Obesity: Widhalm K

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a 1. lékarská fakulta Univerzity Karlovy, Praha, Cesko. · Vnitr Lek. · Pubmed #18630623 No free full text.

This publication has no abstract.

Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K, Anonymous00354. · Clinical Center for Minimally Invasive and Bariatric Surgery, Prague, Czech Republic. · Obes Surg. · Pubmed #17476884 No free full text.

This publication has no abstract.

Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic. · Int J Obes (Lond). · Pubmed #17325689 No free full text.

Abstract: In 2005, for the first time in European history, an extraordinary Expert panel named 'The BSCG' (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European Scientific Societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective Scientific Societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past two years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

Fussenegger D, Pietrobelli A, Widhalm K. · Division Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Austria. · Obes Rev. · Pubmed #17727620 No free full text.

Abstract: The dramatically increasing prevalence of obesity, especially among children, has become a major public health problem in Europe. In reaction to this alarming trend, a series of initiatives and actions has been launched in recent years. As the potential impact of these activities is widely unknown so far, we underline the need for adequate evaluation of these measures. The aim of this paper is to report the latest developments in the fight against obesity at different political levels across Europe, with special attention to the major results of the recent World Health Organization European Ministerial Conference on Counteracting Obesity. In accordance with the main principles of the European Charter on Counteracting Obesity adopted at the meeting, immediate action should be taken now by implementing the few available schemes with proven effectiveness. Finally, given the lack of appropriate evaluation, we consider it particularly important to establish national research centres to collect country-specific data that are to be evaluated together by a central European administration department. Based on the results of such a comprehensive data pool, concrete strategies could be developed for future policy building.

Brambilla P, Lissau I, Flodmark CE, Moreno LA, Widhalm K, Wabitsch M, Pietrobelli A. · ASL Provincia di Milano 2, Milano, Italy. · Int J Obes (Lond). · Pubmed #17384660 No free full text.

Abstract: BACKGROUND: The diagnostic criteria of the metabolic syndrome (MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. OBJECTIVES: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. RESULTS: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis; the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. CONCLUSION: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.

Flodmark CE, Lissau I, Moreno LA, Pietrobelli A, Widhalm K. · Childhood Obesity Unit, Department of Pediatrics, University Hospital Malmö, Sweden. · Int J Obes Relat Metab Disord. · Pubmed #15365581 No free full text.

Abstract: EDITOR'S NOTE: The problem of childhood obesity is accelerating throughout the world. The following is a position paper from The European Childhood Obesity Group (ECOG) that outlines the nature of the problem of childhood obesity along with treatment and prevention methods available today. The paucity of literature on prevention and treatment of obesity in children as documented in this paper points out the need for much additional research on obesity in children. OBJECTIVES: The awareness of childhood obesity as a major health problem and an uncontrolled worldwide epidemic has to be increased in the society. DESIGN: In order to improve the quality of the health care and to minimize the cost it is important to investigate and standardize pediatric obesity prevention and treatment and to adapt to social and cultural aspects. RESULTS: Obesity is the result of excess body fat. The different norms and definitions in Europe and the US is described and clarified. However, the available methods for the direct measurement of body fat are not easily used in daily practice. For this reason, obesity is often assessed by means of indirect estimates of body fat, that is, anthropometrics. There are essentially six relevant levels, which could be involved in prevention of child and adolescent obesity: family (child, parents, siblings, etc), schools, health professionals, government, industry and media. Evidence-based health promotion programs has to be given a high priority. Government should encourage media increase information about healthy nutrition and to avoid the marketing of unhealthy foods including sweet drinks, for example, in TV. Many different approaches of treatments of obesity have been investigated, including diet, exercise, behavioral therapy, surgery, and medication. None have been found to be effective enough as sole tools in children. This has led to focus on multidisciplinary programs especially involving families. Behavioral cognitive therapy is effective in treating childhood obesity as is family therapy. Surgery and drug treatment cannot be recommended without additional research. Clinicians should consider the various factors that can influence body composition. CONCLUSION: It is important to know and to follow nutritional factors, energy intake and composition of the diet, nutrition and hormonal status, food preferences and behavior, and the influence of non-nutritional factors. We recommend that obesity should be the major priority both in the health care system, on the scientific level and for future political actions.

Rettenbacher E, Tarnow P, Brumm H, Prayer D, Wermter AK, Hebebrand J, Biebermann H, Hinney A, Widhalm K. · Department of Child and Adolescent Psychiatry, Rheinische Kliniken Essen, University of Duisburg-Essen, Germany. · Exp Clin Endocrinol Diabetes. · Pubmed #17286227 No free full text.

Abstract: BACKGROUND: Functionally relevant mutations in the melanocortin-4 receptor gene ( MC4R) currently display the most common major gene/allele effect on extreme obesity. OBJECTIVE: Mutation screen of the MC4R in consecutively ascertained Austrian children and adolescents with severe obesity, to analyse the phenotype of mutation carriers and to functionally characterise novel mutations. SUBJECTS AND METHODS: 102 unrelated extremely obese children and adolescents (mean BMI 33.5+/-7.1 kg/m(2), >97th centile; mean age 13.8+/-4.1 yr) and 109 parents (79 mothers/30 fathers) of 88 of these patients were studied. The MC4R coding region was screened using denaturing high-performance liquid chromatography (dHPLC); PCR products of aberrant dHPLC pattern were re-sequenced. Signal transduction properties of mutant MC4R was investigated by challenge with the highly potent agonist NDP-alpha-MSH. Cell surface expression was determined by ELISA. Magnetic resonance imaging (MRI) of the central nervous system (CNS) was applied to a 2.3 year old index patient. Body fat and bone mineral content were assessed in three of the five mutation carriers by dual energy x-ray absorptiometry (DEXA). Oral glucose tolerance test (OGTT) was applied to some mutation carriers. RESULTS: Heterozygous carriers of two non-synonymous mutations, two polymorphisms and a silent variation were identified within the study group. (1) A novel MC4R non-synonymous mutation (S136F) was detected in a 2.3 year old girl with extreme obesity (BMI 33.2 kg/m(2), >99th centile); (2) a previously described non-synonymous mutation (V253I) was identified in an obese mother (BMI 28.1 kg/m(2)) who did not transmit this mutation to her extremely obese son; (3) two known polymorphisms (V103I and I251L) were also identified; and (4) one obese mother was carrier of a silent variation (c.594C>T; I198). Co-segregation of S136F with the obesity phenotype was shown for three generations. IN VITRO functional studies revealed a complete loss of signal transduction activity of the mutant receptor while cell surface expression was only slightly reduced compared to the wild-type receptor. CONCLUSIONS: We detected a novel non-synonymous mutation (S136F) that leads to a complete loss of MC4R function IN VITRO.

Eisenkölbl J, Kartasurya M, Widhalm K. · Department of Pediatrics, Division of Neonatology, Intensive Care and Congenitas Anomalies, University of Vienna, Vienna, Austria. · Eur J Clin Nutr. · Pubmed #11423918 links to  free full text

Abstract: OBJECTIVE: The aim of the study was to investigate whether there is a difference between body fat mass percentage measured by BIA and DXA method. DESIGN: Transversal study, randomized. SETTING: Lipid and Obesity Outpatient Clinic, Department of Pediatrics, University of Vienna, Austria. SUBJECTS: Twenty-seven children and adolescents from the Lipid and Obesity Outpatient Clinic, Department of Pediatrics, University of Vienna, were included in the study (14 boys and 13 girls between 6 and 18 y; mean age 12.6 and 13.1 y). METHODS: The body fat percentage was measured with BIA (bioelectrical impedance analyzer BIA 2000-M) and DXA (dual energy X-ray absorptiometry) methods on the same day. RESULTS: The mean difference between the body fat mass percentage measured by BIA and DXA was 4.48 with a standard deviation of 2.93. The results measured by BIA were almost always lower than that by DXA by about 12%. The lower and upper limit of the difference in 95% confidence interval was -5.64 and -3.32. By paired t-test, these results were significantly different (P<0.001). The correlation between the two measurements was 0.826. The mean percentage of body fat mass measured by BIA was 34.86+/-7.08% and by DXA 39.75+/-5.63%. The differences were not changed by age and body fat percentage but they were by sex. CONCLUSIONS: The results of the study show that the body fat percentages measured by BIA and DXA method were significantly different. This is very important because BIA technique is a routine technique for clinical purposes. Adjustments to the formula used for calculating the total fat mass in obese children and adolescence are necessary. Underestimation of body fat percentage measured by bioelectrical impedance analysis compared to dual X-ray absorptiometry method in obese children is three times higher with boys than with girls.

Reinehr T, Widhalm K, l'Allemand D, Wiegand S, Wabitsch M, Holl RW, Anonymous00051. · Department of Pediatric Nutrition Medicine, Vestische Children's Hospital, University of Witten/Herdecke, Witten, Germany. · Obesity (Silver Spring). · Pubmed #19584877 No free full text.

Abstract: Although randomized controlled trials demonstrated the long-term efficacy of lifestyle interventions in overweight children, the effects of these interventions in clinical practice under real-life conditions are largely unknown. One hundred twenty-nine centers specialized in outpatient pediatric obesity care participated in this quality assessment. All patients presenting before the year 2006 for lifestyle intervention of at least 6 months duration in these institutions were analyzed in a 2-year follow-up. A total of 21,784 (45% male) overweight children and adolescents aged 2-20 years (mean BMI 30.4 kg/m2, mean SDS-BMI 2.51, mean age 12.6 years) were included in the analysis. Based on an intention-to-treat analysis with variables set back to baseline in lost of follow-up, 22% of the children reduced their SDS-BMI after 6 months, 15% after 12 months, and 7% after 24 months, but only in 24, 17, and 8% of children, respectively, complete data were available. In the five treatment centers with the best outcome (518 patients), 83% of the children reduced their overweight after 6 months, 67% after 12 months, and 51% after 24 months. Under real-life conditions, most treatment centers cannot prove the long-term efficacy of their interventions due to high drop-out rate or lack of documentation. Conversely, some institutions achieved a reduction of overweight in nearly the half of their patients 24 months after baseline demonstrating the great heterogeneity in outcome. To improve the effectiveness of lifestyle interventions in real-life studying, the process and structure quality as well as their long-term results is urgently needed.

Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JW, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. · Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a Univerzita Karlova--1.lékarská fakulta, Praha, Ceská republika. · Rozhl Chir. · Pubmed #19174948 No free full text.

This publication has no abstract.

Moreno LA, De Henauw S, González-Gross M, Kersting M, Molnár D, Gottrand F, Barrios L, Sjöström M, Manios Y, Gilbert CC, Leclercq C, Widhalm K, Kafatos A, Marcos A, Anonymous00026. · Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain. · Int J Obes (Lond). · Pubmed #19011652 No free full text.

Abstract: OBJECTIVE: To provide an overview of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) design, with particular attention to its quality control procedures. Other important methodological aspects are described in detail throughout this supplement. DESIGN: Description of the HELENA-CSS sampling and recruitment approaches, standardization and harmonization processes, data collection and analysis strategies and quality control activities. RESULTS: The HELENA-CSS is a multi-centre collaborative study conducted in European adolescents located in urban settings. The data management systems, quality assurance monitoring activities, standardized manuals of operating procedures and training and study management are addressed in this paper. Various quality controls to ensure collection of valid and reliable data will be discussed in this supplement, as well as quantitative estimates of measurement error. CONCLUSION: The great advantage of the HELENA-CSS is the strict standardization of the fieldwork and the blood analyses, which precludes to a great extent the kind of immeasurable confounding bias that often interferes when comparing results from isolated studies.

Dirisamer A, Widhalm H, Aldover-Macasaet E, Molzer S, Widhalm K. · Department of Obesity and Lipid Disorder, University of Vienna, Austria. · Acta Paediatr. · Pubmed #18684164 No free full text.

Abstract: BACKGROUND: levels of Lp(a) and low-molecular-weight apolipoprotein(a) isoform are strongly associated with the development of early cardiovascular disease. Certain types of apo(a) isoforms in combination with elevated levels of Lp(a) may be important in the determining of premature coronary artery disease. Therefore, we investigated the association of familial history of premature coronary artery disease and apo(a) size and Lp(a) levels in children and adolescents with hypercholesterolemia using a novel method determining apo(a) isoforms. METHODS AND RESULTS: Isoforms were classified in six phenotype patterns: S1-S4, B, F and according to their K-IV repeats. Apo(a) isoforms were divided into two groups: low-molecular- and high-molecular apo(a) isoforms. In subjects with double-banded apo(a) isoforms containing a small- and a large-isoform Lp(a) each contribution was based on the intensity of staining of the two bands. The percentage of patients with elevated levels of Lp(a) and a small apo(a) isoform (i.e. elevated small-isoform Lp(a)) was 46% in the risk group and 20% in the control group, p < 0.05. The percentage number of children and adolescents with elevated Lp(a) levels was higher in the risk group, reaching statistical significance (p < 0.05). CONCLUSION: Elevated levels of small-isoform Lp(a) might be a strong and independent risk factor for the development of premature coronary artery disease in children and adolescents with hypercholesterolemia.

I'Allemand D, Wiegand S, Reinehr T, Müller J, Wabitsch M, Widhalm K, Holl R, Anonymous00320. · Children's Hospital of Eastern Switzerland, St Gallen, Switzerland. · Obesity (Silver Spring). · Pubmed #18451769 No free full text.

Abstract: OBJECTIVE: Although the obesity epidemic is progressing in European children too, there is no consensus on the population-specific prevalence of comorbidities or efficient diagnostic strategies. Therefore, weight-related risk factors, their interrelationship, and association with biological parameters were assessed in a large group of overweight (OW) children, documented by an electronic database. METHODS AND PROCEDURES: Data of 26,008 children (age 12.6+/-2.9 years, 56% females) presented for OW (BMI >90th percentile) or obesity (>97th percentile) in 98 specialized centers were evaluated using a simple software (Adipositas Patienten Verlaufsbeobachtung (APV)) for standardized longitudinal documentation. After local anonymization, data were transmitted for central analysis including multiple logistic regression. RESULTS: A total of 5.9% of the children were normal weight, 41% obese (OB), and 37% extremely OB (>99.5th percentile, XXL; 41% of the girls). In 50%, at least one risk factor and in 11% a cluster of two were found, comprising increased blood pressure (BP): 35.4%, dyslipidemia: 32% (total cholesterol: 14.1%, low-density lipoprotein (LDL)-cholesterol: 15.8%, high-density lipoprotein (HDL)-cholesterol: 11.1%, triglycerides: 14.3%), impaired glucose tolerance (IGtT): 6.5% and suspicion of diabetes: 0.7%. The degree of OW was inversely associated with HDL-cholesterol and directly with clustered risk factors, impaired glucose metabolism, increased BP and triglycerides (odds ratios (ORs) XXL vs. normal=6.15, >10, 4.3, 3.0 and 2.5, respectively), but not with LDL-cholesterol. DISCUSSION: In a very large cohort of young Europeans risk factors for cardiovascular (CV) diseases are frequently found, related to the degree of OW and tend to cluster, thus a comprehensive screening is justified in all OW or OB children. Electronic patient documentation is feasible in a large obesity care network.

Widhalm K, Dietrich S, Prager G, Silberhummer G, Orth D, Kispal ZF. · Division of Nutrition and Metabolism, Department of Pediatrics, Medical University of Vienna, Vienna, Austria. · Int J Pediatr Obes. · Pubmed #18278637 No free full text.

Abstract: INTRODUCTION: In cases that do not respond to non-surgical multidisciplinary treatment regimes, it seems the only possibility to offer bariatric surgical procedures. METHODS: All ten patients (17.3+/-3 years old; body mass index (BMI): 49.1+/-6.8 kg/m(2)), who underwent bariatric surgery because of their morbid obesity at the Medical University of Vienna were included in the study and underwent medical care, psychological and nutritional treatment from a physician, a psychologist, and a nutrition expert before and after surgery (follow-up for a mean of 41+/-15.6 months) at regular intervals. RESULTS: In total, all patients had a BMI loss of -10.33 kg/m(2), standard deviation, SD+/-6.6 (range from -3.3 to -25.07) at follow-up after 41 months, SD+/-15 months (range from 3 to 57), two patients dropped out because of lack of compliance. From a psychological perspective, the actual psychological condition was measured by five different psychological tests, e.g., 80% had a high score for depression, and 40% had negative self-acceptance. DISCUSSION: The laparascopic gastric banding operation was not as effective in weight reduction as expected. We have to turn our attention to compliance, postoperative treatment and the psychological component.

Moreno LA, González-Gross M, Kersting M, Molnár D, de Henauw S, Beghin L, Sjöström M, Hagströmer M, Manios Y, Gilbert CC, Ortega FB, Dallongeville J, Arcella D, Wärnberg J, Hallberg M, Fredriksson H, Maes L, Widhalm K, Kafatos AG, Marcos A, Anonymous00025. · Escuela Universitaria de Ciencias de la Salud, Domingo Miral s/n, 50009 Zaragoza, Spain. · Public Health Nutr. · Pubmed #17617932 No free full text.

Abstract: OBJECTIVES: To identify the main knowledge gaps and to propose research lines that will be developed within the European Union-funded 'Healthy Lifestyle in Europe by Nutrition in Adolescence' (HELENA) project, concerning the nutritional status, physical fitness and physical activity of adolescents in Europe. DESIGN: Review of the currently existing literature. RESULTS: The main gaps identified were: lack of harmonised and comparable data on food intake; lack of understanding regarding the role of eating attitudes, food choices and food preferences; lack of harmonised and comparable data on levels and patterns of physical activity and physical fitness; lack of comparable data about obesity prevalence and body composition; lack of comparable data about micronutrient and immunological status; and lack of effective intervention methodologies for healthier lifestyles. CONCLUSIONS: The HELENA Study Group should develop, test and describe harmonised and state-of-the-art methods to assess the nutritional status and lifestyle of adolescents across Europe; develop and evaluate an intervention on eating habits and physical activity; and develop and test new healthy food products attractive for European adolescents.

Ciba I, Widhalm K. · Division of Nutrition and Metabolism, Department of Paediatrics, Vienna Medical University, Wien, Austria. · Acta Paediatr. · Pubmed #17187615 No free full text.

Abstract: AIM: To investigate whether there are correlations between non-alcoholic fatty liver disease (NAFLD) and insulin resistance in obese children. For the first time, we present clinical data of 20 obese children with NAFLD, including an oral glucose tolerance test. METHODS: Twenty obese children were diagnosed as having NAFLD by abdominal ultrasonography. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (gamma-GT) were reported. Insulin sensitivity was evaluated by oral glucose tolerance test, oral glucose insulin sensitivity (OGIS) and homeostasis is model assessment (HOMA) index. All parameters were compared to 20 obese age- and sex-matched patients without NAFLD. RESULTS: With 81% the prevalence of insulin resistance according to HOMA or OGIS criteria was high in the NAFLD-patients compared to the other group with 63%. Statistically significant differences between both groups were found for mean serum ALT levels, mean glucose levels after 30, 60 and 90 minutes and mean insulin levels after 60 minutes of the glucose tolerance test. CONCLUSION: The high prevalence of insulin resistance we found in children with NAFLD confirms the suggestion that there may be an association between insulin resistance and NAFLD in obese children and indicates that markers of insulin sensitivity could be useful screening parameters for NAFLD.

Haider DG, Holzer G, Schaller G, Weghuber D, Widhalm K, Wagner O, Kapiotis S, Wolzt M. · Department of Clinical Pharmacology, Medical University of Vienna, Austria. · J Pediatr Gastroenterol Nutr. · Pubmed #17033537 No free full text.

Abstract: OBJECTIVE: The insulin-mimetic adipocytokine visfatin has been linked to adiposity and the metabolic syndrome. DESIGN: Cross-sectional study. SUBJECTS: Eighty-three nondiabetic obese children and 40 healthy controls. MEASUREMENTS: We analyzed plasma visfatin concentrations to assess whether this adipokine is associated with adiposity. RESULTS: Plasma visfatin concentrations were nearly 2-fold higher in obese children (mean, 1.1 ng/mL; 95% CI, 0.2-6.6) than in controls (0.6 ng/mL, 95% CI, 0.6 to 0.6; P < 0.001). No relationship was detectable between visfatin and other subject characteristics, hsCRP or the lipid profile. CONCLUSIONS: Visfatin may be involved in the development of metabolic derangements in obese children.

Kapiotis S, Holzer G, Schaller G, Haumer M, Widhalm H, Weghuber D, Jilma B, Röggla G, Wolzt M, Widhalm K, Wagner OF. · Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria. · Arterioscler Thromb Vasc Biol. · Pubmed #16973973 links to  free full text

Abstract: BACKGROUND: Obesity is generally accepted as a risk factor for premature atherosclerosis. Subclinical inflammation as quantified by blood levels of C-reactive protein (CRP) contributes to the development and progression of atherosclerosis. We hypothesized that inflammation in obese children is related to functional and early morphological vascular changes. METHODS AND RESULTS: Blood levels of high sensitivity (hs) CRP, hsIL-6, the soluble intercellular adhesion molecule1 (ICAM-1), vascular cell adhesion molecule (VCAM)-1, and E-selectin were measured in 145 severely obese (body mass index [BMI], 32.2+/-5.8 kg/m2) and 54 lean (BMI, 18.9+/-3.2 kg/m2) children 12+/-4 years old. Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measured by high-resolution ultrasound as markers of early vascular changes were assessed in 92 (77 obese and 15 lean) and 59 (50 obese and 9 lean) children, respectively. Obese children had significantly higher levels of hsCRP, hsIL-6, and E-selectin than healthy controls (4.1+/-4.8 versus 0.9+/-1.5 mg/L, P<0.001 for hsCRP; 1.99+/-1.30 versus 1.42+/-1.01 pg/mL, P=0.05 for hsIL-6; and 78+/-38 versus 59+/-29 ng/mL, P=0.01 for E-selectin). There were no differences in the levels of ICAM-1 and VCAM-1 between groups. Obese children had lower peak FMD response (7.70+/-6.14 versus 11.06+/-3.07%, P=0.006) and increased IMT (0.37+/-0.04 versus 0.34+/-0.03 mm, P=0.03) compared with controls. Morbidly obese children (n=14, BMI 44.1+/-3.9 kg/m2) had highest levels of hsCRP (8.7+/-0.7 mg/L), hsIL-6 (3.32+/-1.1 pg/mL), and E-selectin (83+/-40 ng/mL). CONCLUSIONS: A proinflammatory state is detectable in obese children, which is accompanied by impaired vascular endothelial function and early structural changes of arteries, even in young subjects at risk. It remains to be determined whether high hsCRP in obese children predicts cardiovascular events.

Weghuber D, Zaknun D, Nasel C, Willforth-Ehringer A, Müller T, Boriss-Riedl M, Widhalm K. · Division of Metabolism and Nutrition, Department of Pediatrics, Vienna Medical University, Vienna, Austria. · Eur J Pediatr. · Pubmed #16924542 No free full text.

Abstract: A 2-year-old morbidly obese boy presented with early manifestation of vascular disease associated with several obesity-related features of the metabolic syndrome due to massive overfeeding. Ultrasound of the carotid arteries showed significant thickening of the intima media, perfusion magnetic resonance spectroscopy indicated cerebral microcirculation disturbance, and echocardiography revealed left ventricular hypertrophy. Thorough assessment of morbidly obese children seems to be of importance from early childhood on. Studies evaluating the prevalence of obesity-related metabolic and vascular comorbidities in very young morbidly obese children are warranted.

Silberhumer GR, Miller K, Kriwanek S, Widhalm K, Pump A, Prager G. · Medical University Vienna, Department of Surgery, Vienna, Austria. · Obes Surg. · Pubmed #16901361 No free full text.

Abstract: BACKGROUND: Morbid obesity is a rising problem in adolescents in the industrial nations. Up to 25% of children have a body mass index (BMI) higher than the 85th age- and sex-adjusted percentile. Obesity in youth is associated with increased risk for morbidity and mortality in adulthood. In addition, these patients suffer from psychological problems and decreased quality of life. Bariatric procedures have shown effective long-term results in adults, but they are still discussed controversially in adolescent patients. METHODS: Between 1998 and 2004, 50 adolescent patients with a mean age of 17.1+/-2.2 years (range 9-19 years) underwent laparoscopic adjustable gastric banding (LAGB) in Austria. The psychological changes were analyzed by using Moorehead-Ardelt/BAROS questionnaire. RESULTS: The mean BMI decreased from 45.2+/-7.6 kg/m2 at time of surgery to 32.6+/-6.8 kg/m2 after a mean follow-up of 34.7+/-17.5 months. The mean excess weight loss was 61.4+/-35.5%. Most of the adolescents showed remarkable improvements in their quality of life. The outcome was regarded as "excellent or very good" in 32 patients, "good" in 12 patients and "fair" in 5 patients. Only one patient noticed no alterations after surgery. Two-thirds of the preoperative co-morbidities resolved, and one-third improved during follow-up. Except for one port dislocation, no peri- or postoperative complications arose. CONCLUSION: LAGB is an effective and attractive treatment option in very carefully selected obese adolescents, because of its adjustability and the preservation of the gastrointestinal passage. The majority of patients showed a remarkable improvement in their quality of life.

Widhalm K, Fussenegger D. · Division Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Vienna, Austria. · Int J Obes (Lond). · Pubmed #16385765 No free full text.

Abstract: In view of the dramatically increasing prevalence of obesity among European children and adolescents and its comorbidities, the EU and national health authorities are confronted with a major public health problem, starting in childhood. So far, little is known about policies and prevention programs that are planned and implemented in EU member states in order to combat childhood obesity epidemic. For this reason all 25 Ministries of Health have been asked to give a report on their activities in that specific field. In all, 19 ministries responded and provided information on their measures in varying detail. Taken together, it shows that most ministries are aware of that severe problem and different kind of 'National Action plans against Obesity' have been recently established. However, in most cases no detailed information about the realization and the effectiveness of these programs were given. Thus, there is an urgent need for specific actions both at national and European levels in regard to succeed in fighting childhood obesity.

Pietrobelli A, Flodmark CE, Lissau I, Moreno LA, Widhalm K. · Pediatric Unit, Verona University Medical School, Verona, Italy. · Int J Obes (Lond). · Pubmed #16385743 No free full text.

Abstract: BACKGROUND: In the last 15 y there has been a tremendous increase in the number of studies on pediatric obesity looking at epidemiology, health-related risks, etiology, methodology and treatment. During the early 1990s, the European Childhood Obesity Group (ECOG) was born as a group of scientists' expert in the field of pediatric obesity. ECOG this year celebrates the approach to early maturity with an excited and omni-comprehensive program developing through eight different tracks. METHODS: Comments on different 'key' papers in each of the eight tracks. RESULTS: The eight tracks were (1) Nutrition requirements and food habits, (2) physical activity, (3) prevention and political actions/strategies, (4) diabetes, (5) metabolism, (6) psychology, (7) pathology, and (8) treatment with emphasis on drugs. CONCLUSION: Looking at the overall picture of the ECOG workshop we could conclude that despite the fact that childhood obesity is a crisis facing worldwide youth, it is necessary that action to control it must be taken now. All the six relevant levels (ie, family, schools, health professionals, government, industry and media) could be involved in prevention of child and adolescent obesity.

Dämon S, Dietrich S, Widhalm K. · Division of Clinical Nutrition, Department of Paediatrics, Medical University of Vienna, Vienna, Austria. · Acta Paediatr Suppl. · Pubmed #16175809 No free full text.

Abstract: The PRESTO project has been launched as a school-oriented pilot project. The aims were to influence nutrition, physical activity and health. The intervention was performed by a multiprofessional team and covered 11 nutrition and health-related sessions with 1 h per week in each class. The initial poor knowledge was improved significantly to the control group with better results in grammar schools compared to comprehensive schools. BMI was not improved in overweight children. However, this project could serve as a successful model in Austria.

Widhalm K, Dietrich S, Prager G. · Division of Nutrition and Metabolism, Department of Pediatrics, Medical University of Vienna, A-1090 Vienna, Austria. · Int J Obes Relat Metab Disord. · Pubmed #15543218 No free full text.

Abstract: BACKGROUND: Excessive obesity in children and adolescents is increasing in western countries all over the world. Treatment of those young subjects is extremely difficult. In cases who do not respond in any regard to conservative treatment regimens, it is worthwhile to also offer bariatric surgical procedures. METHODS: In eight young subjects with a mean age of 16.0+/-1.3 y, mean BMI 49.1+/-5.2 who where totally resistant against different therapeutic regimens, we performed adjustable laparoscopic banding surgery. Psychological tests were carried out to find out if there were any psychological disturbances. In all patients, the depression inventory for adolescents (DIKJ) and clinical interviews were carried out. RESULTS: No complications were seen; mean follow-up of 10.5+/-6.0 months showed a weight loss of 25+/-6.5 kg. All adolescents felt for the first time that it was possible to lose weight and were very happy about their body attitude. They were able to adhere to a strict dietary regimen, which allowed them to eat without any hunger problems. It was observed that most of these patients have depressive symptoms and a very low self-esteem. Some patients suffer from nervous anxiety, poor peer acceptance, less athletic competence or forms of victimisation too. CONCLUSIONS: From these results, we conclude that laparoscopic gastric banding surgery seems to be a method that could be offered to morbidly obese adolescents. However, long-term follow-up is essential and psychological problems should be carefully studied.

Denzer C, Reithofer E, Wabitsch M, Widhalm K. · Department of Paediatrics, University Hospital, Prittwitzstrasse 43, 89073 Ulm, Germany. · Eur J Pediatr. · Pubmed #14691718 No free full text.

Abstract: Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6-16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients' body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients' initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an "obesity" (initial BMI-SDS >/=90th percentile, at least three visits attended, n=59) and an "excessive obesity" (initial BMI-SDS >/=99th percentile, at least four visits attended, n=75) subgroup showed a mean reduction of BMI-SDS in the "obesity" group at visit three of 0.14 (SD 0.21, P<0.0001), and in the "excessive obese" group at visit four of 0.17 (SD 0.22, P<0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups. CONCLUSION: there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.