Anke Schaefer

Changes in self-reported and parent-reported health-related quality of life in overweight children and adolescents participating in an outpatient training: findings from a 12-month follow-up study

BackgroundHealth-related quality of life (HRQoL) was found to improve in participants of weight management interventions. However, information on moderately overweight youth as well as on maintaining HRQoL improvements following treatment is sparse. We studied the HRQoL of 74 overweight, but not obese participants (32.4% male, mean age = 11.61 ± 1.70 SD) of a comprehensive and effective six-month outpatient training at four time-points up to 12 months after end of treatment.MethodsHRQoL was measured by self-report and proxy-report versions of the generic German KINDL-R, including six sub domains, and an obesity-specific additional module. Changes in original and z-standardized scores were analyzed by (2×4) doubly multivariate analysis of variance. This was done separately for self- and proxy-reported HRQoL, taking into account further socio-demographic background variables and social desirability. Additionally, correlations between changes in HRQoL scores and changes in zBMI were examined.ResultsThere were significant multivariate time effects for self-reported and proxy-reported HRQoL and a significant time-gender interaction in self-reports revealed (p < .05). Improvements in weight-specific HRQoL were evident during treatment (partial η2 = 0.14-0.19). Generic HRQoL further increased after end of treatment. The largest effects were found on the dimension self-esteem (partial η2 = 0.08-0.09 for proxy- and self-reported z-scores, respectively). Correlations with changes in weight were gender-specific, and weight reduction was only associated with HRQoL improvements in girls.ConclusionsPositive effects of outpatient training on generic and weight-specific HRQoL of moderately overweight (not obese) children and adolescents could be demonstrated. Improvements in HRQoL were not consistently bound to weight reduction. While changes in weight-specific HRQoL were more immediate, generic HRQoL further increased after treatment ended. An extended follow-up may therefore be needed to scrutinize HRQoL improvements due to weight management.Trial registrationclinicaltrials.gov NCT00422916

Overweight children and adolescents – is there a subjective need for treatment?

Objectives:We report on the first months of recruitment for a study to evaluate outpatient training for moderately overweight youths.Methods:Various recruitment strategies were employed, including media exposure, paediatricians, school events, and the distribution of flyers. Roughly 6 160 overweight and 4 720 obese children and adolescents of the target age range were estimated to live in the study area.Results:Altogether, 172 families enrolled for participation. Only 38 enrolled children (22.1%), however, were overweight and thereby eligible for participation, 132 children (76.7%) were obese and two were normal weight. Most eligible participants were recruited via media or paediatricians.Conclusions:Reaching overweight, but not obese, children and adolescents for intervention is difficult, where a low recognition of the condition in its less extreme form might be a particular problem.

Health-related quality of life in overweight German children and adolescents: do treatment-seeking youth have lower quality of life levels? Comparison of a clinical sample with the general population using a multilevel model approach

BackgroundHealth-related quality of life (HRQoL) is reduced in obese children and adolescents, especially in clinical samples. However, little is known regarding the HRQoL of moderately overweight youth. Moreover, several studies have indicated perceived overweight as a critical factor associated with lower HRQoL. Our main objective was to compare HRQoL between treatment-seeking overweight youth and the general adolescent population, whilst separating the effects of treatment-seeking status and perceived weight from those of objective weight status.MethodsWe compared the HRQoL of a clinical sample of overweight youth (N=137 patients, mean age±s.e.=11.24±0.15 years) with that of a representative population sample (N=6354, mean age=12.75±0.03 years). The population sample was subdivided into groups based on measured and perceived weight status. We used hierarchical linear models to compare HRQoL subscale scores (self- and parent-reported) between patients and population groups, adjusted for sociodemographic characteristics and taking into account clustering of the population sample.ResultsThe parent-reported HRQoL of the treatment sample was significantly lower than that of other overweight youth perceived as ‘too fat’ on two subscales: ‘self-esteem’ and ‘friends’ (effect sizes: d=0.31 and 0.34, respectively). On other subscales, patients scored lower than adolescents perceived as having a ‘proper weight’ by their parents. The patterns for self-reported HRQoL in adolescents were different: patients reported higher self-esteem than other overweight youth feeling ‘too fat’ (d=-0.39). Female patients also reported higher physical well-being (d=-0.48), whereas males scored lowest among all compared groups (d=0.42-0.95). Patients did not differ from other overweight youth who felt ‘too fat’ with respect to other HRQoL dimensions. In general, lower HRQoL was primarily associated with a perceived, rather than actual, overweight status.ConclusionsThe treatment-seeking status of overweight youth was notably associated with low social well-being, which may therefore be the main motive for seeking treatment. Other HRQoL domains were not consistently reduced in treatment-seekers. Our results further indicate that perceived overweight rather than actual overweight impacts HRQoL in youth with a modest excess weight. These results have implications for interventions in overweight youth and in individuals who are dissatisfied with their weight.Trial registration‘Obeldicks light’ is registered at clinicaltrials.gov (NCT00422916).

Development and evaluation of the lifestyle intervention “Obeldicks light” for overweight children and adolescents

AimSpecific interventions for overweight but not obese children have not been established yet. Therefore, we developed the methods, materials, and an evaluation protocol for a lifestyle intervention for overweight children based on an intervention for obese children.Subjects and methodsThe 1-year lifestyle intervention “Obeldicks” for obese children, compromised of physical activity plans, nutritional education, and behavioural counselling, including individual psychological care for both children and their parents, was shortened, reducing the amount of exercise training and individual counselling by about 50%, forming a 6-month intervention (“Obeldicks light”).ResultsThe evaluation protocol was based on guidelines and validated instruments with available German healthy normal-weight controls. As the ideal study design, a multicentre randomised controlled trail with the primary outcome change of weight status was identified. As secondary outcomes, improvement of body composition (skinfold thickness, bioimpedance analysis), cardiovascular risk factors (blood pressure, waist circumference), quality of life, dietary habits, eating, exercise, and sedentary behaviour were established. Potential influencing factors for treatment success were identified, such as parental BMI, ethnicity, and socioeconomic status. All proposed instruments were validated in the German representative KiGGS and DONALD study.ConclusionsAdapting a well-established program for obese children to overweight children is an easy way to create a lifestyle intervention for overweight children. Our study protocol using instruments validated in German normal weight cohorts allows evaluating this new intervention.