Obesity in Germany

The purpose of this study is to address a novel epidemic in Germany. Obesity rates, and more specifically, extreme obesity rates of adolescents (14-21 years old) have been steadily increasing over the last three decades. However, while obesity as a whole has been well-studied, few studies on extreme obesity in adolescents have been conducted. This extreme obesity has caused social problems as well as serious health problems including higher mortality rates. The negative effects are felt not only in the lives of those who experience this obesity, but also have led to higher healthcare costs for Germany as a whole. Since this is a relatively new problem for Germany, medical and social support for these adolescents is not up to par. To correct this, the authors of the study initiated the Youths with Extreme obesity Study (YES) which aims to build the medical and social support structures for adolescents with obesity through scientific analysis.

While obesity is typically thought of as a singular disease, research is showing that the differentiation between extreme and non-extreme obesity is important. Health complications are significantly worse in those who experience extreme obesity. The authors also show that the treatment of extreme obesity is much more difficult. Conventional methods of pharmacological and behavioral support have not produced results on the morbidly obese. Weight loss surgery has been the most effective method in these cases, leading to a reduction in health problems as well as an increase in social functioning and quality of life. However, there are complications with these surgeries in 10% of individuals and mortality occurs in 0.1% to 0.5% of patients. Also, these surgeries are historically only practiced on adults, though there has been a recent surge of adolescents undergoing weight loss surgery.

The researchers that designed the YES made it to have four subprojects. These subprojects organize the study and give it a specific schedule as each subproject is implemented at a specific time after the start of the study. In addition to the subprojects, there is an overarching observational study that is set to occur throughout the duration of the YES. Subproject 1 deals with recruitment and the assessment of extremely obese adolescents. It was noted that many adolescents with extreme obesity do not actively seek treatment, so the recruitment process works to actively recruit these individuals as well as those who do seek treatment. The researchers also use questionnaires to gather qualitative data relating to the psychopathological, socio-demographic, and gender traits of the members in the study. These data will help the researchers effectively randomize the study.

Subproject 2 basically tests the effectiveness of low-level intervention compared to treatment as usual (TAU). It features a randomized controlled test that evaluates the safety and efficacy of the new intervention methods and uses the treatment as usual as a control group. The TAU features a group intervention that mimics the standard guidelines followed by Germans at the time of the study. These group interventions specifically focus on weight loss and the causes of obesity such as fast food and inactivity. In the group undergoing the new intervention, groups focus on improving quality of life and social functioning while not specifically focusing on weight loss or obesity. Researchers are then able to test if there is a statistically significant difference in the compliance of individuals and if there is a statistically significant difference in the quality of life between the two groups.

Subproject 3 tests the effectiveness and safety of weight loss surgery in adolescents. This surgery is also coupled with pre and post-surgery treatment. The pre-surgery treatment takes the form of educating prospective patients about the surgery, focusing on potential risks and benefits. A control group is formed through the individuals who read through the pre-surgery materials and decide not to have the surgery. From there, researchers are able to test if there is a significant difference in weight loss between the control group and the group who undertook the surgery. They also keep track of safety and are able to compare those two over the duration of the experiment. Also, it should be noted that there are multiple different surgery procedures being used in this study with the hope of pinpointing one that is most effective.

Subproject 4 explores the economic effect of extreme obesity in adolescents. Researchers look to measure all of the direct and indirect costs of prolonged obesity over time compared to the costs of intervention methods. The researchers focus on health-care costs primarily for this subproject. They collect data on direct and indirect costs every 6 months after the initial recruitment. The researchers hypothesized that the cost of intervention would be significantly lower than the long-term costs of obesity. Regarding the longitudinal observational cohort study, all individuals who were initially recruited and participated in the baseline examination will be observed for a minimum of nine years to track the long-term results of the subprojects.

There are no results in this article, likely because the test is still being undertaken and initial results are not in. However, regardless of what the data eventually says, the design of this experiment is such that it should give clear answers regarding the effectiveness of each of the treatment options that are being studied. Such is the way of groundbreaking research that seeks to answer the questions that have not been previously asked. The researchers deserve credit for their collaborative approach to investigating these different treatment options. They should also be commended for having control groups in each of their subprojects. However, the recruitment process in subproject three could have been set up to be fairer. Individuals who undertook the surgery were rigorously screened and were selected for maximal compliance. This set up an unfair advantage compared to the control group, who were not selected for maximal compliance. The control group should have also been screened for maximal compliance, even if they were not going to undertake the surgery. Other than that, the researchers have set up a very well thought out experiment that will be able to test multiple variables and provide very important data on an untested subject.