Contents of This Issue

In the current issue of Obesity Facts, two original studies [1, 2] and a guideline of the Childhood Obesity Task Force of EASO [3] pertain to pediatric obesity. Two papers deal with surgical interventions (intragastric balloon and laparoscopic adjustable gastric banding) [4, 5]. Three papers cover an intervention to reduce stigmatization [6], weight loss via whole body vibration [7] and the effect of animal versus soy protein in a high protein diet [8], respectively. The editorial written by Jocelin I. Hall (UK) [9] addresses the reluctance to treat due to both our currently limited understanding of obesity and negative attitudes to obese patients. The last section of this issue includes the 23 hot topic abstracts of the 17th European Congress on Obesity (ECO2009), Amsterdam, May 6–9, 2009 [10]. According to previous mostly population-based studies, many obese children underestimate their weight status. Rudolph et al. (Germany) [1] now report that clinically referred obese children perceived their weight status realistically. Most of their parents also correctly perceived the weight status of their children. Weight concerns were prominent among the obese children, particularly among the older 14to 17-year-old group. Self-concept and self-worth were significantly reduced in obese versus co-assessed lean children. Compared to patients ascertained via the pediatric pulmonary disease outpatient clinic, the obese children more often depicted physical activities as their favorite activities (80 vs. 58.14%). The ascertainment via the obesity outpatient clinic could very well be a plausible explanation for the largely correct perception of weight status by the patients themselves and their parents. School settings have proven important for health behavior interventions; some have been shown to be effective in reducing childhood overweight. Based on the fact that the consumption of sugar-sweetened beverages had increased by 50% for boys and 33% for girls between 1987 and 1998, Visscher et al. (The Netherlands) [2] designed an intervention study to reduce the consumption of such beverages. Six schools with a total of 5,866 pupils in the city of Zwolle (approximately 115,000 inhabitants) formed the intervention and control schools. The intervention consisted of placing water coolers in the canteen; additionally, free water bottles were handed out. The study took place between November 2006 and February 2007. The mean volume of water consumption per pupil per day was highest (67 ml) at the start and dropped by almost 50% at the end of the intervention period. Sales of sugar-sweetened beverages did not differ between intervention and control schools. Over one third of the boys and one fourth of the girls consumed sugar-sweetened beverages at school every day; mean consumption of such beverages at school was almost 600 ml for boys and 275 ml for girls. Roughly 70% of the pupils reported no perceived impact of the free water coolers on the volume of beverages they drank. The results of the study are in line with other intervention studies that have shown little effect of the placement of water coolers in schools. The authors discuss that the timing of their pilot study during the winter months was not fortunate. Interestingly, the study had been requested by the Dutch ministry of health; the investigators suggest that the prioritized provision of free water at secondary school canteens to alternative health promotion interventions is reconsidered. In their guideline [3], the Childhood Obesity Task Force of EASO provides practical tips for the treatment of overweight/ obese children for the primary health care provider. The focus is on history taking, categorization of obesity based on underlying causes and co-morbid disorders, physical and laboratory examinations, and provision of tips aiming to improve nutritional and physical activity habits of the obese child. The guideline specifically addresses setting realistic goals and expectations. The proposed treatment ‘aims at changing behaviors of the child and his family to improve diet, physical activity and the quality of life’. In light of the well-documented difficulties of children and adolescents to lose weight in specific weight reduction programs, several guideline statements require thorough evaluation. Intragastric balloon treatment for obesity is no longer in use in the USA because of complications of this procedure. According to the NICE guidelines (/www.nice.org.uk/nicemedia/pdf/CG43FullGuideline5bv.pdf), gastric balloons are a short-term option; they were not considered as an appropriate surgical intervention in the long term. However, intragastric balloon treatment continues to be used in different parts of Europe. Peker et al. (Turkey) [4] treated 31 patients (19 females) with a mean age of approximately 35 years. The mean BMI was 42 kg/m (range: 30–63 kg/m). Six months after placement, the mean BMI was 36.5 kg/m. The patients lost most of their weight during the first 3 months. Morbidly obese patients profited most. No major complications were observed during this study.