Emily Finne

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

Age, puberty, body dissatisfaction, and physical activity decline in adolescents. Results of the German Health Interview and Examination Survey (KiGGS).

BackgroundPhysical activity (PA) shows a marked decline during adolescence. Some studies have pointed to pubertal status or timing as possible PA determinants in this age group. Furthermore, it was supposed that the impact of pubertal changes on PA might be mediated by psychological variables like body dissatisfaction (BDS).MethodsThe 11- to 17-year-old subsample of the German Health Interview and Examination Survey (KiGGS) was used (n = 6 813; 51.3% male, response rate = 66.6%). Through sex-specific sequential multinomial logistic regressions we analysed the univariate and independent associations of chronological age, absolute pubertal status, relative pubertal timing, and BDS with the frequency of PA.ResultsChronological age showed a significantly negative association with PA in both sexes, independent of puberty. The odds of inactivity in contrast to nearly daily PA increased about 70% in boys and 35% in girls for each year of age, respectively. Adjusted for age and other possible confounders, inactivity was significantly less likely for boys in late pubertal stages (OR = 0.27, 95% CI = 0.09-0.78). The risk of inactivity was more than doubled in boys maturing earlier than peers in terms of relative pubertal timing (OR = 2.20, 95% CI = 1.36-3.56). No clear significant puberty effects were found in girls, but the inactivity was more likely for those with irregular menstruation (OR = 1.71, 95% CI = 1.06-2.75). BDS also contributed to the prediction of PA in both sexes. It partially mediated puberty effects in boys but not in girls.ConclusionsOverall, chronological age was a far more important predictor of PA in German adolescents than absolute pubertal status or relative pubertal timing. Further possible explanatory variables like sociocultural influences, social support or increasing time requirements for education should be analysed in conjunction with chronological age in future studies.

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.

Physical activity and screen-based media use: cross-sectional associations with health-related quality of life and the role of body satisfaction in a representative sample of German adolescents

Purpose: Although it is widely accepted that physical activity (PA) positively, and screen-based media use (SBM) negatively, affects well-being, there is a lack of studies relating PA and SBM to health-related quality of life (HRQoL) in adolescents. We examined these associations in German adolescents for different HRQoL subdomains and explored the role of body satisfaction as a possible mediator. Methods: The 11–17-year-old subsample of the German Health Interview and Examination Survey (2003–2006) was analysed (N = 6813; 51.3% male). Cross-sectional associations of self-reported PA frequency and amount of daily SBM with HRQoL subscale scores (according to KINDL-R) were examined by hierarchical linear regression models, adjusting for the clustering of the sample and for a variety of possible confounders. The size and significance of indirect effects via body (dis)satisfaction (BDS) were examined by mediation analyses. Results: Higher PA frequency was significantly associated with higher HRQoL on nearly all subscales and dose–response-relationships were observable. Variations were greatest in terms of social well-being in boys (effect size d = 0.59) and physical well-being in girls (d = 0.43). Higher SBM was related to lower HRQoL on all subscales in girls and on some subscales in boys, with the largest effects for school functioning in both genders (d = 0.31 and 0.37, respectively). The mediated effects for PA and SBM were significant in both genders, but the sizes and the proportions of total effects mediated by body satisfaction were rather small. Conclusions: Higher PA frequency was associated with higher self-reported HRQoL, and higher SBM was associated with lower self-reported HRQoL in both genders, even after adjusting for relevant covariates. The results support the assumption of independent health impacts of both behaviours, although no causal relationship can be confirmed with these cross-sectional data. Mechanisms other than body satisfaction must largely account for the effects of PA and SBM on well-being.

Individual and school level correlates of moderate to vigorous physical activity among school-children in Germany - a multi-level analysis

BackgroundYoung people spend half of their days in school, but evidence concerning the influence of school environment on the physical activity (PA) of pupils is still inconsistent. A better understanding of potential correlates of PA on the school-level and their possible interaction with individual aspects is needed to improve the development of more effective interventions.MethodsWe used data from the 2009/10 German Health Behaviour in School-aged Children study (HBSC)-sample (n=5,005 students aged 11–15 years) including self-reported moderate to vigorous intensity PA as well as a variety of biological, demographic and behavioral correlates and matched them with school-level data from the national school principals’ HBSC questionnaire. We analyzed the associations of individual- and school-level correlates with MVPA by gender-specific multi-level regression.ResultsOnly a small share of the overall variation in student’s PA was attributable to the school-level. Consequently, the associations of individual-level correlates with PA were stronger than those of the school-level. Our analysis revealed significant associations of individual-level (i.e. age, consumption of softdrinks, overweight) as well as school-level correlates (i.e. the availability of a football ground and a swimming pool) with MVPA. We also observed some gender-specific findings especially for the school level correlates. Cross-level interactions between individual- and school-level were not apparent.ConclusionsOur findings indicate the usefulness of applying an ecological framework to understand and explain complex health behaviors like PA. As we found gender-specific association it might be important to acknowledge that boys and girls have specific needs to be more physically active. Further research should also take other features/elements of the school environment and neighborhood as well as socio-cognitive correlates into account to advance the field.

The transtheoretical model in the context of physical activity in a school-based sample of German adolescents.

Abstract Physical activity in adolescents is an important public health issue. Regular participation in physical activity is associated with various health benefits. However, problems with motivational adherence to physical activity have been documented. The transtheoretical model is a model of behaviour change. This model, which consists of stages of change, self-efficacy, decisional balance, and processes of change, has not been extensively investigated in youth. In addition, the health-enhancing physical activity concept has rarely been applied in this context. A cross-sectional design was used. A random sample of seven junior high schools from Bremen (Germany) resulted in a sample of 588 adolescents (50.5% males, mean age=15.0 years, s=0.67). Respondents completed a self-administered questionnaire assessing stages of change, self-efficacy, decisional balance, and processes of change. Univariate analyses of variance were used to identify which constructs differed significantly across the stages of change. Discriminant analysis was used to determine which variables best discriminate the stages. Distribution of the sample across the stages was: precontemplation, n=175 (29.8%); contemplation, n=135 (22.0%); preparation, n=63 (10.7%); action, n=20 (3.4%); and maintenance, n=195 (33.2%). Significant effects of stages of change were found for self-efficacy, pros, and seven of the ten processes of change. In general, scores of these constructs increased across the stages. Cons did not differ significantly across the stages. The results provide support for some of the assumptions of the transtheoretical model in a German sample of adolescents. Some of our findings raise questions about the usefulness of five discrete stages. From a public health viewpoint, tailored interventions based on motivational readiness to change would be fruitful, but further research is warranted.

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).

Die Entwicklung von Geschlechterunterschieden im gesundheitsrelevanten Verhalten Jugendlicher von 2001 bis 2010

Health behaviours are influenced by gender-specific conceptions and norms of the society. These conceptions and norms are changing over time. The aim of this analysis is to describe gender differences in health behaviour of adolescents and to interpret these gender differences in terms of theories of social construction.We used the national German data of the Health-Behaviour in School-aged Children (HBSC) studies conducted in the years 2001/02, 2005/06 und 2009/10 with respect to the following health behaviours: tobacco use, binge drinking, diet, fruit and vegetable consumption, daily breakfast and physical activity. We describe the difference in frequencies between girls and boys and used a series of logistic regressions to test the significance of the gender difference in health behaviours with survey year as the predictor.There is only a small difference -between girls and boys with respect to tobacco use and binge drinking. For binge drinking girls nearly converge with the figures of boys. Relatively stable gender differences over time are existing for diet, nutrition and physical activity.From a theoretical gender perspective it might be possible that with respect to risky behaviours like tobacco use and alcohol consumption a clear gender specific connotation has changed over time. In other words risk behaviours become less important in presenting oneself as masculine. A gender sensible development of preventive interventions should consider the changes over time of gender-related -social constructions.

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.

Prävention von sexualisierter Gewalt in der Schule: Erste Erfahrungen mit einem niedrigschwelligen Ansatz für Lehrkräfte und Kinder im Grundschulalter

Befunde zur Pravalenz sexualisierter Gewalt von Kindern und Jugendlichen zeigen, dass es in Einrichtungen, die beauftragt und verpflichtet sind, Kinder zu schutzen, noch immer an verbindlichen Standards, Leitlinien und Masnahmen zur Pravention mangelt. Der Artikel konzentriert sich insbesondere auf die schulische Praventionsarbeit und nimmt exemplarisch Bezug auf das IGEL-Programm, welches nicht nur die Entwicklung und Implementierung, sondern auch die Evaluation schulbasierter Praventionsprogramme in den Blick nimmt. Das Ziel des IGEL-Praventionsprogrammes besteht zum einen darin, die Selbstschutzfahigkeit der Schuler_innen zu erhohen. Daruber hinaus soll eine Steigerung des Wissens uber sexualisierte Gewalt sowie eine Zunahme der Handlungskompetenzen erwirkt werden. Zum anderen zielt das Programm auf eine erhohte Sensibilitat fur sexuellen Missbrauch auf Seiten der Lehrkrafte ab. Resumierend benennen die Autor_innen Empfehlungen fur die weitere Entwicklung von schulischen Schutzkonzepten.