Predictors and determinants for weight reduction in overweight and obese children and adolescents.

Introduction: Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. This multicenter non-randomised trial aimed to identify parameters and determinants of long-term weight reduction. Patients and methods: A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9 +/- 2.4 years, BMI 31.2 +/- 5.4 kg/m(2), BMI-SDS 2.51 +/- 0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, standardized questionnaires to assess socio-demographic and socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape). Results: 66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53 +/- 0.09 mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45 mm), 40% a slightly elevated (>= 0.45 to <= 0.50 mm) and 45% an elevated (> 0.50 mm) thickness. After the inpatient treatment lasting 40.4 +/- 4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52 +/- 3.94 (0.4 to 13.3) kg (p < 0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with longterm weight reduction were identified (R-square = 0.53): well-being (beta = -0.543), resilience (beta = 0.434), and sense of coherence (beta = 0.315). Conclusion: The different parameters (i.e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs.