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Aktuelle Ernährungsmedizin 2015; 40(02): 109-122
DOI: 10.1055/s-0034-1387626
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© Georg Thieme Verlag KG Stuttgart · New York

Adipositas im Kindes- und Jugendalter

Obesity in Childhood and Adolescence
C. Knop
Abteilung für Endokrinologie, Diabetes und Ernährungsmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Deutschland
,
T. Reinehr
Abteilung für Endokrinologie, Diabetes und Ernährungsmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Deutschland
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Publikationsdatum:
28. April 2015 (online)

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Zusammenfassung

Adipositas ist bereits im Kindes- und Jugendalter mit einer Vielzahl von kardiovaskulären Risikofaktoren assoziiert. Während diese meist asymptomatisch sind, leiden die adipösen Kinder v. a. unter den psychosozialen Folgen. Die Ursache der Adipositas im Kindesalter ist meist multifaktoriell und reicht von genetischen Faktoren über Umweltfaktoren bis hin zur familiären Situation. Bisherige Präventionskonzepte sind noch nicht nachhaltig überzeugend. Die Therapie der Wahl besteht aus einer Lebensstilintervention basierend auf Schulungsprogrammen. Misserfolge sind nicht nur auf fehlende Motivation, sondern auch auf die Gegenregulation des Körpers bei Gewichtsabnahme zurückzuführen. Die Therapie der extremen Adipositas im Jugendalter ist ein ungelöstes Problem, da Schulungsprogramme in der Regel nicht erfolgreich sind. Bariatrische Verfahren können zwar effektiv das Ausmaß des Übergewichts reduzieren, haben jedoch vielfältige Nebenwirkungen und benötigen eine lebenslange Betreuung, welche vor Beginn der Operation gewährleistet sein muss.

Abstract

Obesity in childhood and adolescence is associated with multiple cardiovascular risk factors. Most of them are asymptomatic and the obese children suffer from psychosocial consequences. The causes of obesity in childhood are mainly multi-factorial including beside others genetic factor, family stetting and environmental factors. Preventions concepts have failed so far to reduce effectively the prevalence of obesity. The treatment of choice is lifestyle intervention. Failures are not only caused by lack of motivation but also by counter regulation of body weight in weight loss. Therapy of extreme obese adolescents has not been solved. Bariatric surgery is able to reduce weight in these adolescents however, the complications and side effects have to be kept in mind. Furthermore, there is a need for a life-long medical care, which has to be guaranteed before surgery.

Schlüsselwörter

Adipositas bei Kindern - Lebensstilintervention - Prävention - metabolisches Syndrom - bariatrische Chirurgie

Keywords

obesity in childhood - lifestyle intervention - prevention - metabolic syndrome - bariatric surgery
 

  • Literatur

  • 1 Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360: 473-482
    CrossrefPubMedGoogle Scholar
  • 2 Biro FM, Wien M. Childhood obesity and adult morbidities. Am J Clin Nutr 2010; 91: 1499S-1505S
    CrossrefPubMedGoogle Scholar
  • 3 I'Allemand D, Wiegand S, Reinehr T et al. Cardiovascular risk in 26,008 European overweight children as established by a multicenter database. Obesity (Silver Spring) 2008; 16: 1672-1679
    CrossrefPubMedGoogle Scholar
  • 4 Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter. Guidelines of the German working group on obese children and adolescents. Im Internet: 2015. http://www.a-g-a.de/Leitlinie.pdf (Stand: 5.1.2015)
    Google Scholar
  • 5 Kromeyer-Hauschild K, Wabitsch M, Geller F et al. Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001; 149: 807-818
    CrossrefPubMedGoogle Scholar
  • 6 Kurth BM, Schaffrath RA. The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50: 736-743
    CrossrefPubMedGoogle Scholar
  • 7 Moss A, Klenk J, Simon K et al. Declining prevalence rates for overweight and obesity in German children starting school. Eur J Pediatr 2012; 171: 289-299
    CrossrefPubMedGoogle Scholar
  • 8 Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45-60
    PubMedGoogle Scholar
  • 9 Han JC, Lawlor DA, Kimm SY. Childhood obesity. Lancet 2010; 375: 1737-1748
    CrossrefPubMedGoogle Scholar
  • 10 Muckelbauer R, Libuda L, Clausen K et al. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics 2009; 123: e661-e667
    CrossrefPubMedGoogle Scholar
  • 11 James J, Kerr D. Prevention of childhood obesity by reducing soft drinks. Int J Obes (Lond) 2005; 29 (Suppl. 02) 54-57
    CrossrefPubMedGoogle Scholar
  • 12 Pereira MA, Kartashov AI, Ebbeling CB et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005; 365: 36-42
    CrossrefPubMedGoogle Scholar
  • 13 Reinehr T, Hinney A, de Sousa G et al. Definable somatic disorders in overweight children and adolescents. J Pediatr 2007; 150: 618-622
    CrossrefPubMedGoogle Scholar
  • 14 Reinehr T, Dobe M, Winkel K et al. Adipositas bei behinderten Kindern und Jugendlichen. Eine therapeutisch vergessene Patientengruppe. Dtsch Arztebl Int 2010; 107: 268-275
    PubMedGoogle Scholar
  • 15 Reinehr T, de Sousa G, Andler W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J Clin Endocrinol Metab 2006; 91: 3088-3091
    CrossrefPubMedGoogle Scholar
  • 16 Reinehr T, Kulle A, Wolters B et al. Relationships between 24-hour urinary free cortisol concentrations and metabolic syndrome in obese children. J Clin Endocrinol Metab 2014; 99: 2391-2399
    CrossrefPubMedGoogle Scholar
  • 17 Reinehr T, Andler W, Denzer C et al. Cardiovascular risk factors in overweight German children and adolescents: relation to gender, age and degree of overweight. Nutr Metab Cardiovasc Dis 2005; 15: 181-187
    CrossrefPubMedGoogle Scholar
  • 18 Hinney A, Vogel CI, Hebebrand J. From monogenic to polygenic obesity: recent advances. Eur Child Adolesc Psychiatry 2010; 19: 297-310
    CrossrefPubMedGoogle Scholar
  • 19 Hebebrand J, Friedel S, Schauble N et al. Perspectives: molecular genetic research in human obesity. Obes Rev 2003; 4: 139-146
    CrossrefPubMedGoogle Scholar
  • 20 Scherag A, Dina C, Hinney A et al. Two new Loci for body-weight regulation identified in a joint analysis of genome-wide association studies for early-onset extreme obesity in French and german study groups. PLoS Genet 2010; 6: e1000916
    CrossrefPubMedGoogle Scholar
  • 21 Speliotes EK, Willer CJ, Berndt SI et al. Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. Nat Genet 2010; 42: 937-948
    CrossrefPubMedGoogle Scholar
  • 22 Kromeyer-Hausschild K, Gläßer N, Zellner K. Waist Circumference percentile in Jena children (Germany) 6 to 18 years of age. Aktuel Ernahrungsmed 2008; 33: 116-122
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 23 Wunsch R, de Sousa G, Reinehr T. Intima-media thickness in obesity: relation to hypertension and dyslipidaemia. Arch Dis Child 2005; 90: 1097
    PubMedGoogle Scholar
  • 24 Reinehr T, Kiess W, de Sousa G et al. Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism 2006; 55: 113-118
    CrossrefPubMedGoogle Scholar
  • 25 Roth CL, Kratz M, Ralston MM et al. Changes in adipose-derived inflammatory cytokines and chemokines after successful lifestyle intervention in obese children. Metabolism 2011; 60: 445-452
    CrossrefPubMedGoogle Scholar
  • 26 Bluher M. Adipokines – removing road blocks to obesity and diabetes therapy. Mol Metab 2014; 3: 230-240
    PubMedGoogle Scholar
  • 27 Reinehr T. Type 2 diabetes mellitus in children and adolescents. World J Diabetes 2013; 4: 270-281
    CrossrefPubMedGoogle Scholar
  • 28 Wiegand S, Keller KM, Röbl M et al. Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16 390 overweight or obese children and adolescents. Int J Obes (Lond) 2010; 34: 1468-1474
    CrossrefPubMedGoogle Scholar
  • 29 Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med 2005; 352: 2100-2109
    CrossrefPubMedGoogle Scholar
  • 30 Wille N, Bullinger M, Holl R et al. Health-related quality of life in overweight and obese youths: results of a multicenter study. Health Qual Life Outcomes 2010; 8: 36
    CrossrefPubMedGoogle Scholar
  • 31 Gortmaker SL, Must A, Perrin JM et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329: 1008-1012
    CrossrefPubMedGoogle Scholar
  • 32 Holzapfel C, Landsberg B, Ried J et al. Prävention von Adipositas: Perspektiven, Chancen und Grenzen in Deutschland und Europa. Adipositas 2013; 7: 97-103
    PubMedGoogle Scholar
  • 33 Sobol-Goldberg S, Rabinowitz J, Gross R. School-based obesity prevention programs: a meta-analysis of randomized controlled trials. Obesity (Silver Spring) 2013; 21: 2422-2428
    CrossrefPubMedGoogle Scholar
  • 34 Bleich SN, Segal J, Wu Y et al. Systematic review of community-based childhood obesity prevention studies. Pediatrics 2013; 132: e201-e210
    CrossrefPubMedGoogle Scholar
  • 35 Oude LH, Baur L, Jansen H et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009; CD001872
    PubMedGoogle Scholar
  • 36 Müller J, Reinehr T, Hebebrand J. Prävention und Therapie der Adipositas im Kindes- und Jugendalter. Deutsches Ärzteblatt 2006; 103: 334-340
    PubMedGoogle Scholar
  • 37 Reinehr T, Kiess W, Kapellen T et al. Insulin sensitivity among obese children and adolescents, according to degree of weight loss. Pediatrics 2004; 114: 1569-1573
    CrossrefPubMedGoogle Scholar
  • 38 Wunsch R, de Sousa G, Toschke AM et al. Intima-media thickness in obese children before and after weight loss. Pediatrics 2006; 118: 2334-2340
    CrossrefPubMedGoogle Scholar
  • 39 Reinehr T, Dobe M, Kersting M. Tipps und Tricks von Obeldicks und Optimix: Der Ratgeber für Eltern übergewichtiger Kinder. 2.. Aufl. Göttingen: Hogrefe; 2009
    Google Scholar
  • 40 Shai I, Schwarzfuchs D, Henkin Y et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359: 229-241
    CrossrefPubMedGoogle Scholar
  • 41 Sacks FM, Bray GA, Carey VJ et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009; 360: 859-873
    CrossrefPubMedGoogle Scholar
  • 42 Reinehr T. Lifestyle intervention in childhood obesity: changes and challenges. Nat Rev Endocrinol 2013; 9: 607-614
    CrossrefPubMedGoogle Scholar
  • 43 Reinehr T, Roth CL. The gut sensor as regulator of body weight. Endocrine 2014; Epub ahead of print
    PubMedGoogle Scholar
  • 44 Knop C, Singer V, Uysal Y et al. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes 2013; 10: 7-14
    PubMedGoogle Scholar
  • 45 McGovern L, Johnson JN, Paulo R et al. Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 2008; 93: 4600-4605
    CrossrefPubMedGoogle Scholar
  • 46 Courcoulas AP, Christian NJ, Belle SH et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA 2013; 310: 2416-2425
    PubMedGoogle Scholar
  • 47 Inge TH, Xanthakos S. Sleeve gastrectomy for childhood morbid obesity: why not?. Obes Surg 2010; 20: 118-120
    CrossrefPubMedGoogle Scholar
  • 48 Sjostrom L, Peltonen M, Jacobson P et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA 2014; 311: 2297-2304
    CrossrefPubMedGoogle Scholar
  • 49 Black JA, White B, Viner RM et al. Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis. Obes Rev 2013; 14: 634-644
    CrossrefPubMedGoogle Scholar
  • 50 O'Brien PE, Sawyer SM, Laurie C et al. Laparoscopic adjustable gastric banding in severely obese adolescents: a randomized trial. JAMA 2010; 303: 519-526
    CrossrefPubMedGoogle Scholar
  • 51 Inge TH, Zeller MH, Jenkins TM et al. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 2014; 168: 47-53
    CrossrefPubMedGoogle Scholar