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ZusammenfassungAdipositas im Kindes- und Jugendalter stellt auch infolge der COVID-19 Pandemie ein wachsendes Problem dar. In der Therapie wiesen verhaltensorientierte multimodale Programme mit den Schwerpunkten Ernährung, Bewegung, medizinische und psychosoziale Betreuung unter Einbezug des familiären Umfeldes bzw. der Eltern über einen Zeitraum von 6 bis 12 Monaten die beste Evidenz auf. Allerdings gibt es nach wie vor keine flächendeckende Versorgung Betroffener. Dies ist hauptsächlich auf eine uneinheitliche Kostenübernahme durch unterschiedliche Kostenträger und Verantwortlichkeiten zurückzuführen. Die vom Gesetzgeber vorgesehene Entwicklung eines Disease Management Programms Adipositas stellt einen möglichen Schritt zur adäquaten Versorgung dar. Um den Besonderheiten von Kindern und Jugendlichen gerecht zu werden, sollte neben einem DMP für Erwachsene eines für diese Altersgruppe konzipiert werden. Zusätzlich sollte dieses DMP „Adipositas im Kindes- und Jugendalter“ in ein Gesamtkonzept eingebettet werden, das patientenzentriert den Bedürfnissen der Betroffenen i.S. ambulanter und stationärer Maßnahmen gerecht wird. Um aber die Versorgungssituation zu verbessern, sind darüber hinaus sozialgesetzbuchüberschreitende innovative Absätze wie beispielsiweise kommunal verankerte Beratungsstellen wünschenswert.

Allergic diseases, including atopic dermatitis (AD), food allergy (FA), asthma and allergic rhinitis/rhinoconjunctivitis (AR) are the most prevalent chronic childhood diseases affecting one in four children in the Western world (1). This global health problem imposes a significant burden on patient's quality of life (2), family, health care and society. The current state of knowledge assumes that complex interactions between genetic and environmental factors influence a child´s immune maturation prior to the development of allergic diseases (3). To date, no reliable predictions of allergy development exists. Current scores, including clinical features and laboratory data, have only reached limited specificity and/or sensitivity (4).

Background: Allergic diseases are the most prevalent chronic childhood diseases resulting in a massive societal and economic burden for the community and a significant reduction of health-related quality of life (HRQoL) for affected families. The project CHAMP (CHildhood Allergy and tolerance: bioMarkers and Predictors) was funded in 2017 by the German Federal Ministry for Education and Research. Methods: CHAMP investigates the determinants of different allergic diseases from birth to adolescence to identify clinically relevant biomarkers predicting onset, progression, remission and severity. Data on HRQoL and patient’s needs and requirements were collected, supported by the German Asthma and Allergy Association (DAAB). Using validated questionnaires and outpatient visits, eight subprojects analysed allergic diseases in epidemiological or clinical cohorts (more than 2500 children/adolescents), sampling numerous biomaterials to assess omics on several levels. Murine models disentangled underlying mechanisms of early tolerance, translating findings from the cohorts to models and vice versa. Results: The DAAB survey, including 851 participants, showed that 83% were interested in prediction of the course of different current allergic diseases and future manifestation. 86% of participants considered doctor’s specialized training and their education as highly important, over 70% chose research for allergy understanding and prevention as critical. CHAMP addresses these needs. Common SOPs have been established and recruitment is ongoing. Conclusion: The DAAB patient survey confirmed the critical need for translational allergy research. CHAMP envisions to predict onset, tolerance and remission of allergic diseases and to identify disease sub-phenotypes for future development of preventive strategies and novel avenues for therapeutic options.

Objective Obesity is associated with many cardiovascular risk factors (CVRF) in childhood. There is an ongoing discussion whether there is a linear relationship between degree of overweight and deterioration of CVRFs justifying body mass index (BMI) cut-offs for treatment decisions. Methods We studied the impact of BMI-SDS on blood pressure, lipids, and glucose metabolism in 76,660 children (aged 5–25 years) subdivided in five groups: overweight (BMI-SDS 1.3 to 2.8–3.3), and class IV (BMI-SDS > 3.3). Analyses were stratified by age and sex. Results We found a relationship between BMI-SDS and blood pressure, triglycerides, HDL cholesterol, liver enzymes, and the triglycerides–HDL-cholesterol ratio at any age and sex. Many of these associations lost significance when comparing children with obesity classes III and IV: In females Conclusions Since a BMI above the highest BMI cut-off was not associated consistently with dyslipidemia and disturbed glucose metabolism in every age group both in boys and girls, measurements of CVRFs instead of BMI cut-off seem preferable to guide different treatment approaches in obesity such as medications or bariatric surgery.

Objective: The objective of this study is to analyze whether sociodemographic characteristics or cardiovascular risk factors differ in children and adolescents at the beginning of a lifestyle intervention (LI) for obesity within Germany. Methods: A total of 40,942 children and adolescents with German residence from the APV-registry were included. Subjects were assigned to the 16 federal states of Germany according to their postal code. Sociodemographic and cardiovascular risk factors at the beginning of a LI for obesity were compared between the federal states. Logistic models were implemented for the prevalence of extreme obesity, hypertension, dyslipidemia, abnormal carbohydrate metabolism, nonalcoholic fatty liver disease (NAFLD), and treatment modality (inpatient vs. outpatient). Results: Age at the beginning of a LI ranged from 11.5 to 13.5 years. Proportion with a migration background was between 5.8% and 49.7%. Within Germany, extreme obesity in children and adolescents initiating a LI strongly differed between 35.6% and 50.8%. Regional differences were also found for obesity-related risk factors: hypertension (39.0–68.1%), dyslipidemia (24.9–44.6%), NAFLD (9.4–20.4%), abnormal carbohydrate metabolism (0.7–6.2%) (all p Conclusion: Several factors as individual socioeconomic status, personal attitude, treatment accessibility, or regional differences in reimbursement decisions might have contributed to the disparities.

Objective: Treatment of paediatric obesity focuses on changes of nutrition and eating behaviour and physical activity. The evaluation of the patient education programme by KgAS was utilised to analyse the association of changes of portion size, eating rate and dietary habits with BMI-SDS reductions. Methods: Patients (n = 297) were examined at the beginning and at the end of treatment and after 1-year follow-up at different out-patient centres. Their parents completed questionnaires including estimation of children's portion size, eating rate and frequency of food intake. Associations of 1- and 2-year changes in BMI-SDS and behaviour were calculated for patients with complete data in BMI-SDS, portion size, eating rate, frequency of green, yellow and red food intake (n = 131) by multiple linear regression models. Results: Significant changes were found in the desired direction for BMI-SDS, portion size, eating rate and the intake of unfavourable red food items both after 1 and 2 years as well as for the consumption of favourable green food items after 1 year. Significant positive associations with BMI-SDS reduction after 1 and 2 years were detected for portion size (Cohen's f2 0.13 and 0.09) and eating rate (Cohen's f2 0.20 and 0.10), respectively. Conclusion: Reduced portion sizes and eating rates are associated with BMI-SDS reduction after 1 and 2 years. These findings suggest to focus on appropriate portion sizes and reduced eating rates in patient education programmes.

Zusammenfassung Hintergrund: Die Beobachtungsstudie zur Evaluation ambulanter und stationärer Versorgung zur Behandlung der Adipositas im Kindes- und Jugendalter in Deutschland (BZgA-Studie) zeigte in einer breiten Angebotspalette sehr heterogene Therapieadhärenz und Ergebnisse. Es soll gezeigt werden, welche Ergebnisse durch ein homogenes, leitliniengerechtes, ambulantes Programm der Konsensusgruppe Adipositasschulung für Kinder und Jugendliche e. V. (KgAS) in der multizentrischen Anwendung erzielt warden können. Methode: 8–16-jährige adipöse Patienten und ihre Familien wurden an 14 Standorten in Deutschland ein Jahr ambulant nach dem KgAS-Programm in einer Gruppenschulung behandelt. Neben einem Fragebogen zur Lebensqualität wurden zu Therapiebeginn (T0) und -ende (T1) sowie ein Jahr später (T2) BMI, Blutdruck und Adipositas-relevante Laborwerte von den Patienten erhoben. Die Analyse erfolgte sowohl für Fälle mit vollständigen Daten als auch mit Baseline observation carried foreward (BOCF)-Methode für Patienten mit fehlenden Daten. Ergebnisse: Der BMI der 297 Patienten lag zu T0 im Mittel bei 28,7 kg/m², bzw. +2,37 SDS, 13,2 % übergewichtig, 55,8 % adipös, 31,0 % extrem adipös. Das mittlere Alter betrug 11,7 Jahre, 52,1 % waren weiblich und einen Migrationshintergrund hatten 34,7 % der Patienten. Zu T1 konnten 97 % der Patienten untersucht werden, zu T2 59 %. Der BMI-SDS reduzierte sich bis T1 signifikant (für vollständige Daten von +2,32 auf +2,03 zu T1 und +2,07 zu T2 und BOCF +2,37 [T0], 2,14 [T1] und 2,22 [T2]). Die Hypertonieprävalenz verminderte sich kurz- und langfristig signifikant (für vollständige Daten N=103, p Schlussfolgerung: Die KgAS-Studie weist mit einem standardisierten Programm in der multizentrischen Durchführung für alle dargestellten Behandlungsziele signifikante Verbesserungen nach: Übergewichtsreduktion, Reduktion von kardiovaskulären Risikofaktoren sowie positive Veränderungen der Lebensqualität.

Objective: To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade. Methods: 65,453 subjects (Results: Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups. Conclusion: During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.

Objective: Childhood obesity is high on the global public health agenda. Although risk factors are well known, the influence of social risk on the therapeutic outcome of lifestyle intervention is poorly examined. This study aims to investigate the influence of migration background, low education, and parental unemployment. Methods: 62,147 patients participated in multidimensional lifestyle intervention programs in 179 pediatric obesity centers. Data were collected using standardized software for longitudinal multicenter documentation. 12,305 (19.8%) attended care for 6-24 months, undergoing an intensive therapy period and subsequent follow-ups for up to 3 years. A cumulative social risk score was calculated based on different risk indicators. Results: Migration background, low education, and parental employment significantly influenced the outcome of lifestyle intervention. The observed BMI-SDS reduction was significantly higher in the subgroup with low social risks factors (Δ BMI-SDS -0.19) compared to those presenting moderate (Δ BMI-SDS -0.14) and high social risk (Δ BMI-SDS -0.11). Conclusion: Our data underline the effect of children's social setting on the outcome of multidimensional lifestyle intervention. The presence of a high social risk burden is a negative predictor for successful weight loss. Specific therapeutic programs need to be developed for disadvantaged children and adolescents.

Objective: The aim of the study was to analyze the adherence to current guidelines for co-morbidity screening in overweight and obese pediatric patients participating in the Adipositas-Patienten-Verlaufsdokumentation (APV) initiative in three German-speaking countries. Methods: APV database: 181 centers from Germany, Austria and Switzerland, specialized in obesity care, contributed standardized, anonymous data of medical examinations from 65,397 patients performed between 2000 and 2010. Completeness of screening for hypertension, dyslipidemia, and impaired glucose metabolism was analyzed using adjusted means. Results: Mean age of the cohort was 12.5 ± 2.9 years and 46.5% were male. 17.3% were overweight (>90th-97th percentile), 45.1% obese (>97th-99.5th percentile), and 37.7% extremely obese (>99.5th percentile). In 2000, blood pressure was documented for 55.1% of patients, increasing to 88.7% in 2010. The rate of lipid diagnostics also improved from 45.0 to 67.7%, and screening for diabetes rose from 32.7 to 62.3% in the same time period. Blood pressure measurements were performed more often during inpatient care (88.5%) compared to outpatient programs (77.5%). Screening was more complete with increasing age and increasing degree of obesity. In boys screening rate was higher than in girls. Conclusion: During the 11-year period, screening for co-morbidity improved significantly in overweight or obese children and adolescents. However, adherence to guidelines is still insufficient in some institutions. Quality control based on benchmarking may improve obesity care and outcome.