Das Freiburger Interventions programm FITOC

Zusammenfassung

Hintergrund: FITOC (Freiburg Intervention Trial for Obese Children) ist ein interdisziplinäres Interventionsprogramm zur ambulanten Therapie der Adipositas im Kindes- und Jugendalter. Das seit 1987 existierende Programm beinhaltet eine Kombination aus organisiertem Sport, Ernährungsschulung und einer Verhaltenstherapie. Im Vergleich zu anderen Programmen erfolgt in FITOC eine Sportbetonung (3x/Woche eine spezielle Sportstunde). Das Programm ist seit August 2008 vom Medizinischen Dienst (MDS) zertifiziert und auf andere Regionen Deutschlands übertragbar.

Methoden: Die Daten von 31 Gruppen mit 496 Kindern (267 Mädchen, 229 Jungen) mit einem mittleren Alter von 10,5 Jahre warden dargestellt. Körpergröße und Körpergewicht, LDL-Cholesterin (LDL-C) und körperliche Fitness wurden zu Therapiebeginn, nach 8,5 Monaten und nach 3,3 Jahren gemessen.

Ergebnisse: Nach der achtmonatigen Intensivphase konnte bei beiden Geschlechtern sowohl der BMI als auch der BMI-SDS reduziert warden (p<0,001). Außerdem ging das LDL-C bei beiden Geschlechtern signifikant zurück und das Fitness-Niveau (Watt/kg KG) verbesserte sich (p<0,001). Die positiven Veränderungen waren noch 3,3 Jahre nach Therapiebeginn bei den zur Untersuchung erschienenen Kindern dokumentierbar.

Schlussfolgerung: Die Ergebnisse zeigen, dass adipöse Kinder erfolgreich in dem ambulanten Programm behandelt werden können. Um den therapeutischen Erfolg zu erhalten, müssen die Kinder in Zusammenarbeit mit Vereinen in normale Sportgruppen integriert werden und Hilfe erhalten, einen aktiveren Lebensstil beizubehalten.

Summary

Background: The Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary, outpatient program for obese children consisting of regular physical exercise and comprehensive dietary and behavioral education. This program is orientated towards sports compared with other interventions programs. The program is certificated since 2008 by the MDS (Medizinischer Dienst der Spitzenverbände der Krankenkassen) and it is possible to transfer the program in other parts of Germany.

Methods: Data were collected from 31 groups comprising 496 children (267 girls, 229 boys), with an average age of 10.5 years. Body height and weight, fasting LDL-Cholesterol (LDL-C) and physical performance were measured initially after 8.5 months and 3.3 years. Results: After the intensive intervention phase of eight months, body mass index (BMI) as well as body mass index deviation scores (BMI-SDS) decreased in both sexes (p<0.001). LDL-C decreased significantly in both sexes. The fitness levels (Watt/kg body weight) improved in the intervention group (p<0.001) even after 3.3 years.

Conclusions: The results indicate that obese children can be successfully treated in such an intervention program. To maintain therapeutical success, we highly recommended that these children enroll in community-based exercise programs in order to help them maintain a more active life-style.

Schlüsselwörter

Ambulantes Adipositastherapieprogramm - Kinder und Jugendliche - körperliche Aktivität

Keywords

Outpatient program for obese children - physical activity

• Literatur

• 1 Bailey RC, Olson J, Pepper SL. et al. The level and tempo of children’s physical activities: an observational study. Med Sci Sports Exerc 1995; 27 (07) 1033-1041.
• 2 Berg A, Jakob E, Lehmann M. et al. Aktuelle Aspekte der modernen Ergometrie. Pneumologie 1990; 44 (01) 2-13.
• 3 Berg A, Korsten-Reck U. Strategien zur Verbesserung des Aktivitäts- und Ernährungsverhaltens bei Kindern und Jugendlichen. Der Lipidreport 1995; 04: 15-22.
• 4 Berkey CS, Rockett HR, Gillman MW, Colditz GA. One-year changes in activity and in inactivity among 10– to 15-year-old boys and girls: relationship to change in body mass index. Pediatrics 2003; 111 (4 Pt 1): 836-843.
• 5 Braddon FE, Rodgers B, Wadsworth ME, Davies JM. Onset of obesity in a 36 year birth cohort study. Br Med J (Clin Res Ed) 1986; 293 6542 299-303.
• 6 Eliakim A, Kaven G, Berger I. et al. The effect of a combined intervention on body mass index and fitness in obese children and adolescents – a clinical experience. Eur J Pediatr 2002; 161 (08) 449-454.
• 7 Flegal KM. The obesity epidemic in children and adults: current evidence and research issues. Med Sci Sports Exerc 1999; 31 (Suppl. 11) S509-S514.
• 8 Freedman DS, Shear CL, Burke GL. et al. Persistence of juvenile-onset obesity over eight years: the Bogalusa Heart Study. Am J Public Health 1987; 77 (05) 588-592.
• 9 Goran MI, Gower BA, Nagy TR, Johnson RK. Developmental changes in energy expenditure and physical activity in children: evidence for a decline in physical activity in girls before puberty. Pediatrics 1998; 101 (05) 887-891.
• 10 Gortmaker SL, Peterson K, Wiecha J. et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999; 153 (04) 409-418.
• 11 Guo SS, Roche AF, Chumlea WC. et al. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr 1994; 59 (04) 810-819.
• 12 Kavey RE, Daniels SR, Lauer RM. et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation 2003; 107 (11) 1562-1566.
• 13 Korsten-Reck U, Kaspar T, Korsten K. et al. Motor abilities and aerobic fitness of obese children1. Int J Sports Med 2007; 28 (09) 762-767.
• 14 Korsten-Reck U, Korsten K, Haeberle K. et al. The psychosocial situation of obese children: Psychosocial factors and quality of liefe. Psychology Research and Behavior Management 2009; 02: 23-29.
• 15 Korsten-Reck U, Kromeyer K, Korsten K. et al. Freiburg Intervention Trial for obese Children (FITOC): Ergebnisse einer klinischen Beobachtungsstudie. Deutsch Z Spormed 2006; 57 (02) 36-41.
• 16 Korsten-Reck U, Kromeyer-Hauschild K, Korsten K. et al. Frequency of secondary dyslipidemia in obese children. Vascular Health and Risk Management 2008; 04 (05) 1089-1094.
• 17 Kromeyer-Hauschild K, Wabitsch M, Kunze D. et al. Perzentile für den Body-Mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 2001; 149 (08) 807-818.
• 18 Lake JK, Power C, Cole TJ. Women’s reproductive health: the role of body mass index in early and adult life. Int J Obes Relat Metab Disord 1997; 21 (06) 432-438.
• 19 Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: the Muscatine Study. Pediatrics 1988; 82 (03) 309-318.
• 20 Lobstein T, Jackson-Leach R. Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease2. Int J Pediatr Obes 2006; 01 (01) 33-41.
• 21 Molnar D, Livingstone B. Physical activity in relation to overweight and obesity in children and adolescents. Eur J Pediatr 2000; 159 (Suppl. 01) S45-S55.
• 22 Must A, Jacques PF, Dallal GE. et al. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 1992; 327 (19) 1350-1355.
• 23 Reinehr T, Kersting M, Wollenhaupt A. et al. Evaluation of the training program “OBELDICKS” for obese children and adolescents. Klin Padiatr 2005; 217 (01) 1-8.
• 24 Robinson TN. Reducing children`s television viewing to prevent obesity: a randomized controlled trial. JAMA 1999; 282 (16) 1561-1567.
• 25 Srinivasan SR, Bao W, Wattigney WA, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism 1996; 45 (02) 235-240.
• 26 Summerbell CD, Ashton V, Campbell KJ. et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2003; 03: CD001872.
• 27 Trost SG, Sirard JR, Dowda M. et al. Physical activity in overweight and nonoverweight preschool children. Int J Obes Relat Metab Disord 2003; 27 (07) 834-839.
• 28 Wang G, Dietz WH. Economic burden of obesity in youths aged 6 to 17 years: 1979–1999. Pediatrics 2002; 109 (05) E81.
• 29 Whitaker RC, Wright JA, Pepe MS. et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997; 337 (13) 869-873.
• 30 World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000 894.