Prävention von Übergewicht bei Kindern und Jugendlichen

Background

The prevalence of obesity has increased in recent decades. Obesity is now considered endemic in children, adolescents and adults. Thus prevention of overweight is necessary. However present evidence suggests only limited success rates of traditional preventive measures (i.e. school-based interventions).

Aims

After analysing existing prevention strategies and their long-standing effects, the question is answered if the“key players” of prevention have optimal positions and strategies. The main aim of this analysis consists in defining a theoretical basis and an evidence-based framework of prevention and intervention strategies against overweight and obesity.

Results

The present article provides a theoretical basis as well as a framework of future strategies to combat overweight at a societal level. From a public health point of view, different players, i.e. experts, politicians, insurances, the industry as well as the media, all have to be involved in the solution of the problem. The epidemiological triad provides orientation to the different actors to find their place for effective intervention strategies. Co-ordination of different activities is a challenge for future work. These ideas follow current WHO strategies (i.e. the WHO Istanbul Charter).     

Einfluss des Konsumverhaltens auf die Entwicklung von Übergewicht bei Kindern

The goal of this article is to provide an overview of internal and external factors influencing childhood obesity. Overweight and obese children are more likely to become overweight and obese adults with the well-known negative psychological, social, and economic consequences. Politics and research are searching for efficient prevention and intervention strategies. Consumer research helps to better understand the underlying mechanisms and feedback loops. Increasingly, children’s complex and multilayered “obesogenic” environment is held responsible for the increasing number of overweight children. Based on an ecological model, the paper explores the scientific evidence of these environmental factors on an individual, an interpersonal (i.e., family, peers), as well as on a community level (i.e., the physical environment). Furthermore, it looks at societal factors, such as media influence, advertising, product offers, and consumer policies. It concludes that access, affordability, and availability of healthy diets and lifestyles are crucial factors to develop and sustain healthy lifestyles. Implications for consumer and corporate policy are drawn.     

Übergewicht und Adipositas in Deutschland

The increase in overweight and obesity is a worldwide health problem. The first wave of the “German Health Interview and Examination Survey for Adults” (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n?=?7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥?25 kg/m²) and obesity (BMI ≥?30 kg/m²). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.     

Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland

Overweight and obesity are an increasing problem: worldwide, for Germany and for children and adolescents. Until now there have been no representative and age-specific assessments of the prevalence of obesity among children and adolescents in Germany. Thus, the standardised height and weight measurements gathered in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) have, for the first time, provided national, representative data about overweight and obesity in young people. The terms 'overweight' and 'obese' are defined based on percentiles of the body mass index (BMI) of the Kromeyer-Hauschild reference system. Of children and adolescents between the ages of 3 and 17, 15% exceed the 90th BMI percentile of the reference data and are thus overweight, 6.3% exceed the 97th BMI percentile and thus suffer from obesity by this definition. The proportion of overweight rises from 9% of 3-6-year-olds to 15% of 7-10-year-olds and 17% of 14-17-year-olds. The prevalence of obesity is 2.9%, 6.4% and 8.5% for the same age groups respectively. No clear differences between boys and girls or between East and West Germany are detected. Children are at a higher risk of being overweight or obese if they have a lower socioeconomic status, have a migration background, or have mothers who are also overweight.     

Programme der Primärprävention von Adipositas und Übergewicht im Kindesalter

The prevalence of obesity and overweight in childhood and among adolescents is dramatically increasing worldwide with high impact on their self-esteem and on their health as adults. Therefore, effective programs for primary prevention are urgently required. The focus of these programs should not only be on nutrition but also account for the complete sociocultural environment of the child. This paper will describe some of the more important programs on the one hand and present an exemplary concept for a scientifically observed program for prevention of obesity in preschool children on the other hand. The discussion will be completed by a short overview of programs for secondary prevention. In summary, it can be concluded that no sufficiently evaluated programs for primary prevention of obesity in childhood currently exist in Germany.     

Evidenzbasierung von Primärprävention am Beispiel einer Interventionsstudie zum kindlichen Übergewicht

Background

The most challenging step on the road map to primary prevention is transferring evidence-based intervention modules into practice and achieving their sustainability. This road map is illustrated by an epidemiological intervention study targeting lifestyle-related disorders in children.

Methods

Starting from the health problem of interest a suitable target group is identified that can be reached effectively and in whom the most profound effects are to be expected. Modifiable risk factors and realistic targets of the intervention are specified.

Results

These determine the outcome measures as the main evidence of the effectiveness of the intervention. Target groups and outcome measures are the cornerstones of the study design and the definition of comparison groups. If the intervention requires the active involvement of participants, then the program should follow participatory approaches and take into account the sociocultural and living environment.

Conclusions

Evaluation is the key component of any intervention. It involves assessing the structure and process and evaluating the outcome according to rigid scientific criteria.     

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.     

Der Einfluss von Geschlecht und sozialer Lage auf Ernährung und Übergewicht im Kindesalter

Overweight and adiposity in children and adolescents are increasing problems in Germany, and more and more primary and secondary prevention programs are being developed. When planning and designing prevention strategies, one should be aware of the target groups and settings. Analysis of epidemiological data for sex/gender, social class, and ethnicity indicates where there is increased need for intervention. Clearly elevated prevalence rates for overweight and adiposity can be found in socially underprivileged children, whereas findings for sex differences are inconsistent because of different systems of reference. This paper gives an overview of epidemiological data in Germany and discusses starting points for prevention. The argumentation focuses on the idea of cooperation between health,education, and social services to reach socially underprivileged children without stigmatizing them and their families.     

Übergewicht und Adipositas in Deutschland 1984–2003

The magnitude and the development of the prevalence of overweight and obesity in Germany during the past 20 years are analysed in this contribution. Using body mass index (BMI) data of the National Examination Surveys (1984-1992), the German National Health Interview and Examination Survey 1998 as well as the Telephone Health Survey 2003, all representative of the adult non-institutionalised population, the occurrence of overweight and obesity is studied. To improve the comparability with measurement values, the Telephone Health Survey data which were based on self-reporting were adjusted. All data were weighted to improve the representativeness for the time of assessment. Although the proportion of persons with a BMI between 25 and 30 did not change essentially during the last 20 years, the proportion of obese individuals (BMI>or=30) increased considerably. At present, about 70% of men and 50% of women in Germany are overweight or obese. In conclusion, the prevalence of overweight and obesity in Germany continues to increase.     

Struktur- und Zusammenhangsanalyse der Ursachen von Arbeitsunf?llen

Zusammenfassung Zur Prüfung von strukturellen Charakteristiken der Berufsunfälle in der Schweiz und von Zusammenhängen zwischen verschiedenen Variablen wurde eine Zufallsstichprobe von 11162 Fällen aus den 225275 von der SUVA 1979 anerkannten Berufsunfällen gezogen. Die Merkmale Heimat, Geschlecht und Wirtschaftszweig der Verunfallten, Tätigkeit vor dem Unfall, der Unfallhergang und die Unfallschwere bilden die Untersuchungsvariablen. Mit hohen relativen Risiken von 2,6 bzw. 2,3 treten die Forstwirtschaft und das Bauwesen in Erscheinung. Die besonderen Gefahren in den einzelnen Wirtschaftszweigen werden spezifiziert. Mittels Log-linearen Modellen werden die komplexen Zusammenhänge auf multivariater Basis näher untersucht. Es erweist sich, dass Strukturvariablen wie die Heimat und das Geschlecht im Modell nicht bloss die Art der Tätigkeit des Verunfallten bestimmen, sondern auch Einfluss auf den Unfallhergang und die Unfallschwere, das heisst auf die Dauer der Arbeitsunfähigkeit, nehmen.

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Summary A random sample of 11,162 events was drawn from 225,275 accidents which were certified by the Swiss National Accident Insurance Fund, in order to assess the structural characteristics of accidents during work and their relation to a number of variables. Domicile, sex and occupation of the accident victim, activity prior to the accident, the course of the accident and its severity were studied. Forestry and the building trade exhibit high relative risks of 2.6 and 2.3, respectively. The dangers specific to separate occupations are identified. The complex relationships are examined more closely by means of log-linear models in multivariate analyses. It is found that structural variables in this model like domicile and sex do not only determine the type of occupation of the accident victim but influence the course and severity of the accident, i.e. the duration of work incapacity.

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Analyse des structures et des rapports entre les facteurs causals des accidents professionnels

Résumé Pour analyser les caractéristiques structurelles des accidents professionnels en Suisse et les relations entre diverses variables, on a pris un échantillon aléatoire de 11162 cas sur les 225275 accidents professionnels acceptés par la CNA en 1979. Les caractéristiques pays d'origine, sexe et secteur économique des accidentés, activité exercée avant l'accident, le déroulement et la gravité de l'accident constituent les variables examinées. L'économie forestière et la construction accusent respectivement les risques relatifs élevés de 2,6 et 2,3. On spécifie les risques particuliers au sein des divers secteurs économiques. Au moyen de Log Linear Models, on examine les relations complexes sur une base multivariée. Il apparaît que, dans le modèle, non seulement les variables structurelles telles que le pays d'origine et le sexe déterminent le genre d'activité de l'accidenté, mais qu'elles influent en outre sur le déroulement et la gravité de l'accident, c'est-à-dire sur la durée de l'incapacité de travail.

     

Über die Ursachen der Beschwerden der Elektroschweißer

Ohne Zusammenfassung     

Soziale Ungleichheit, Migrationshintergrund, Lebenswelten und Übergewicht bei Kindern und Jugendlichen

This study aimed at studying the relationships between different social determinants, overweight, migration background, lifestyle factors, and neighborhood characteristics in children and adolescents aged 6–14 years. Data were collected within the Kiel Obesity Prevention Study (KOPS). The lower the social status, the higher the prevalence of overweight (e.g., parental education low/middle/high,%: 18.4/13.6/7.9). Non-German children are twice as often overweight as German children (20.2% versus 11.7%) with a social gradient in overweight (%: 26.0/28.2/17.2). There are social differences in health-related behavior between the social groups and also between German and non-German children of the same social group. The social gradient in overweight is, in part, independent of lifestyle factors. Neighborhood characteristics like high food supply and traffic density add to the development of overweight. To summarize, overweight is a social issue; direct prevention has to address the social determinants of health as well as families with migration background. In addition, the development of “healthy” neighborhoods may support the prevention of overweight.     

Schlafdauer und ��bergewicht

Sleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.