Übergewicht und Adipositas bei Kindern und Jugendlichen
There is a worldwide increase of overweight and obesity not only in adults, but also in children. Data used to estimate prevalence are, however, collected in differing age groups using nonstandardized measurements and instruments and refer to differing time periods. Moreover, various reference systems to classify overweight and obesity exist, thus, adding to the difficulty in comparing countries. In this paper, these problems are discussed in detail. The most common reference systems are introduced, and their impact on the estimation of the prevalence of overweight and obesity is demonstrated. Based on available data of the global situation, maps that depict the worldwide distribution of the prevalence of overweight and obesity in children and adolescents are presented. Finally, these maps will be discussed critically. Although it may be assumed that these data are collected according to the best quality standards available, the lack of a unified protocol to conduct studies on childhood obesity hampers the comparability of data between countries. Obvious limitations in that respect are the use of different reference systems, differing sampling schemes, and differing age groups. More subtle limitations result from, e.g., different measurement methods, including self-reported weight and height.
Available from: uni-ulm.de
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ABSTRACT: Background: Guidelines can provide orientation, help for medical decision processes, and science-based, practice-oriented recommendations. Obesity in childhood and adolescence increased in the last years worldwide. Guidelines for treating obesity in childhood and adolescence in Germany were first published by the workgroup "Obesity in Childhood and Adolescence" (AGA) in 2000. The aim now was to gradually amend and replace this consensus-based (S2-) guideline with an evidence-based (S3-) guideline. Methods: After a systematic computer-based literature research (keywords, Medline, 1988 - 2006) and literature selection and validation, a first text draft was composed on the basis of the core messages of the sighted literature. Within multiple feedback and consensus steps, the text was revised and consensus for the recommendations with included recommendation grades was achieved via a moderated so called "nominal group process". Results: For this guideline, consensus was achieved for a total of 23 recommendations. The detailed description of the classification of consensus strength can be gathered from the methods report appendant to this guideline. During development of this guideline, it was noticed that the number of patients employed in therapy studies is high. However, some of these studies have methodical deficiencies. The achieved results show that bodyweight and body fat mass are significantly influenceable with conventional behaviour-based measures and also with the current available drug therapies. However, the extent of the achieved weight reduction is rather small. In contrast, surgical measures are very successful in reduction of bodyweight. However, this is an unproved, experimental therapy which can only be considered as "ultima ratio" in special selected patients. The guideline with appendant methods report can be retrieved both on the homepages of the AWMF (www.awmf.org) and of the AGA (www.a-g-a.de).
Available from: augsburg.de
Available from: B-M Kurth
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ABSTRACT: The increasing prevalence of overweight and obesity is a reason for concern not only in Germany but also in other countries. There are various methods and data sources that can be used to assess the extent of this public health problem. The present publication gives an overview of the reference systems that are in use in Germany to assess body mass index (BMI), which is calculated from height and weight, and an overview from several data sources: the school entry examinations, the HBSC study of the WHO, and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Current prevalence estimates are based on the KiGGS survey, which found that, based on the Kromeyer-Hauschild reference system, 14.8% of the children and adolescents in Germany aged 2-17 years are overweight, including 6.1% suffering from obesity. In absolute numbers referring to the most recent population numbers, this corresponds to 1.7 million overweight children and adolescents in Germany aged 2 years and older, 750,000 of whom are obese. This description of the status quo represents the benchmark for all future studies of BMI that aim at assessing temporal trends and, thus, the efficacy of national prevention and intervention programs. Regular examinations of certain age groups of children and adolescents in Germany, such as the school entry examinations, can be used for the assessment of temporal trends, if certain standards are followed during the examination. Studies that rely on self-reported height and weight instead of measurements, such as the German part of the HBSC study, however, need a correction based on the subjective body perception. The KiGGS participants themselves are also subject to follow-up interviews and examinations. Thus, it will be possible to regularly update the assessment of the prevalence of overweight and obesity. The Kromeyer-Hauschild reference system should not be replaced by the KiGGS BMI data, in order not to artificially lower the prevalences of overweight and obesity. It should, however, not be used for children below 2 years of age.
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