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Prävention von Übergewicht und Adipositas bei Kindern und Jugendlichen

Kritische Bewertung der Evidenzbasierung

Prevention of overweight and obesity in children and adolescents

Critical appraisal of the evidence base

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Hintergrund

Trotz sorgfältiger Planung und Umsetzung zeigen Präventionsprogramme zur Vorbeugung von Übergewicht/Adipositas bei Kindern und Jugendlichen keine, widersprüchliche oder nur schwache Effekte. Diese Programme streben in der Regel Verhaltensänderungen, selten auch Verhältnisänderungen an, die von allgemein akzeptierten Annahmen bzgl. der Determinanten ausgehen.

Fragestellung

Es wird die Evidenzlage bzgl. der Determinanten Ernährung, körperliche Aktivität und Stress kritisch hinterfragt. Vor diesem Hintergrund werden zudem die Ergebnisse internationaler Interventionsstudien diskutiert.

Material und Methoden

Es wird das Mediatoren-Modifikatoren-Variablen-Modell zugrunde gelegt und der Einfluss von Mediatoren sowie von Effektmodifikatoren und deren Verknüpfungen untersucht.

Ergebnisse

Entgegen der gängigen Annahme besteht hinsichtlich der möglichen Determinanten von Übergewicht/Adipositas im Kindes- und Jugendalter keine eindeutige Evidenzlage. Darüber hinaus scheint auch die Evidenz für eine starke kausale Beziehung zwischen vermuteten Mediatoren und den zu adressierenden Verhaltensweisen inkonsistent zu sein. Zudem werden Effektmodifikatoren häufig nicht in adäquater Weise berücksichtigt.

Diskussion

Es ist davon auszugehen, dass es sich bei der Entstehung von Übergewicht/Adipositas um ein komplexes multikausales Geflecht handelt. Zur Durchführung erfolgreicher Interventionen scheint weitere Forschung zum Verständnis der Ätiologie und der Wirkmechanismen der unter Verdacht stehenden Einflussfaktoren bei Kindern und Jugendlichen erforderlich. Nur wenn es möglich ist, eine substanzielle Veränderung von relevanten Mediatoren mit vertretbarem Aufwand und unter realen Bedingungen zu bewirken, machen Interventionsprogramme auf Bevölkerungsebene Sinn.

Abstract

Background

Despite careful planning and implementation, overweight/obesity prevention interventions in children and adolescents typically show no, inconsistent or merely weak effects. Such programs usually aim at behavior changes, rarely also at environmental changes, that draw upon conventional wisdom regarding the commonly accepted determinants of childhood overweight/obesity.

Objective

This paper evaluates the evidence base of the apparently overweight-/obesity-related determinants diet, physical activity and stress. The results of international intervention studies are discussed against this background.

Methods and Materials

Based on the mediating-moderating variable model, we investigate the effect of theory specified mediating variables and how potential moderating variables may impact these relationships.

Results

Contrary to common beliefs, recent research has revealed inconsistent evidence regarding associations between potentially obesogenic behaviors and overweight/obesity in youth. Moreover, the evidence for strong and causal relationships between mediating variables and targeted behaviors seems to be inconsistent. In addition, inadequate attention is paid to moderating effects.

Discussion

The etiology of overweight/obesity in youth is likely the result of a complex interplay of multi-causal influences. Future prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and of the mechanisms of suspected behaviors for affecting overweight/obesity. Only if substantial change can be demonstrated in mediators with reasonable effort under real world circumstances, it will make sense to progress to community behavior change trials.

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Danksagung

Dieser Artikel entstand als Teil der IDEFICS-Studie (www.idefics.eu). Die IDEFICS-Studie wurde von der Europäischen Kommission im 6. Forschungsrahmenprogramm unter der Kontrakt-Nr. 016181 (FOOD) gefördert. Dieser Beitrag basiert in wesentlichen Teilen auf [18], der mit Unterstützung der BZgA erstellt wurde. Wir danken der Zeitschrift Obesity Reviews für die Erlaubnis, das mit dem Copyright von 2015, World Obesity versehenen Material aus [18] für diesen Beitrag zu verwenden.

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Authors and Affiliations

  1. Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS, Fachbereich 03: Mathematik und Informatik, Universität Bremen, Achterstr. 30, 28359, Bremen, Deutschland

    Iris Pigeot & Wolfgang Ahrens

  2. USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA

    Tom Baranowski

  3. School of Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Leslie Lytle

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  1. Iris Pigeot
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  2. Tom Baranowski
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  3. Leslie Lytle
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  4. Wolfgang Ahrens
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Correspondence to Iris Pigeot.

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Interessenkonflikt

I. Pigeot, T. Baranowski, L. Lytle und W. Ahrens geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pigeot, I., Baranowski, T., Lytle, L. et al. Prävention von Übergewicht und Adipositas bei Kindern und Jugendlichen. Bundesgesundheitsbl 59, 1423–1431 (2016). https://doi.org/10.1007/s00103-016-2449-x

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