In Reply:

We thank Cremer for his valuable comments regarding children and adolescents with spina bifida. He rightly points out the difficulties inherent in using the BMI to capture the extent of overweight in children who are disabled by spina bifida. This is generally true for all children and adolescents with disabilities. As we said in our article, children and adolescents with disabilities have a different body composition, and, consequently, BMI and body composition do not fully correlate in such children (1). Instead of using arm reach to calculate the BMI, measuring skin folds or waist circumference, and possibly analyzing bioimpedance, may provide better parameters to determine body composition. However, standardized values for these groups of patients are lacking thus far, and future research should concentrate on how the extent of overweight in people with disabilities may be measured.

We agree with Cremer that the data situation regarding successful treatment—or otherwise—of overweight in spina bifida patients in the literature is sparse. In our study we mentioned a lifestyle intervention that increased physical fitness in the short term but did not reduce overweight (2). The missing proof that a lifestyle intervention is effective applies to all overweight children and adolescents. However, in spite of this, therapists should not deny the problem of overweight in children and adolescents with disabilities and—in the absence of evidence based insights—should take recourse to the obvious preventive and therapeutic recommendations (such as adapting the child’s diet to the reduced scope of their exercise options; and in case of rapid weight gains to provide information about overweight and its individual consequences).

DOI: 10.3238/arztebl.2010.0541b

Prof. Dr. med. Thomas Reinehr

Chefarzt der Abteilung für Pädiatrische Endokrinologie,
Diabetologie und Ernährungsmedizin

Vestische Kinder- und Jugendklinik Datteln

Universität Witten/Herdecke

Dr. F. Steiner Str. 5

45711 Datteln, Germany

T.Reinehr@kinderklinik-datteln.de

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.