Table 3 Components of the inpatient weight-loss program
Intervention component | Items | Description | Aims | Frequency/Dose |
|---|---|---|---|---|
Structured physical activity (10 h/week) | Therapeutic sports | Different types of outdoor activities such as ascending stairs, road running and cross country runs etc. | Endurance training according to individual abilities | 2x/week à 60 min |
Swimming | Lane swimming ~1.000 m | Endurance training; Learning/improving swimming technique | 1x/week à 50 min plus the 6 km walk to the pool (~3 km downhill, 3 km uphill) | |
Group sports | Different physical activities (e.g. ball games, dancing and gymnastics) | Focus on playing and having fun | 1x/week à 45-90 min | |
Postural training | Strength training: gymnastics, dumbbells, stretch bands, etc. | Strength training to achieve or maintain good posture | 1x/week à 45 min | |
Hiking | 10-12 km hikes in the mountains | Endurance training with nature experience | 1x/week à 3 h | |
Non structured physical activity (~6 h/week) | 'Fun- Walk' | Walking to the town centre (~1 km downhill, 1 km uphill); Time for individual activities | Endurance training, having fun | 1x/week à 2 h (in total) |
Excursions | Various excursions and activities like playing miniature golf, sightseeing, table tennis tournaments, etc. | Having fun, group activities to improve social skills | Dimension of physical activity varies; within 4 weeks of intervention, it accounts for 6 h/week | |
Obesity patient training courses (16 sessions within 4 weeks) | Psychotherapy | • Developing rules for healthy eating behavior • Rigid versus flexible dieting | Improving self-esteem and body perception, prevention of relapse. | 5 session within 4 weeks à 45 min |
• Recognition of signs of both hunger and satiety • Learning to enjoy food as well as to cope with difficult situations | ||||
• Developing motivation for participating in regular physical activity | ||||
Individual sessions if the children suffer from psychosomatic, psycho-vegetative and/or psychological diseases | Treating individual psychological problems | 1-3 individual sessions à 45 min/week | ||
Nutritional lessons | Teaching children to choose the appropriate (amount of) food according to their personal needs | Enabling the children to prepare healthy food for themselves | 5 sessions within 4 weeks à 45 min | |
Physical education | Improving knowledge on energy balance, effects and limitations of physical activity, measures of self-control and good posture | Increase knowledge of the effects of physical activity to support adherence to the regular physical activity recommendations | 4 sessions within 4 weeks à 45 min | |
Medical education | Improving knowledge on medical background of overweight and obesity (normal/ideal weight, BMI, comorbidities etc.) | Increase knowledge of the medical consequences of overweight and obesity and promote a realistic goal setting | 2 sessions within 4 weeks à 45 min | |
Social competence | Training sessions | • Training for conflict resolution, communication, ability to offer and receive criticism, body language, self-assurance, empathy etc. • Role playing • Concentration training | • Development of emotional-cognitive abilities • Development of occupational skills • Reflecting on and improving social behavior skills | 1x/week à 45 min |
Nutrition | Cooking | Cooking as a creative activity and a positive group experience | Transfer of theoretical knowledge into practice | 1x/week, 2 h |
Lessons for grocery shopping | • Learning how to read packaging labels correctly (e.g. sample sizes, nutritional information) • Learning how to make educated nutritional decisions about potentially misleading products (e.g. 'organic') | Enabling the children to judge different food products correctly | 1x/week, 90 min | |
Parents | Supportive training | Parents receive background information on obesity and advice about how to best support their child. In addition, they are requested to take their child to subsequent outpatient psychological treatment. They also receive special handouts about healthy living, including nutrition, physical activity, media consumption etc. | Improving parental support of the children after conclusion of the inpatient program | Two conversations with the physician (at the start and the end of intervention. In special cases, parents are contacted by telephone) |
School | Theoretical lessons | German, English and Mathematics | Keeping the children current with the appropriate educational curriculum | Groups 3 and 4: 5x/week à 45 min Groups 1 and 2: 6x/week à 45 min |