[Which Factors Affect Weight Maintenance? A Qualitative Study with Adolescents and their Parents who have Completed a Ten-months Intervention]. / Welche Faktoren beeinflussen die Gewichtsstabilisierung nachhaltig? Eine qualitative Befragung von Kindern und Jugendlichen sowie deren Eltern, nach Teilnahme an einem Gewichtsreduktionsprogramm.

BACKGROUND: The alarming increase in the prevalence of childhood obesity is recognised as a major public health concern. Currently, structured multi-modal therapy programmes present the gold standard of therapy strategies for obese children and adolescents. However, effects of these treatments are still a matter of discussion. Failure to isolate and understand the external and internal factors contributing to successful, long-term weight reduction may well be contributing to the ineffectiveness of current treatment interventions. OBJECTIVE: A qualitative approach was chosen in order to identify subjectively perceived resources and barriers to weight maintenance after previous weight reduction. The research question focused on how these resources and barriers affect success of participants. Additionally the question arose as to how and to what extent parents should and could be involved in the therapy process. The results can deliver important starting points for the development of therapy programmes and future research. METHOD: 7 participants of a weight reduction and maintenance programme and 7 of their parents were interviewed on their personal experiences during and after the treatment. The interviews were analysed based on the qualitative content analysis. RESULTS: Continuous motivation, especially after the initial weight reduction phase, was identified as the strongest predictor of successful weight maintenance. Successful weight maintainers generally showed characteristics of higher self-efficacy, internal motivation concerning physical activity and flexible self-control concerning food intake. Unsuccessful weight gainers stated a lack of motivation concerning physical activity and lost control over their eating habits. Concerning the role of parents in the therapy process, the results show that higher parental involvement does not predict greater success. The general relationship between parents and their children seems to be more significant, especially concerning the issues of responsibility. CONCLUSION: It is disputable to what extent the post treatment intervention contributed to the development of intrinsic motivation. More attention should be paid to the age (children or adolescents) of participants of therapy programmes, especially concerning the involvement of parents. It is assumed that general aspects of education should be discussed with parents.

[Dietary interventions and social care for treating obesity in children]. / Therapie der Adipositas aus sozialpädiatrischer, ernährungstherapeutischer und gesundheitswissenschaftlicher Sicht.

The prevalence of obesity and associated comorbidities among children and adolescents has risen worldwide throughout the past 3 decades. To break this trend, population-based activities in health promotion/prevention and health care are necessary. Studies showed that long-term eating behavior improvement with the cooperation of the patient's family together with child-friendly organization support both individual therapeutic improvements as well as a relevant reduction of obesity prevalence. A significant BMI reduction can be achieved with a normal varied diet, whose energetic value is 300-400 kcal/day below the patient's daily energetic needs, due to the lower consumption of fat and sugar. This requires, however, that the entire family be willing to change their unhealthy eating behaviors (e.g., soft drinks and fast food) and to introduce regular meals into their daily routine. Sensibly, most therapies combine diet therapy with increased physical activity and parental training. Controlled media consumption, active leisure-time behavior, and a structured daily routine are further conditions for successful weight reduction. The high-risk groups for pediatric obesity, i.e., families with migration background and/or low socioeconomic status, have been poorly reached by established programs.

Ethnicity and comorbidities in an overweight and obese multiethnic childhood cohort in Berlin.

AIM: This study aims to analyse the association between ethnicity, elevated metabolic parameters and metabolic syndrome (MS) in a multiethnic cohort of overweight to obese children and adolescents. METHODS: For 1053 patients, standard deviation of body mass index (BMI-SDS) was calculated and metabolic parameters (fasting blood glucose, fasting insulin, homeostasis model assessment-IR, lipids, blood pressure) were measured. MS was defined by WHO criteria. Bivariate and multivariate analyses were performed. Adjusted differences in BMI-SDS and metabolic parameters between different migration groups were assessed with linear regression models. The risk for MS was calculated with multiple logistic regression models. RESULTS: Forty-eight per cent of the children were German, 25% Turkish and 27% had another ethnicity. Concerning weight status, 23% are overweight, 31% obese and 46% extremely obese with higher rates among the immigrant population. Multivariable models indicate significant associations between elevated metabolic parameters and higher BMI-SDS values. Overall prevalence of MS was 32.3%. MS was detected significantly more often among Turkish patients (40.4%) compared to Germans (27.3%; p=0.02). Logistic regression analysis showed a greater risk for MS with older age (OR=1.09; p=0.003) and Turkish ethnicity (OR=1.62; p=0.02). CONCLUSION: Nearly all patients had symptoms of MS, and 40% had MS showing that this highly health-threatening condition is quite common. Therefore, effective therapy and prevention efforts must be developed for this high risk group. More migration-specific research regarding insulin resistance, MS and Type 2 DM is needed.

[Association between health-related quality of life and selected indicators for 10- to 15-year-old girls in Berlin]. / Einflussfaktoren auf die gesundheitsbezogene Lebensqualität von 10- bis 15-jährigen Mädchen in Berlin.

OBJECTIVE: The state of knowledge on health-related quality of life (HRQOL) is incomplete. The influence of social and behavioural factors on HRQOL of 10- to 15-year-old girls was investigated. METHOD: The Berlin School Children's Cohort (BSCOC-cross-sectional study 2006-2007) included 1 842 girls and their parents (n=1 683) in Berlin. Height and body weight were measured. A standardised questionnaire to capture the HRQOL of the girls (KINDL(®) questionnaire) and possible influencing factors was used. The association of the variables age, social situation, migration background, family situation, weight status, menarche status, eating behaviour and illness in the last weeks with the HRQOL and its partial scales were controlled for using the Kruskal-Wallis test. Variables which showed a statistically significant relationship with HRQOL were included as independent variables in a linear regression model with the outcome variable HRQOL to test their influence and quantify it. RESULTS: In comparison to the KINDL reference values (KiGGS), the HRQOL values of the assessed girls are lower. Quality of life is unfavourably swayed by age, low social status, two-sided migration background, sickness in the last few weeks, little physical activity, unfavourable eating behaviour, overweight and obesity and when post-menarche. With the exception of migration background and menarche status, all results were confirmed in the multivariate model. CONCLUSION: The results of the linear regression model demonstrate a higher importance of body and behaviour-related factors and places and confirm the relevance of past prevention and health promotion in the named areas also for the HRQOL of the girls.

Is there a further acceleration in the age at onset of menarche? A cross-sectional study in 1840 school children focusing on age and bodyweight at the onset of menarche.

OBJECTIVE: More than 30 years ago Frisch and Revelle proposed a body weight threshold for the onset of menarche. Based on this hypothesis, a further acceleration of age at menarche can be expected in times of childhood obesity. DESIGN: A cross-sectional study of 1840 healthy school girls (Berlin school children's cohort, BSCOC) within the age groups 10-15 years was conducted in 2006-2007. METHODS: Median age of menarche was calculated by Kaplan-Meier survival analysis. Bi- and multivariate analyses were performed to analyze the associations between menarche age and weight status. A locally weighted regression was used to analyze the relationship respectively between height, weight, and body mass index (BMI)-SDS and age stratified by menarche status. RESULTS: Nine hundred and thirty six (50.9%) girls had already experienced menarche at a median age of 12.8 years. Two hundred and thirty six of these girls reached their menarche recently. Obese/overweight girls reached menarche significantly earlier (12.5 years), than normal weight (12.9 years), and underweight girls (13.7 years). The mean total body weight was similar in all girls at menarche irrespective of age (mean 51.1 kg, s.d. 8.1) and height. BMI-SDS remained the only significant factor for onset of menarche within a multiple regression model for early menarche (OR 2.1, 95% confidence interval 1.3-3.3, P=0.002). CONCLUSIONS: Age at onset of menarche did not accelerate even in a childhood population with more than 10% obesity prevalence. Nevertheless, a negative correlation of BMI-SDS with age at onset of menarche exists.

[A basic set of indicators for mapping migrant status. Recommendations for epidemiological practice]. / Mindestindikatorensatz zur Erfassung des Migrationsstatus. Empfehlungen für die epidemiologische Praxis.

Data on the health status of migrants are still scarce. One of the reasons for this is that migration status has not been well recorded in official statistics and epidemiological studies. In order to obtain an adequate and standardised operationalisation of migrant status, we first need an exact definition of the terms "migrant" and "migration background". We discuss approaches to the definition of terms and the surveying of ethnic minorities and migrants, and then develop a basic set of migration status indicators for use in epidemiological research. This set of indicators includes country of birth of the father and mother, year of immigration, mother tongue, German language skills and status of residence. The key indicator for the identification of migrants is the country of birth of the parents and not the nationality as was previously often the case. Thus, the classification based on the judicial category of nationality is replaced by a classification based on the biographical event "migration". Migration brings with it specific life conditions and challenges that can impact health across several generations. An instrument for surveying migrant status must be further developed both to reflect the special conditions of the life situation resulting from the migration experience and to take as full account as possible of all aspects of a migrant's history.

[Interdisciplinary Network for Epidemiological Research in Berlin--EpiBerlin]. / Interdisziplinärer Forschungsverbund Epidemiologie--EpiBerlin.

The Interdisciplinary Network for Epidemiological Research in Berlin (EpiBerlin) has the goal of bringing together epidemiologists and experts in epidemiology and public health in Germany's capital city of Berlin and to offer them opportunities for knowledge transfer and networking. In that way, existing resources may be strengthened and additional potential in Berlin as a science center may be developed. EpiBerlin was founded by an initiative of the Berlin Center of Public Health (BZPH) and is closely affiliated with the three universities in Berlin (Free University, Technical University, and Humboldt University) as well as the Robert Koch Institute, Germany's national center for health research. EpiBerlin is evenly funded by the state of Berlin, through the Senatsverwaltung für Wissenschaft, Forschung und Kultur (Senate Administration for Science, Research, and Culture), and the Bund-Länder-Kommission (Commission of the Federation and States). The development of a databank of the epidemiological databases in the region of Berlin (EpiDB) aims to show the variety of epidemiological work in the area. The aim of EpiDB is to provide transparency and an overview of existing and current research in Berlin, which may also benefit external users. Cooperation, networking, and division of labor for joint venture research may be promoted, also beyond the region of Berlin.