Interventionseffekte auf die Anthropometrie, psychischen Auffälligkeiten und die allgemeine psychische Belastung bei adipösen Kindern und Jugendlichen

Roland Kayser

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Abstract

Introduction: Beside possible somatic consequences it is not seldom that psychosocial burdens are accompanied to juvenile obesity which children and adolescents cannot escape (Wabitsch 2000). The risk of developing psychiatric disorders gets higher the more obese children and adolescents weigh (Puhl & Brownell 2003). The purpose of the present investigation of obese children and adolescents was to find out how effective an ambulant interdisciplinary intervention program - FITOC and FITOC-MAXI- influences anthropometric data, psychiatric disorders and overall psychic stress. Methods: 84 children and adolescents who have finished the one year FITOC- and FITOC-MAXI intervention program were examined at the beginning (T0), after ending the program (T1) and after 18 months (T2). Obese children and adolescents on the waiting list who were examined at T0 and T1 served as a control group (CG: n = 38). Along with the Child Behavior Check List/4-18 (CBCL/4-18) as evaluation instruments in the IG and CG to record psychiatric disorders and the overall psychic stress, additionally, the Youth Self Report/11-18 (YSR/11-18; only IG), the Teacher's Report Form (TRF only IG) and the Children Depression Inventory (DIKJ; only IG) were used in the IG for children and adolescents as self-report questionnaires and for assessing the therapist’s judgements. Results: At the beginning of the intervention the participants of the IG were in the mean 12.0 ± 2.5 years old, 156.4 ± 13.7 cm large and weighed 72.5 ± 19.9 kg. At the same time the children and adolescents of the CG were in the mean 11.7 ± 2.8 years old, were 154.5 ± 15.2 cm large and weighed 70.6 ± 23.7 kg. Both groups showed no significant gender differences in the examined parameters. At the time of T0 the participants of the IG recorded the BMI-SDS at 2.42 ± 0.42 (CG: 2.43 ± 0.49) and decreased the BMI-SDS after the one-year intervention (T1) significantly (p ≤ 0.001) to 2.24 ± 0.49 and could be stabilized 6 months (T2) after treatment at 2.19 ± 0.49 (T0 to T2: p ≤ 0,001). The CG could not lower the BMI-SDS (T0: 2.43 ± 0.49; T1: 2.48 ± 0.47; n.s.). The prevalence rates of psychiatric disorders at T0 in CBCL/4-18 laid at 28.1 % (CG: 31.8 %), in the YSR at 12.0 % and in the TRF at 27.0 %. At the end of the treatment (T1) psychiatric disorders decreased significantly (p ≤ 0,001) in the judgement of the parents (14.9 %), therapists (4.7 %) and the adolescents (2.9 %). 6 months after treatment (T2) the prevalence rates of psychiatric disorders in the YSR/11-18 amounted to 12.0 % (T0 to T2: n.s) and in the CBCL/4-18 at 15.0 % (T0 to T2: p ≤ 0,001). In the CG parents stated in the CBCL/4-18 that psychiatric disorders increased to 38.1 % (p ≤ 0,001). Depression existed at T0 by 19.0 % of the adolescents in the IG and could not be discovered after the intervention (p ≤ 0.001). Also significantly reduced was the mean value of the DIKJ from T0 (48.6 ± 13.6) to T1 (42.3 ± 12.1; p ≤ 0,001) and to T2 (45.6 ± 10.5; T0 to T2: p = 0.021). The overall psychic stress (total raw score) was significantly (p ≤ 0,001) reduced from T0 (t-score 59) to T1 (t-score 54) in the IG compared to the CG (T0: t-score: 55; T1: t-score 59; n.s.). 6 months after the intervention parents did not record significant changes in the overall psychic stress (T2: t-score 56). In judgement of therapists und adolescents the overall psychic stress reduced significantly (p ≤ 0.001) from T0 (therapists and adolescents: both t-score 55) to T1 (therapists: t-score 51; adolescents: t-score: 50). 6 months afters the intervention (T2) the overall psychic stress of the adolescents increased again (T2: t-score 51) and was not significantly different from T0 to T2. The regression analysis showed the difference of the BMI-SDS from T0 (2.42 ± 0.42) to T1 (2.24 ± 0.49) of the IG as a predictor for the total value of the syndrome scales of the CBCL/4-18. The more clearly the children and adolescents reduced their BMI-SDS the less psychological disorders were reported by the parents. Discussion: It could be shown that an interdisciplinary intervention with psychological support reduces the BMI-SDS, the prevalence rates of psychiatric disorders and the overall psychic stress within obese children and adolescents with a lasting effect. After the intervention significant reductions appeared in the categories ‘withdrawn’, ‘anxious/depressed’ and ‘social problems’. Nevertheless, adolescents see fewer changes than therapists and parents. Six months after the end of treatment a reduction of depressive symptoms had been observed and, from the point of view of the parents, it appeared the adolescents furthermore showed a reduction of psychiatric disorders. Obese children and adolescents seem to apply the learned coping strategies in judgement of their parents. For longer lasting effects to the children and adolescents they should be tied up to a treatment center beyond intervention.
Original languageGerman
Place of PublicationKöln
PublisherDeutsche Sporthochschule Köln
Number of pages181
Publication statusPublished - 2012

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