Prevention and care for obese children and adolescents in Germany: Quality and deficiencies of programs and interventions

The Hamburg University Hospital (UKE), together with the German Federal Centre for Health Education (BZgA), conducted a nationwide screening of obesity-related care. The screening was composed of two stages: Firstly, a short questionnaire of 150 items was developed and validated by experts. It comprised 14 summary criteria, derived from obesity care guidelines. The most important aspects of the providers' services were surveyed. This resulted in a description of intervention quality in 492 institutions or programs on a national level, controlled for representativity, and analyses of quality in specific institutional types. Secondly, a sample of 38 interventions was selected, using cluster analysis, and assessed in depth by means of the quality assurance system QIP (Quality in Prevention), extended to include obesity-related criteria from medical guidelines. The main results of the survey were as follows: Only 51.4% of the guideline-based quality criteria were met by an average program. The costs of the various programs differed vastly but predicted the intervention quality only to a moderate degree. Two thirds of the programs were offered by outpatient (are institutions. The screening documented that there was a lack of setting-related projects. On the basis of the findings, a registration system for projects and programs, based upon evidence-based quality criteria, is proposed. Furthermore, outpatient services and projects should be strengthened, and setting-based interventions should be developed, enhanced by a national strategy of obesity prevention on several policy levels, according to WHO recommendations.