Zusammenfassung
Adipositas rein auf die medizinische Problematik zu reduzieren wird der Komplexität des Störungsbildes nicht gerecht. Im Mittelpunkt stehen für die betroffenen Kinder und Jugendlichen weniger die aktuellen und zukünftigen körperlichen Gesundheitsbeeinträchtigungen, sondern die psychosozialen Aspekte der Adipositas. Gerade das hohe Maß an Stigmatisierung trägt wesentlich zur psychosozialen Belastung der Betroffenen bei. Einschränkungen der Lebensqualität, aber auch erhöhte Prävalenzen von psychischen Störungen werden bei übergewichtigen und adipösen Kindern und Jugendlichen berichtet. Im Sinne eines psychosozialen Teufelskreises nehmen diese wiederum Einfluss auf das Ernährungs- und Bewegungsverhalten und somit auf zentrale Stellgrößen von Gewichtskontrollmaßnahmen. Daher haben sich in der Therapie komplexe multimodale Programme, die diesen Zusammenhängen Rechnung tragen, längst etabliert. Zahlreiche Studien unterstreichen die Wirksamkeit von Lebensstilprogrammen mit moderaten Gewichtsverlusten. Elterneinbezug und Vermittlung von Verhaltensstrategien sind mit besseren Ergebnissen verbunden. Zukünftige Studien sollten verschiedene psychosoziale Outcomes einbeziehen und sich der Frage nach den psychosozialen Prädiktoren für kurz- und langfristige Behandlungseffekte widmen.
Abstract
To simply reduce obesity to the medical set of problems falls short due to the complexity of the disorder. The focus of the affected children and adolescents is less on acute and future somatic health impairments but on the psychosocial aspects of obesity. The high degree of stigmatization especially accounts for the psychosocial burdens of the persons concerned. Constraints in the quality of life and a higher prevalence of mental disorders are reported by overweight and obese children and adolescents. In the sense of a vicious psychosocial circle, these variables in turn influence our eating and exercise behavior and hence central influences of weight control actions. Therefore, complex multimodal programs, which take into account these relationships, have long since been established in therapy. Numerous studies have underscored the efficacy of such lifestyle interventions resulting in moderate weight loss effects. Parent involvement and including behavioral strategies is associated with better results. Future studies should focus more on various psychosocial outcomes and addressing the question of psychosocial predictors of short- and long-term treatment success.
Literatur
Esposito L, Fischer JO, Menella JA et al (2009) Developmental perspectives on nutrition and obesity from gestation to adolescence. Prev Chronic Dis 6:1–11
Patrick H, Nicklas TA (2005) A review of family and social determinants of children’s eating patterns and diet quality. J Am Colleg Nutr 24:83–92
Ogden J (2010) The psychology of eating, 2. Aufl. Wiley-Blackwell, Chichester
Mazur JE (2006) Lernen und Verhalten, 6., aktualisierte Aufl. Pearson Education, München
Fisher J, Liu Y, Birch LL, Rolls B (2007) Effects of portion size and energy density on young children’s intake at a meal. Am J Clin Nutr 86:174–179
Temple JL, Giacomelli AM, Kent KM et al (2007) Television watching increases motivated responding for food and energy intake in children. Am J Clin Nutr 85:355–361
Guerrieri R, Nederkoorn C, Jansen A (2008) The interaction between impulsivity and a varied food environment: its influence on food intake and overweight. Int J Obes (Lond) 32:708–714
Sørensen LB, Moller P, Flint A et al (2003) Effect of sensory perception of foods on appetite and food intake: a review of studies on humans. Int J Obes (Lond) 27:1152–1166
Jansen A, Theunissen N, Slechten K et al (2003) Overweight children overeat after exposure to food cues. Eat Behav 4:197–209
Salvy SJ, Howard M, Read M, Mele E (2009) The presence of friends increases food intake in youth. Am J Clin Nutr 90:282–287
Tanofsky-Kraff M, Theim KR, Yanovski SZ et al (2007) Validation of the Emotional Eating Scale adapted for use in children and adolescents (EES-C). Int J Eat Disord 40:232–240
Webber L, Hill C, Saxton J et al (2009) Eating behaviour and weight in children. Int J Obes (Lond) 33:21–28
Kröller K, Warschbuger P (2011) Problematisches Essverhalten im Kindesalter: Welche Rolle spielt die mütterliche Steuerung? Praxis Kinderpsych Kinderpsychiatr 60:253–269
Strien T van, Oosterveld P (2008) The children’s DEBQ for assessment of restrained, emotional, and external eating in 7- to 12-year-old children. Int J Eat Disord 41:71–81
Warschburger P, Petermann F (2008) Adipositas. Leitfaden Kinder- und Jugendpsychotherapie (Band 10). Hogrefe Verlag für Psychologie, Göttingen
Puhl M, Latner JD (2007) Stigma, obesity, and the health of the nation’s children. Psychol Bull 133:557–580
Latner JD, Stunkard AJ (2003) Getting worse: the stigmatization of obese children. Obes Res 11:452–456
Daníelsdóttir S, O’Brien KS, Ciao A (2010) Anti-fat prejudice reduction: a review of published studies. Obes Facts 3:47–58
Sweeting H, West P (2001) Being different: correlates of the experience of teasing and bullying at age 11. Res Pap Education 16:225–246
Warschburger P, Kröller K (2005) Adipositas im Kindes- und Jugendalter. Risikofaktoren für die Entstehung einer Binge-Eating Disorder. Z Gesundheitspsych 13:69–78
Neumark-Sztainer D, Falkner N, Story M et al (2002) Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors. Int J Obes Relat Metab Disord 26:123–131
Tang-Péronard JL, Heitmann BL (2008) Stigmatization of obese children and adolescents, the importance of gender. Obes Rev 9:522–534
Schwartz MB, Vartanian LR, Nosek BA, Brownell KD (2006) The influence of one’s own body weight on implicit and explicit anti-fat bias. Obesity (Silver Spring) 14:440–447
Warschburger P, Döring I (2011) Du bist nicht mehr unser Freund – Peer-Viktimisierung adipöser und normalgewichtiger Kinder im Vorschulalter. Adipositas 5:25–29
Puhl RM, Moss-Racusin CA, Schwartz MB (2007) Internalization of weight bias: Implications for binge eating and emotional well-being. Obesity (Silver Spring) 15:19–23
Griffiths LJ, Parsons TJ, Hill AJ (2010) Self-esteem and quality of life in obese children and adolescents: a systematic review. Int J Pediatr Obes 5:282–304
Warschburger P (2009) Körperunzufriedenheit und gestörtes Essverhalten bei Jugendlichen. Prax Klin Verhaltensmed Rehab 85:152–158
Herpertz-Dahlmann B, Wille N, Hölling H et al (2008) Disordered eating behaviour and attitudes, associated psychopathology and health-related quality of life: results of the BELLA study. Eur Child Adolesc Psychiatry 7:82–91
Thiels C, Pätel J (2008) Erhebung von Essverhalten und Verhaltensauffälligkeiten bei Kindern und Jugendlichen. Z Kinder Jugendpsychiatr Psychother 36:265–274
Warschburger P (2000) Chronisch kranke Kinder und Jugendliche – Psychosoziale Belastungen und Bewältigungsanforderungen. Hogrefe Verlag für Psychologie, Göttingen
Cortese S, Angriman M, Maffeis C et al (2008) Attention-deficit/hyperactivity disorder (ADHD) and obesity: a systematic review of the literature. Crit Rev Food Sci Nutr 48:524–537
Braet C, Claus L, Verbeken S, Vlierberghe L van (2007) Impulsivity in overweight children. Eur Child Adolesc Psychiatry 16:473–483
Nederkoorn C, Braet C, Eijs Y van et al (2006) Why obese children cannot resist food: the role of impulsivity. Eat Behav 7:315–322
Agranat-Meged AN, Deitcher C, Goldzweig G et al (2005) Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obese hospitalized children. Int J Eat Disord 37:357–359
Rojo L, Ruiz E, Dominguez JA et al (2006) Comorbidity between obesity and attention deficit/hyperactivity disorder: population study with 13–15-year-olds. Int J Eat Disord 39:519–522
Waring ME, Lapane KL (2008) Overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder: results from a national sample. Pediatrics 122:e1–e6
Tsiros MD, Olds T, Buckley J et al (2009) Health related quality of life in obese children and adolescents. Int J Obes (Lond) 33:387–400
Warschburger P (2005) The unhappy obese child. Int J Obes (Lond) 29:127–129
Varni JW, Limbers CA, Burwinkle TM (2007) Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes 5:43
Kitzmann KM, Dalton WT 3rd, Stanley CM et al (2010) Lifestyle interventions for youth who are overweight: a meta-analytic review. Health Psychol 29:91–101
Lowry KW, Sallinen BJ, Janicke DM (2007) The effects of weight management programs on self-esteem in pediatric overweight populations. J Pediatr Psychol 32:1179–1195
McGovern L, Johnson JN, Paulo R et al (2008) Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 93(12):4600–4605
Oude Luttikhuis H, Baur L, Jansen H et al (2009) Interventions for treating obesity in children. Cochrane Database Syst Rev 1:CD001872
Whitlock EP, O’Connor EA, Williams SB et al (2010) Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics 125:e396–e418
Wilfley DE, Tibbs TL, Van Buren DJ et al (2007) Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol 26:521–532
Butryn ML, Wadden TA (2005) Treatment of overweight in children and adolescents: Does dieting increase the risk of eating disorders? Int J Eat Disord 37:285–293
Zeller M, Kirk S, Claytor R et al (2004) Predictors of attrition from a pediatric weight management program. J Pediatr 144:466–470
Jelalian E, Hart CN, Mehlenbeck RS et al (2008) Predictors of attrition and weight loss in an adolescent weight control program. Obesity (Silver Spring) 16:1318–1323
Braet C (2006) Patient characteristics as predictors of weight loss after an obesity treatment for children. Obesity (Silver Spring) 14:148–155
Moens E, Braet C, Van Winckel M (2010) An 8-year follow-up of treated obese children: children’s, process and parental predictors of successful outcome. Behav Res Ther 48:626–633
Pott W, Albayrak O, Hebebrand J, Pauli-Pott U (2009) Treating childhood obesity: family background variables and the child’s success in a weight-control intervention. Int J Eat Disord Bd 42:284–289
Egmond-Fröhlich A van, Bräuer W, Goldschmidt H et al (2006) Effekte eines strukturierten ambulanten Weiterbehandlungsprogrammes nach stationärer medizinischer Rehabilitation bei Kindern und Jugendlichen mit Adipositas – Multizentrische, randomisierte, kontrollierte Studie. Rehabilitation 45:41–51
Yackobovitch-Gavan M (2009) The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children. Am J Prev Med 36:35–42
Madsen KA, Garber AK, Mietus-Snyder ML et al (2009) A clinic-based lifestyle intervention for pediatric obesity: efficacy and behavioral and biochemical predictors of response. J Pediatr Endocrinol Metab 22:805–814
Kalarchian MA, Levine MD, Arslanian SA et al (2009) Family-based treatment of severe pediatric obesity: a randomized controlled trial. J Pediatr Psychol 124:1060–1068
Nederkoorn C, Jansen E, Mulkens S, Jansen A (2006) Impulsivity predicts treatment outcome in obese children. Behav Res Ther 45:1071–107
Pauli-Pott U, Albayrak O, Hebebrand J, Pott W (2010) Does inhibitory control capacity in overweight and obese children and adolescents predict success in a weight-reduction program? Eur Child Adolesc Psychiatry 19:135–141
Butryn ML, Phelan S, Hill JO, Wing RR (2007) Consistent self-monitoring of weight: a key component of successful weight loss maintenance. Obesity (Silver Spring) 15:3091–3096
Germann JN, Kirschenbaum DS, Rich, BH (2007) Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children. J Pediatr Psychol 32:111–121
Cerin E, Barnett A, Baranowski T (2009) Testing theories of dietary behavior change in youth using the mediating variable model with intervention programs. J Nutr Educ Behav 41:309–318
Teixeira PJ, Going SB, Sardinha LB, Lohman TG (2005) A review of psychosocial pre-treatment predictors of weight control. Obes Rev 6:43–65
Warschburger P, Fromme C, Petermann F et al (2001) Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity. Int J Obes (Lond) 25:1–3
Interessenkonflikt
Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Warschburger, P. Psychologische Aspekte der Adipositas. Bundesgesundheitsbl. 54, 562–569 (2011). https://doi.org/10.1007/s00103-011-1264-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00103-011-1264-7