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