[Practical implementation of treatment guidelines concerning obesity in children and adolescents]

Guidelines recommend a long-term outpatient lifestyle intervention in obese children and adolescents that also addresses the children's parents. However, lifestyle interventions are performed only in 1% of the 1,000,000 obese children and adolescents in Germany, suggesting a large gap between guidelines and medical care in real life. Possible reasons are a lacking awareness of the consequences of overweight, no time resources, and the lack of motivation to change lifestyle habits in some obese children and their families. Furthermore, there is no treatment option throughout Germany. The long-term success rate varies widely between outpatient treatment centers (<50% up to >70%), while the long-term effectiveness of short-term, inpatient intervention (rehabilitation) is unknown. However, many more obese children are treated by short-term rehabilitation compared to long-term outpatient intervention. Older and extreme obese children and adolescents are treated by lifestyle intervention, although this kind of intervention is more effective in younger and not so obese children. Some subgroups (extreme obese adolescents, obese disabled children) have no meaningful and effective treatment options.