Current Guidelines for Obesity Prevention in Childhood and Adolescence.

OBJECTIVE: Current guidelines for prevention of obesity in childhood and adolescence are discussed. METHODS: A literature search was performed in Medline via PubMed, and appropriate studies were analyzed. RESULTS: Programs to prevent childhood obesity have so far remained mainly school-based and effects have been limited. Analyses by age group show that prevention programs have the best results in younger children (<12 years). Evidence-based recommendations for pre-school- and early school-aged children indicate the need for interventions that address parents and teachers alike. During adolescence, school-based interventions proved most effective when adolescents were addressed directly. To date, obesity prevention programs have mainly focused on behavior-oriented prevention. Recommendations for community- or environment-based prevention have been suggested by the German Alliance of Noncommunicable Diseases and include a minimum of 1 h of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory standards for meals at kindergartens and schools as well as a ban on unhealthy food advertisement aimed at children. CONCLUSION: Behavior-oriented prevention programs showed only limited long-term effects. Certain groups at risk for the development of obesity are not reached effectively by current programs. Although universally valid conclusions cannot be drawn given the heterogeneity of available studies, clearly combining behavior-based programs with community-based prevention to counteract an 'obesogenic environment' is crucial for sustainable success of future obesity prevention programs.

High-Intensity Interval Training for Overweight Adolescents: Program Acceptance of a Media Supported Intervention and Changes in Body Composition.

High-intensity interval training (HIIT) consists of short intervals of exercise at high intensity intermitted by intervals of lower intensity and is associated with improvement of body composition and metabolic health in adults. Studies in overweight adolescents are scarce. We conducted a randomized controlled trial in overweight adolescents to compare acceptance and attendance of HIIT with or without weekly motivational encouragement through text messages and access to a study website. HIIT was offered for six months (including summer vacation) twice a week (60 min/session). Participation rates were continuously assessed and acceptance was measured. Clinical parameters were assessed at baseline and after six months. Twenty-eight adolescents participated in this study (age 15.5 ± 1.4; 54% female). The standard deviation score for body mass index over all participants was 2.33 at baseline and decreased by 0.026 (95% CI -0.048 to 0.10) units, p = 0.49. Waist to height ratio was 0.596 at baseline and decreased by 0.013 (95% CI 0.0025 to 0.024), p = 0.023. Participation within the first two months ranged from 65% to 75%, but fell to 15% within the last three months. Attendance in the intervention group was 14% (95% CI -8 to 37), p = 0.18, higher than the control group. Overall program content was rated as "good" by participants, although high drop-out rates were observed. Summer months constitute a serious problem regarding attendance. The use of media support has to be assessed further in appropriately powered trials.

Psychosocial Well-Being of Adolescents Before and After a 1-Year Telephone-Based Adiposity Prevention Study for Families.

PURPOSE: Body image and psychosocial well-being play an important role in influencing health behavior of obese adolescents. Effects of family-based interventions on self-image and mental well-being are poorly understood. The effects of a parent-delivered intervention on psychosocial well-being in obese adolescents were investigated. METHODS: A subset of secondary variables from the randomized-controlled Telephone-based Adiposity prevention study For Families (T.A.F.F. study) was analyzed. Multivariate analysis of variance and Pearson correlations were used to examine intervention effects on measures of body image, body dissatisfaction, self-efficacy, self-worth, and resilience and changes of standard deviation score of body mass index (BMI-SDS). RESULTS: A total of 154 randomized adolescents participated in this study (10-17 years). Body dissatisfaction decreased between baseline and follow-up (p = .013, confidence interval [CI], .03-.29), whereas self-efficacy increased (p = .022; CI, -1.73 to -0.14). Both were independent of the randomization arm. Initial body image was a negative predictor of self-efficacy after the intervention. Changes in body dissatisfaction and self-efficacy were positively correlated with changes in self-worth and resilience but were not related to changes in weight status. CONCLUSIONS: Overweight/obese adolescents have a high level of body dissatisfaction, more pronounced in girls than in boys. Interactions within families during overweight and obesity interventions need to be investigated in relation to adolescent body self-concept.

Telephone-based adiposity prevention for families with overweight children (T.A.F.F.-Study): one year outcome of a randomized, controlled trial.

The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5-17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51% females); 144 CG (50% females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21% of the IG was successful as compared to 16% from the CG (95% CI for this difference: (-4, 14), p = 0.3, mean change in BMI-SDS: -0.02 for IG vs. 0.02 for CG; p = 0.4). According to the PPS, however, the success rate was 35% in the IG compared to 19% in the CG (mean change in BMI-SDS: -0.09 for IG vs. 0.02 for CG; p = 0.03). Scores for eating patterns (p = 0.01), media consumption (p = 0.007), physical activity (p = 9 × 10-9), quality of life (p = 5 × 10-8) decreased with age, independent of group or change in BMI-SDS. We conclude that a telephone-based obesity prevention program suffers from well-known high attrition rates so that its effectiveness could only be shown in those who adhered to completion. The connection between lifestyle and weight status is not simple and requires further research to better understand.

Effects of a 1-year exercise and lifestyle intervention on irisin, adipokines, and inflammatory markers in obese children.

OBJECTIVE: Exercise improves weight status and metabolism. Irisin, a novel myokine, may be involved in the regulation of metabolic function. The effect of an exercise and dietary lifestyle intervention for 1-year on irisin, adipokines (leptin, adiponectin, resistin) and inflammatory markers (C-reactive protein (CRP), soluble tumor necrosis factor receptor II (sTNFR-II) was evaluated, and predictors of irisin levels were characterized in obese children. METHODS: Parameters were assessed at baseline and at follow-up for 65 obese children who completed the program (7-18 years, 54%boys). Their relation to weight status and metabolic risk was analyzed. RESULTS: Anthropometric and metabolic parameters improved after completion of the program. Circulating irisin levels at baseline were 111.0 ± 8.0 ng ml(-1) and increased after the intervention by 12% [6%, 17%], P = 0.00003. There was no evidence for differences in irisin levels between genders and across age. Moreover, changes in irisin did not correlate with those in BMI-SDS, adipokines or inflammatory markers. Leptin decreased after the intervention (Δ5.3 ng ml(-1) , [3.2, 6.3], P = 10(-7) ). Anthropometric measures were significantly associated with leptin and inflammatory markers. CONCLUSIONS: A 1-year long lifestyle intervention program is associated with improvement in anthropometric and metabolic parameters and leads to an elevation in irisin levels in obese children.

Case management via telephone counseling and SMS for weight maintenance in adolescent obesity: study concept of the TeAM program.

BACKGROUND: In-patient obesity treatment programs for adolescents are associated with good success and substantial weight loss. However, maintaining weight loss remains a challenge. This article presents the concept of the TeAM (Telephone counseling as Adiposity Management) program. TeAM is an innovative, weight maintenance program for obese adolescents after in-patient therapy. It applies the case management approach in combination with new media (telephone counseling, web forum, and SMS messaging). Adolescents (14-18 years) were recruited via German rehabilitation hospitals. The intervention of the TeAM program consists of telephone counseling through trained case managers in order to maintain body weight reduction (expressed as BMI-SDS: body mass index standard deviation score) achieved during an in-patient obesity therapy. At baseline and after completion of the program, participants provide anthropometric measures (obtained by trained medical staff) as well as information on socio-demographics, usage of health services, psychosocial status, daily physical activity, media consumption, and eating behavior. The core of the intervention is regular telephone contact with the adolescent participants combined with tailored SMS messages. Telephone counseling is based on the systemic approach and addresses the topics of mental hygiene, physical activity, sedentary behavior, diet and eating behavior. RESULTS: Baseline data of the feasibility study: Thirty-eight adolescents were recruited for the feasibility study (14 male, 24 female; mean age 15.82 years); out of them, ten participants lived with a single parent; 68% planned to graduate from school without pre-requisites for university admission (O-level). The mean weight loss during in-patient treatment was 0.32 BMI-SDS units. Mean BMI at the start of intervention was 31.93 kg/m(2), corresponding to a mean BMI-SDS of 2.48. CONCLUSIONS: Weight maintenance treatment programs for adolescent obesity utilizing new media are a promising approach as they reach adolescents directly within their everyday life. TRIAL REGISTRATION: DRKS00004583.

Prevention of childhood obesity: recruiting strategies via local paediatricians and study protocol for a telephone-based counselling programme.

AIM: Prevention research has to elucidate how families with overweight children can be convinced to participate in obesity intervention trials. Here we describe the detailed recruitment process for a telephone-based obesity prevention programme for families with overweight children and present participation rates, the study design and a socio-demographic description of participating families. METHODS: Overweight (BMI > 90th percentile) children and adolescents 4-17 years of age were screened via the German paediatrician network CrescNet. The prevention programme (multiple computer aided telephone counselling interviews) was suggested to eligible families via local paediatricians. Participating families were compared anthropometrically and socio-demographically to the entire screening population and to micro-census data, a representative national survey. RESULTS: The screening process assessed 4005 candidates for eligibility. Paediatricians reported having suggested programme participation to 3387 candidates (referred to as 100%). 427 candidates (12.6%) returned a written consent for programme participation. 303 candidates (9.0%) started the intervention. The study population (n = 303) included more obese (45.6% vs. 33.2%; p < 0.001) and fewer overweight participants (40.4% vs. 55.2%; p < 0.001) than the entire screening population. Compared to the micro-census, families with adolescents (8.2% vs. 16.9%; p < 0.001) and single parents (16.0% vs. 23.3%; p < 0.005) were underrepresented in the study population, whereas families living in rural areas were overrepresented (58.7% vs. 50.2%; p < 0.005). CONCLUSIONS: Although 84.6% of the paediatricians forwarded the suggestion for programme participation to eligible families, participation rates for this low-threshold; telephone-based obesity intervention remained very low. "Hard-to-engage groups" for effective obesity prevention seem to include single parents, as well as parents of adolescents.

Reasons for (non)participating in a telephone-based intervention program for families with overweight children.

OBJECTIVE: Willingness to participate in obesity prevention programs is low; underlying reasons are poorly understood. We evaluated reasons for (non)participating in a novel telephone-based obesity prevention program for overweight children and their families. METHOD: Overweight children and adolescents (BMI>90(th) percentile) aged 3.5-17.4 years were screened via the CrescNet database, a representative cohort of German children, and program participation (repetitive computer aided telephone counseling) was offered by their local pediatrician. Identical questionnaires to collect baseline data on anthropometrics, lifestyle, eating habits, sociodemographic and psychosocial parameters were analyzed from 433 families (241 participants, 192 nonparticipants). Univariate analyses and binary logistic regression were used to identify factors associated with nonparticipation. RESULTS: The number of overweight children (BMI>90(th) percentile) was higher in nonparticipants than participants (62% vs. 41.1%,p<0.001), whereas the number of obese children (BMI>97(th) percentile) was higher in participants (58.9% vs.38%,p<0.001). Participating girls were younger than boys (8.8 vs.10.4 years, p<0.001). 87.3% and 40% of participants, but only 72.2% and 24.7% of nonparticipants, respectively, reported to have regular breakfasts (p = 0.008) and 5 regular daily meals (p = 0.003). Nonparticipants had a lower household-net-income (p<0.001), but higher subjective physical wellbeing than participants (p = 0.018) and believed that changes in lifestyle can be made easily (p = 0.05). CONCLUSION: An important reason for nonparticipation was non-awareness of their child's weight status by parents. Nonparticipants, who were often low-income families, believed that they already perform a healthy lifestyle and had a higher subjective wellbeing. We hypothesize that even a low-threshold intervention program does not reach the families who really need it.

Comparative biochemical characterization of nitrile-forming proteins from plants and insects that alter myrosinase-catalysed hydrolysis of glucosinolates.

The defensive function of the glucosinolate-myrosinase system in plants of the order Capparales results from the formation of isothiocyanates when glucosinolates are hydrolysed by myrosinases upon tissue damage. In some glucosinolate-containing plant species, as well as in the insect herbivore Pieris rapae, protein factors alter the outcome of myrosinase-catalysed glucosinolate hydrolysis, leading to the formation of products other than isothiocyanates. To date, two such proteins have been identified at the molecular level, the epithiospecifier protein (ESP) from Arabidopsis thaliana and the nitrile-specifier protein (NSP) from P. rapae. These proteins share no sequence similarity although they both promote the formation of nitriles. To understand the biochemical bases of nitrile formation, we compared some of the properties of these proteins using purified preparations. We show that both proteins appear to be true enzymes rather than allosteric cofactors of myrosinases, based on their substrate and product specificities and the fact that the proportion of glucosinolates hydrolysed to nitriles does not remain constant when myrosinase activity varies. No stable association between ESP and myrosinase could be demonstrated during affinity chromatography, nevertheless some proximity of ESP to myrosinase is required for epithionitrile formation to occur, as evidenced by the lack of ESP activity when it was spatially separated from myrosinase in a dialysis chamber. The significant difference in substrate- and product specificities between A. thaliana ESP and P. rapae NSP is consonant with their different ecological functions. Furthermore, ESP and NSP differ remarkably in their requirements for metal ion cofactors. We found no indications of the involvement of a free radical mechanism in epithionitrile formation by ESP as suggested in earlier reports.