körner Antje, Spielau Ulrike, Pfäffle Roland, Stein Robert, Kaspar Anika, Vogel Mandy
Hospital for Children and Adolescents and Center for Pediatric Research (CPL), University of Leipzig, Leipzig, Germany.
German Center for Child and Adolescent Health (DZKJ), Leipzig/Dresden Partner Site, Leipzig, Germany.
Obes Facts. 2025 May 2:1-11. doi: 10.1159/000546217.
Research on severe obesity (SO) is scarce and often contradictory. As higher weight status persists into adulthood, we aimed to analyze long-term trends in the prevalence of SO in children and adolescents in Germany using a large real-world data set. Furthermore, we analyzed subgroup differences and assessed how the COVID-19 pandemic affected weight status.
We analyzed data from the CrescNet auxological network, including 1,495,401 clinical visits by 4- to 16-year-old children (2002-2023). Weight trends were examined with a focus on SO using logistic regression, stratified by sex and age. Effects are reported as odds ratio per 5 years (OR5) pre-pandemic and as OR for consecutive years during the pandemic. Quantile regression assessed trends of the 50th, 90th, 97th, and 99th percentiles of excess weight.
Pre-pandemic, SO remained stable or declined in children under 12 until 2010: OR5: 0.8-1, p < 0.001) but rose significantly afterward (OR5: 1.1-1.2, p < 0.001). Children between 12 and 16 years of age showed a continuous increase, especially boys (boys12-16: OR5: 1.3, girls12-16: OR5: 1.1, p < 0.001). During the pandemic, SO peaked in 2021 across all groups (OR21 vs. 19: 1.3-1.7, p < 0.001). By 2023, younger children had returned to pre-pandemic levels, while older children, particularly 8- to 16-year-old girls, remained at higher weights (OR23 vs. 19: 1.2-1.5, p < 0.001-0.002). Weight gain was most prominent in SO groups but could also be seen in pre-pandemic and pandemic overweight and obesity subgroups, generally decreasing toward the end of the pandemic.
SO has increased over the last 2 decades, with the COVID-19 pandemic accelerating this trend, particularly in adolescents. While younger children recovered by 2023, excess weight in older children, especially girls, continues to escalate.
关于重度肥胖（SO）的研究稀缺且往往相互矛盾。由于较高的体重状况持续至成年期，我们旨在利用一个大型真实世界数据集分析德国儿童和青少年中重度肥胖患病率的长期趋势。此外，我们分析了亚组差异，并评估了新冠疫情对体重状况的影响。
我们分析了来自CrescNet人体测量学网络的数据，包括4至16岁儿童的1,495,401次临床就诊（2002 - 2023年）。使用逻辑回归分析体重趋势，重点关注重度肥胖，按性别和年龄分层。效应报告为疫情前每5年的优势比（OR5）以及疫情期间连续年份的优势比。分位数回归评估超重的第50、90、97和99百分位数的趋势。
在2010年之前，12岁以下儿童的重度肥胖保持稳定或下降（OR5：0.8 - 1，p < 0.001），但此后显著上升（OR5：1.1 - 1.2，p < 0.001）。12至16岁的儿童呈现持续上升趋势，尤其是男孩（12 - 16岁男孩：OR5：1.3，12 - 16岁女孩：OR5：1.1，p < 0.001）。在疫情期间，所有组的重度肥胖在2021年达到峰值（2021年与2019年相比的OR：1.3 - 1.7，p < 0.001）。到2023年，年幼儿童已恢复到疫情前水平，而年龄较大的儿童，特别是8至16岁的女孩，体重仍维持在较高水平（2023年与2019年相比的OR：1.2 - 1.5，p < 0.001 - 0.002）。体重增加在重度肥胖组最为显著，但在疫情前和疫情期间的超重及肥胖亚组中也可见，总体上在疫情接近尾声时有所下降。
在过去20年中，重度肥胖有所增加，新冠疫情加速了这一趋势，尤其是在青少年中。虽然年幼儿童到2023年已恢复，但年龄较大儿童，尤其是女孩的超重情况仍在持续恶化。
