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Lifestyle intervention in childhood obesity: changes and challenges

Nature Reviews Endocrinology volume 9, pages 607–614 (2013)Cite this article

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Abstract

Lifestyle interventions are regarded as the therapy of choice in children with obesity. The efficiency of lifestyle intervention for childhood obesity has been proven by several randomized controlled trials and meta-analyses. Even a stable weight in a growing child with obesity is associated with an improvement in cardiovascular risk factors and comorbidities of obesity. In particular, children aged 5–12 years and children with overweight rather than obesity profit from lifestyle interventions. However, in clinical practice, the degree of weight loss with lifestyle intervention is only moderate, and the success rate 2 years after onset of an intervention is low (<10% with a decrease in BMI SD score of <0.25). Nevertheless, the difficulty of a child with overweight or obesity to reduce their weight might be attributable to not only a lack of motivation but also genetic background and/or adaptive changes in basal metabolic rate, hunger and satiety hormones that occur with weight loss. We must accept that lifestyle interventions are successful only in a subgroup of children with obesity. Regardless, the techniques used and the education of therapists need to be improved. If lifestyle interventions do not result in weight loss in a child with obesity, drug treatment to reduce cardiovascular risk factors should be initiated but is currently seldom performed.

Key Points

  • Lifestyle interventions are effective in reducing weight in children with obesity if parents are actively involved

  • Young children aged 5–12 years and children with overweight rather than obesity profit, in particular, from this kind of intervention

  • In clinical practice, lifestyle interventions only reduce mean BMI by −1 to −2 kg/m2, and the long-term success rate (a decrease in BMI SD score of <0.25) at 2 years is <10%

  • By contrast, some specialist treatment centres report maintenance of weight loss in children with obesity 5 years after the end of the intervention and a success rate of ∼50%

  • Stable weight in a growing child with obesity is accompanied by an improvement in cardiovascular risk factors and in comorbidities such as diabetes mellitus, nonalcoholic fatty liver disease and polycystic ovary syndrome

  • Weight loss reduces the basal metabolic rate and affects hunger and the levels of satiety hormones in children with obesity, which might partly explain difficulties in losing weight

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Figure 1: Hormonal changes in children with obesity before and after weight loss.

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References

  1. Han, J. C., Lawlor, D. A. & Kimm, S. Y. Childhood obesity. Lancet 375, 1737–1748 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moss, A. et al. Declining prevalence rates for overweight and obesity in German children starting school. Eur. J. Pediatr. 171, 289–299 (2012).

    Article  PubMed  Google Scholar 

  3. Ogden, C. L., Carroll, M. D., Kit, B. K. & Flegal, K. M. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. JAMA 307, 483–490 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  4. May, A. L., Kuklina, E. V. & Yoon, P. W. Prevalence of cardiovascular disease risk factors among US adolescents, 1999–2008. Pediatrics 129, 1035–1041 (2012).

    Article  PubMed  Google Scholar 

  5. Bray, G. A. Predicting obesity in adults from childhood and adolescent weight. Am. J. Clin. Nutr. 76, 497–498 (2002).

    Article  CAS  PubMed  Google Scholar 

  6. Biro, F. M. & Wien, M. Childhood obesity and adult morbidities. Am. J. Clin. Nutr. 91, 1499S–1505S (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Franks, P. W. et al. Childhood obesity, other cardiovascular risk factors, and premature death. N. Engl. J. Med. 362, 485–493 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Zimmet, P. et al. The metabolic syndrome in children and adolescents—an IDF consensus report. Pediatr. Diabetes 8, 299–306 (2007).

    Article  PubMed  Google Scholar 

  9. I'Allemand, D. et al. Cardiovascular risk in 26,008 European overweight children as established by a multicenter database. Obesity (Silver Spring) 16, 1672–1679 (2008).

    Article  Google Scholar 

  10. Wissler, R. W. & Strong, J. P. Risk factors and progression of atherosclerosis in youth. PDAY Research Group. Pathological Determinants of Atherosclerosis in Youth. Am. J. Pathol. 153, 1023–1033 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Reinehr, T., Kiess, W., de Sousa G., Stoffel-Wagner, B. & Wunsch, R. Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism 55, 113–118 (2006).

    Article  CAS  PubMed  Google Scholar 

  12. Lorenz, M. W., Markus, H. S., Bots, M. L., Rosvall, M. & Sitzer, M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115, 459–467 (2007).

    Article  PubMed  Google Scholar 

  13. Reinehr, T. Calculating cardiac risk in obese adolescents before and after onset of lifestyle intervention. Expert Rev. Cardiovasc. Ther. 11, 297–306 (2013).

    Article  CAS  PubMed  Google Scholar 

  14. Barlow, S. E. & Dietz, W. H. Management of child and adolescent obesity: summary and recommendations based on reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics 110, 236–238 (2002).

    PubMed  Google Scholar 

  15. August, G. P. et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J. Clin. Endocrinol. Metab. 93, 4576–4599 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Oude, L. H. et al. Interventions for treating obesity in children. Cochrane Database of Systematic Reviews 2009, Issue 1. Art No.: CD001872. http://dx.doi.org/10.1002/14651858.CD001872.pub2.

  17. McGovern, L. et al. Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J. Clin. Endocrinol. Metab. 93, 4600–4605 (2008).

    Article  CAS  PubMed  Google Scholar 

  18. Casazza, K. et al. Myths, presumptions, and facts about obesity. N. Engl. J. Med. 368, 446–454 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Skinner, A. C., Steiner, M. J. & Perrin, E. M. Self-reported energy intake by age in overweight and healthy-weight children in NHANES, 2001–2008. Pediatrics 130, e936–e942 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nordmann, A. J. et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch. Intern. Med. 166, 285–293 (2006).

    Article  CAS  PubMed  Google Scholar 

  21. Muckelbauer, R. et al. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics 123, e661–e667 (2009).

    Article  PubMed  Google Scholar 

  22. Ebbeling, C. B. et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N. Engl. J. Med. 367, 1407–1416 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Pereira, M. A. et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 365, 36–42 (2005).

    Article  PubMed  Google Scholar 

  24. Reinehr, T., Brylak, K., Alexy, U., Kersting, M. & Andler, W. Predictors to success in outpatient training in obese children and adolescents. Int. J. Obes Relat Metab. Disord. 27, 1087–1092 (2003).

    Article  CAS  PubMed  Google Scholar 

  25. Puder, J. J. et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ 343, d6195 (2011).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Martinez, V. V. et al. Assessment of an after-school physical activity program to prevent obesity among 9- to 10-year-old children: a cluster randomized trial. Int. J. Obes (Lond.) 32, 12–22 (2008).

    Article  Google Scholar 

  27. Mo-suwan, L., Pongprapai, S., Junjana, C. & Puetpaiboon, A. Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children. Am. J. Clin. Nutr. 68, 1006–1011 (1998).

    Article  CAS  PubMed  Google Scholar 

  28. Peralta, L. R., Jones, R. A. & Okely, A. D. Promoting healthy lifestyles among adolescent boys: the Fitness Improvement and Lifestyle Awareness Program RCT. Prev. Med. 48, 537–542 (2009).

    Article  PubMed  Google Scholar 

  29. Epstein, L. H. et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch. Pediatr. Adolesc. Med. 162, 239–245 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wahi, G., Parkin, P. C., Beyene, J., Uleryk, E. M. & Birken, C. S. Effectiveness of interventions aimed at reducing screen time in children: a systematic review and meta-analysis of randomized controlled trials. Arch. Pediatr. Adolesc. Med. 165, 979–986 (2011).

    Article  PubMed  Google Scholar 

  31. Flodmark, C. E. Management of the obese child using psychological-based treatments. Acta Paediatr. Suppl. 94, 14–22 (2005).

    Article  PubMed  Google Scholar 

  32. Epstein, L. H., Roemmich, J. N. & Raynor, H. A. Behavioral therapy in the treatment of pediatric obesity. Pediatr. Clin. North Am. 48, 981–993 (2001).

    Article  CAS  PubMed  Google Scholar 

  33. Epstein, L. H., Valoski, A., Wing, R. R. & McCurley, J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol. 13, 373–383 (1994).

    Article  CAS  PubMed  Google Scholar 

  34. Sung-Chan, P., Sung, Y. W., Zhao, X. & Brownson, R. C. Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes. Rev. 14, 265–278 (2013).

    Article  CAS  PubMed  Google Scholar 

  35. Reinehr, T. et al. Medical care of overweight children under real-life conditions: the German BZgA observation study. Int. J. Obes. (Lond.) 33, 418–423 (2009).

    Article  CAS  Google Scholar 

  36. Reinehr, T. et al. Two-year follow-up in 21,784 overweight children and adolescents with lifestyle intervention. Obesity (Silver Spring) 17, 1196–1199 (2009).

    Article  CAS  Google Scholar 

  37. Braet, C., Tanghe, A., Bode, P. D., Franckx, H. & Winckel, M. V. Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction. Eur. J. Pediatr. 162, 391–396 (2003).

    PubMed  Google Scholar 

  38. Gately, P. J. et al. Children's residential weight-loss programs can work: a prospective cohort study of short-term outcomes for overweight and obese children. Pediatrics 116, 73–77 (2005).

    Article  PubMed  Google Scholar 

  39. Bayer, O. et al. Short- and mid-term effects of a setting based prevention program to reduce obesity risk factors in children: a cluster-randomized trial. Clin. Nutr. 28, 122–128 (2009).

    Article  PubMed  Google Scholar 

  40. McCallum, Z. et al. Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int. J. Obes. (Lond.) 31, 630–636 (2007).

    Article  CAS  Google Scholar 

  41. Doyle, A. C. et al. Reduction of overweight and eating disorder symptoms via the Internet in adolescents: a randomized controlled trial. J. Adolesc. Health 43, 172–179 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  42. de Niet J. et al. The effect of a short message service maintenance treatment on body mass index and psychological well-being in overweight and obese children: a randomized controlled trial. Pediatr. Obes. 7, 205–219 (2012).

    Article  CAS  PubMed  Google Scholar 

  43. Nguyen, B. et al. Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial. Int. J. Obes. (Lond.) 37, 468–472 (2013).

    Article  CAS  Google Scholar 

  44. Steele, R. G. et al. Comparison of a family-based group intervention for youths with obesity to a brief individual family intervention: a practical clinical trial of positively fit. J. Pediatr. Psychol. 37, 53–63 (2012).

    Article  PubMed  Google Scholar 

  45. Young, K. M., Northern, J. J., Lister, K. M., Drummond, J. A. & O'Brien, W. H. A meta-analysis of family-behavioral weight-loss treatments for children. Clin. Psychol. Rev. 27, 240–249 (2007).

    Article  PubMed  Google Scholar 

  46. Magarey, A. M. et al. A parent-led family-focused treatment program for overweight children aged 5 to 9 years: the PEACH RCT. Pediatrics 127, 214–222 (2011).

    Article  PubMed  Google Scholar 

  47. Okely, A. D. et al. Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study. J. Pediatr. 157, 388–394 (2010).

    Article  PubMed  Google Scholar 

  48. Magarey, A. M. et al. A parent-led family-focused treatment program for overweight children aged 5 to 9 years: the PEACH RCT. Pediatrics 127, 214–222 (2011).

    Article  PubMed  Google Scholar 

  49. Anderson, J. W., Konz, E. C., Frederich, R. C. & Wood, C. L. Long-term weight-loss maintenance: a meta-analysis of US studies. Am. J. Clin. Nutr. 74, 579–584 (2001).

    Article  CAS  PubMed  Google Scholar 

  50. Katz, D. L., O'Connell, M., Njike, V. Y., Yeh, M. C. & Nawaz, H. Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis. Int. J. Obes. (Lond.) 32, 1780–1789 (2008).

    Article  CAS  Google Scholar 

  51. Savoye, M. et al. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics 127, 402–410 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  52. Schaefer, A., Winkel, K., Finne, E., Kolip, P. & Reinehr, T. An effective lifestyle intervention in overweight children: one-year follow-up after the randomized controlled trial on “Obeldicks light”. Clin. Nutr. 30, 629–633 (2011).

    Article  CAS  PubMed  Google Scholar 

  53. Danielsson, P., Kowalski, J., Ekblom, O. & Marcus, C. Response of severely obese children and adolescents to behavioral treatment. Arch. Pediatr. Adolesc. Med. 166, 1103–1108 (2012).

    Article  PubMed  Google Scholar 

  54. Vignolo, M. et al. Five-year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment. Eur. J. Clin. Nutr. 62, 1047–1057 (2008).

    Article  CAS  PubMed  Google Scholar 

  55. Epstein, L. H., Valoski, A., Wing, R. R. & McCurley, J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 264, 2519–2523 (1990).

    Article  CAS  PubMed  Google Scholar 

  56. Reinehr, T., Kleber, M., Lass, N. & Toschke, A. M. Body mass index patterns over 5 y in obese children motivated to participate in a 1-y lifestyle intervention: age as a predictor of long-term success. Am. J. Clin. Nutr. 91, 1165–1171 (2010).

    Article  CAS  PubMed  Google Scholar 

  57. Ho, M. et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 130, e1647–e1671 (2012).

    Article  PubMed  Google Scholar 

  58. Reinehr, T., Kiess, W., Kapellen, T. & Andler, W. Insulin sensitivity among obese children and adolescents, according to degree of weight loss. Pediatrics 114, 1569–1573 (2004).

    Article  PubMed  Google Scholar 

  59. Reinehr, T. & Andler, W. Changes in the atherogenic risk factor profile according to degree of weight loss. Arch. Dis. Child. 89, 419–422 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Reinehr, T., Kleber, M. & Toschke, A. M. Lifestyle intervention in obese children is associated with a decrease of the metabolic syndrome prevalence. Atherosclerosis 207, 174–180 (2009).

    Article  CAS  PubMed  Google Scholar 

  61. Lass, N., Kleber, M., Winkel, K., Wunsch, R. & Reinehr, T. Effect of lifestyle intervention on features of polycystic ovarian syndrome, metabolic syndrome, and intima-media thickness in obese adolescent girls. J. Clin. Endocrinol. Metab. 96, 3533–3540 (2011).

    Article  CAS  PubMed  Google Scholar 

  62. Reinehr, T., Schmidt, C., Toschke, A. M. & Andler, W. Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study. Arch. Dis. Child. 94, 437–442 (2009).

    Article  CAS  PubMed  Google Scholar 

  63. Ford, A. L., Hunt, L. P., Cooper, A. & Shield, J. P. What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Arch. Dis. Child. 95, 256–261 (2010).

    Article  PubMed  Google Scholar 

  64. Wille, N. et al. Health-related quality of life in overweight and obese youths: results of a multicenter study. Health Qual. Life Outcomes 8, 36 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Finne, E., Reinehr, T., Schaefer, A., Winkel, K. & Kolip, P. Changes in self-reported and parent-reported health-related quality of life in overweight children and adolescents participating in an outpatient training: findings from a 12-month follow-up study. Health Qual. Life Outcomes 11, 1 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  66. Finne, E., Reinehr, T., Schaefer, A., Winkel, K. & Kolip, P. Overweight children and adolescents--is there a subjective need for treatment? Int. J. Public Health 54, 112–116 (2009).

    Article  PubMed  Google Scholar 

  67. Nguyen, B. et al. Recruitment challenges and recommendations for adolescent obesity trials. J. Paediatr. Child Health 48, 38–43 (2012).

    Article  PubMed  Google Scholar 

  68. Elfhag, K. & Rossner, S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes. Rev. 6, 67–85 (2005).

    Article  CAS  PubMed  Google Scholar 

  69. Singer, V. et al. Einfluss der motivation der teilnehmer und ausbildung der therapeuten auf den erfolg der schulung obeldicks für adipöse kinder und jugendliche [German]. Monatsschr. Kinderheilkd. 160, 1110–1116 (2012).

    Article  Google Scholar 

  70. Weiss, E. C., Galuska, D. A., Kettel, K. L., Gillespie, C. & Serdula, M. K. Weight regain in U. S. adults who experienced substantial weight loss, 1999–2002. Am. J. Prev. Med. 33, 34–40 (2007).

    Article  PubMed  Google Scholar 

  71. Lowe, M. R., Miller-Kovach, K. & Phelan, S. Weight-loss maintenance in overweight individuals one to five years following successful completion of a commercial weight loss program. Int. J. Obes. Relat. Metab. Disord. 25, 325–331 (2001).

    Article  CAS  PubMed  Google Scholar 

  72. Wilfley, D. E. et al. Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial. JAMA 298, 1661–1673 (2007).

    Article  CAS  PubMed  Google Scholar 

  73. Casazza, K. et al. Myths, presumptions, and facts about obesity. N. Engl. J. Med. 368, 446–454 (2013).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Schwartz, M. W., Woods, S. C., Porte, D. Jr, Seeley, R. J. & Baskin, D. G. Central nervous system control of food intake. Nature 404, 661–671 (2000).

    Article  CAS  PubMed  Google Scholar 

  75. Wren, A. M. et al. Ghrelin enhances appetite and increases food intake in humans. J. Clin. Endocrinol. Metab. 86, 5992 (2001).

    Article  CAS  PubMed  Google Scholar 

  76. Batterham, R. L. et al. Gut hormone PYY(3–36) physiologically inhibits food intake. Nature 418, 650–654 (2002).

    Article  CAS  PubMed  Google Scholar 

  77. Batterham, R. L. et al. Pancreatic polypeptide reduces appetite and food intake in humans. J. Clin. Endocrinol. Metab. 88, 3989–3992 (2003).

    Article  CAS  PubMed  Google Scholar 

  78. Stephens, T. W. et al. The role of neuropeptide Y in the antiobesity action of the obese gene product. Nature 377, 530–532 (1995).

    Article  CAS  PubMed  Google Scholar 

  79. Morley, J. E. & Flood, J. F. Amylin decreases food intake in mice. Peptides 12, 865–869 (1991).

    Article  CAS  PubMed  Google Scholar 

  80. Reinehr, T. Obesity and thyroid function. Mol. Cell Endocrinol. 316, 165–171 (2010).

    Article  CAS  PubMed  Google Scholar 

  81. Roth, C. L. et al. Ghrelin and obestatin levels in severely obese women before and after weight loss after Roux-en-Y gastric bypass surgery. Obes. Surg. 19, 29–35 (2009).

    Article  PubMed  Google Scholar 

  82. Reinehr, T. et al. Ghrelin levels before and after reduction of overweight due to a low-fat high-carbohydrate diet in obese children and adolescents. Int. J. Obes. (Lond.) 29, 362–368 (2005).

    Article  CAS  Google Scholar 

  83. Roth, C. L. et al. Peptide YY is a regulator of energy homeostasis in obese children before and after weight loss. J. Clin. Endocrinol. Metab. 90, 6386–6391 (2005).

    Article  CAS  PubMed  Google Scholar 

  84. Reinehr, T., Enriori, P. J., Harz, K., Cowley, M. A. & Roth, C. L. Pancreatic polypeptide in obese children before and after weight loss. Int. J. Obes. (Lond.) 30, 1476–1481 (2006).

    Article  CAS  Google Scholar 

  85. Reinehr, T. Thyroid function in the nutritionally obese child and adolescent. Curr. Opin. Pediatr. 23, 415–420 (2011).

    Article  CAS  PubMed  Google Scholar 

  86. Reinehr, T., Isa, A., de Sousa, G., Dieffenbach, R. & Andler, W. Thyroid hormones and their relation to weight status. Horm. Res. 70, 51–57 (2008).

    Article  CAS  PubMed  Google Scholar 

  87. Reinehr, T., de Sousa, G., Niklowitz, P. & Roth, C. L. Amylin and its relation to insulin and lipids in obese children before and after weight loss. Obesity (Silver Spring) 15, 2006–2011 (2007).

    Article  CAS  Google Scholar 

  88. Reinehr, T., Kratzsch, J., Kiess, W. & Andler, W. Circulating soluble leptin receptor, leptin, and insulin resistance before and after weight loss in obese children. Int. J. Obes. (Lond.) 29, 1230–1235 (2005).

    Article  CAS  Google Scholar 

  89. Considine, R. V. et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N. Engl. J. Med. 334, 292–295 (1996).

    Article  CAS  PubMed  Google Scholar 

  90. Essah, P. A., Levy, J. R., Sistrun, S. N., Kelly, S. M. & Nestler, J. E. Effect of weight loss by a low-fat diet and a low-carbohydrate diet on peptide YY levels. Int. J. Obes. (Lond.) 34, 1239–1242 (2010).

    Article  CAS  Google Scholar 

  91. Cummings, D. E. et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N. Engl. J. Med. 346, 1623–1630 (2002).

    Article  PubMed  Google Scholar 

  92. Sumithran, P. et al. Long-term persistence of hormonal adaptations to weight loss. N. Engl. J. Med. 365, 1597–1604 (2011).

    Article  CAS  PubMed  Google Scholar 

  93. Reinehr, T., de Sousa, G. & Andler, W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J. Clin. Endocrinol. Metab. 91, 3088–3091 (2006).

    Article  CAS  PubMed  Google Scholar 

  94. Reinehr, T. & Andler, W. Thyroid hormones before and after weight loss in obesity. Arch. Dis. Child. 87, 320–323 (2002).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Reinehr, T. et al. Peptide YY and glucagon-like peptide-1 in morbidly obese patients before and after surgically induced weight loss. Obes. Surg. 17, 1571–1577 (2007).

    Article  PubMed  Google Scholar 

  96. Leibel, R. L. & Hirsch, J. Diminished energy requirements in reduced-obese patients. Metabolism 33, 164–170 (1984).

    Article  CAS  PubMed  Google Scholar 

  97. Rosenbaum, M., Kissileff, H. R., Mayer, L. E., Hirsch, J. & Leibel, R. L. Energy intake in weight-reduced humans. Brain Res. 1350, 95–102 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Rosenbaum, M., Hirsch, J., Gallagher, D. A. & Leibel, R. L. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am. J. Clin. Nutr. 88, 906–912 (2008).

    Article  CAS  PubMed  Google Scholar 

  99. Reinehr, T. Predicting weight loss of obese adolescents in lifestyle interventions by genetic screening: A promising approach for researchers and clinicians? J. Pediatr. 161, 382–384 (2012).

    Article  PubMed  Google Scholar 

  100. Moleres, A. et al. Obesity susceptibility loci on body mass index and weight loss in Spanish adolescents after a lifestyle intervention. J. Pediatr. 161, 466–470 (2012).

    Article  PubMed  Google Scholar 

  101. Reinehr, T. et al. Lifestyle intervention in obese children with variations in the melanocortin 4 receptor gene. Obesity (Silver Spring) 17, 382–389 (2009).

    Article  CAS  Google Scholar 

  102. Reinehr, T., Hinney, A., Nguyen, T. T. & Hebebrand, J. Evidence of an influence of a polymorphism near the INSIG2 on weight loss during a lifestyle intervention in obese children and adolescents. Diabetes 57, 623–626 (2008).

    Article  CAS  PubMed  Google Scholar 

  103. Reinehr, T., Hinney, A., Toschke, A. M. & Hebebrand, J. Aggravating effect of INSIG2 and FTO on overweight reduction in a one-year lifestyle intervention. Arch. Dis. Child. 94, 965–967 (2009).

    Article  CAS  PubMed  Google Scholar 

  104. Milagro, F. I. et al. A dual epigenomic approach for the search of obesity biomarkers: DNA methylation in relation to diet-induced weight loss. FASEB J. 25, 1378–1389 (2011).

    Article  CAS  PubMed  Google Scholar 

  105. Moleres, A. et al. Differential DNA methylation patterns between high and low responders to a weight loss intervention in overweight or obese adolescents: the EVASYON study. FASEB J. 27, 2504–2512 (2013).

    Article  CAS  PubMed  Google Scholar 

  106. Resnicow, K., Davis, R. & Rollnick, S. Motivational interviewing for pediatric obesity: Conceptual issues and evidence review. J. Am. Diet. Assoc. 106, 2024–2033 (2006).

    Article  PubMed  Google Scholar 

  107. Kalarchian, M. A. et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics 124, 1060–1068 (2009).

    Article  PubMed  Google Scholar 

  108. Nowicka, P., Savoye, M. & Fisher, P. A. Which psychological method is most effective for group treatment? Int. J. Pediatr. Obes. 6 (Suppl. 1), 70–73 (2011).

    Article  PubMed  Google Scholar 

  109. Schaefer, A., Winkel, K., Dobe, M. & Reinehr, T. Implementation of the succesful lifestyle intervention “Obeldicks” for obese children and adolescents at a new treatment center [German]. Aktuel. Ernahrungsmed. 6, 291–295 (2008).

    Article  Google Scholar 

  110. Kendall, D. et al. Metformin in obese children and adolescents: the MOCA trial. J. Clin. Endocrinol. Metab. 98, 322–329 (2013).

    Article  CAS  PubMed  Google Scholar 

  111. Kelly, A. S. et al. Exenatide as a weight-loss therapy in extreme pediatric obesity: a randomized, controlled pilot study. Obesity (Silver Spring) 20, 364–370 (2012).

    Article  CAS  Google Scholar 

  112. Colman, E. et al. The FDA's assessment of two drugs for chronic weight management. N. Engl. J. Med. 367, 1577–1579 (2012).

    Article  CAS  PubMed  Google Scholar 

  113. Kelly, A. S. et al. The effect of glucagon-like Peptide-1 receptor agonist therapy on body mass index in adolescents with severe obesity: a randomized, placebo-controlled, clinical trial. JAMA Pediatr. 167, 355–360 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  114. Reinehr, T. et al. Comorbidities in overweight children and adolescents: do we treat them effectively? Int. J. Obes. (Lond.) 37, 493–499 (2013).

    Article  CAS  Google Scholar 

  115. Reinehr, T., Schober, E., Roth, C. L., Wiegand, S. & Holl, R. Type 2 diabetes in children and adolescents in a 2-year follow-up: insufficient adherence to diabetes centers. Horm. Res. 69, 107–113 (2008).

    CAS  PubMed  Google Scholar 

  116. John, J. & Teuner, C. M. Combating pediatric obesity in Germany: the role of economic findings in informing policy. Expert Rev. Pharmacoecon. Outcomes Res. 12, 733–743 (2012).

    Article  PubMed  Google Scholar 

  117. Hollingworth, W. et al. Economic evaluation of lifestyle interventions to treat overweight or obesity in children. Int. J. Obes (Lond.) 36, 559–566 (2012).

    Article  CAS  Google Scholar 

  118. Fuller, N. R. et al. A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care-an international randomised controlled trial. Int. J. Obes (Lond.) 37, 828–834 (2013).

    Article  CAS  Google Scholar 

  119. John, J., Wolfenstetter, S. B. & Wenig, C. M. An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions. Nutrition 28, 829–839 (2012).

    Article  PubMed  Google Scholar 

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Acknowledgements

T. Reinehr received grant support from the German Ministry of Education and Research (Bundesministerium für Bildung und Forschung Obesity network: grant number 01 01GI1120A and 01GI 1120B).

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  1. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr.-Friedrich-Steiner-Straße 5, Datteln, D-45711, Germany

    Thomas Reinehr

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Reinehr, T. Lifestyle intervention in childhood obesity: changes and challenges. Nat Rev Endocrinol 9, 607–614 (2013). https://doi.org/10.1038/nrendo.2013.149

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