Aktuelle Empfehlungen zur Prävention der Adipositas im Kindes- und Jugendalter

Zusammenfassung

Hintergrund: Es werden basierend auf der aktuellen Studienlage Empfehlungen zur Adipositasprävention im Kindes- und Jugendalter vorgestellt.

Methodik: Mithilfe einer Literaturrecherche in Medline/PubMed wurden wissenschaftliche Studien zum Thema ausgewertet.

Ergebnisse: Programme zur Adipositasprävention waren bisher meistens schulbasiert, und die Effekte sind insgesamt gering. Altersgruppenspezifische Auswertungen zeigen, dass Präventionsprogramme bei jüngeren Kindern (< 12 Jahre) die besten Effekte zeigen. Evidenzbasierte Empfehlungen für das Vorschulalter zeigen, dass Interventionen, die sowohl Eltern als auch Lehrer/Betreuer einbeziehen, am effektivsten waren. Für das Jugendalter sind schulbasierte Interventionen am erfolgreichsten, die sich direkt an die Jugendlichen richten. Bislang beinhalten Interventionen vor allem verhaltenspräventive Maßnahmen. Konkrete Maßnahmen zur Verhältnisprävention wurden von der Deutschen Allianz Nichtübertragbarer Krankheiten formuliert und umfassen eine tägliche Sportstunde in den Schulen, gesundheitsfördernde Lebensmittelpreise, verbindliche Qualitätsstandards für Kita- und Schulverpflegung sowie ein Verbot von Kinderwerbung.

Schlussfolgerungen: Maßnahmen, die einen verhaltenspräventiven Ansatz verfolgten (Verhaltensänderung des Einzelnen), haben sich bisher als nur bedingt effektiv erwiesen. Risikogruppen für die Entwicklung einer Adipositas werden bisher nicht zufriedenstellend erreicht. Aufgrund der Heterogenität der vorhandenen Studien lassen sich nur wenige allgemeingültige Aussagen ableiten. Die Kombination mit Verhältnisprävention, die sich gegen ein adipogenes (also Adipositas begünstigendes) Umfeld richtet, ist zukünftig für nachhaltige Erfolge unbedingt erforderlich.

Abstract

Background: Current guidelines for the prevention of obesity in childhood and adolescence are presented.

Methods: A literature search was performed in Medline via PubMed, and appropriate studies were analysed.

Results: Programs to prevent childhood obesity were to date mainly school-based. Effects were limited to date. Analyses tailored to different age groups show that prevention programs have the best effects in younger children (< 12 years). Evidence based recommendations for preschool- and early school age imply the need for interventions addressing parents and teachers alike. During adolescence, school-based interventions were most effective when adolescents were directly addressed. To date, obesity prevention programs have mainly focused on behavior oriented prevention. Recommendations for condition oriented prevention have been suggested by the German Alliance of Non-communicable Diseases and include one hour of physical activity at school, promotion of healthy food choices by taxing unhealthy foods, mandatory quality standards for meals at kindergarten and schools as well as a ban on unhealthy food advertisement addressing children.

Conclusion: Behavior oriented prevention programs showed hardly any or only limited effects in the long term. Certain risk groups for the development of obesity are not reached effectively by available programs. Due to the heterogeneity of available studies, universally valid conclusions cannot be drawn. The combination with condition oriented prevention, which has to counteract on an obesogenic environment, is crucial for sustainable success of future obesity prevention programs.

Schlüsselwörter

Adipositasprävention - Kindesalter - Verhaltensprävention - Verhältnisprävention - Randomisierte klinische Studien - Jugendalter

Key words

obesity prevention - childhood - behavior oriented prevention - condition oriented prevention - randomized controlled trial - adolescence

^* Both authors contributed equally to this work.

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