Search

SamenvattingDit artikel bevat een samenvatting van en achtergrondinformatie over het in 2022 verschenen kinderdeel van de nieuwe overkoepelende multidisciplinaire richtlijn rond diagnostiek, ondersteuning en zorg voor mensen met overgewicht en obesitas. Deze richtlijn, waarvan het deel over volwassenen in 2023 verschijnt, is bestemd voor alle hulp- en zorgverleners die betrokken zijn bij de ondersteuning en zorg voor mensen met obesitas of overgewicht in combinatie met risicofactoren en/of comorbiditeit, en voor degenen die zorgdragen voor de organisatie en bekostiging van de benodigde ondersteuning en zorg.De kernboodschap van het kinderdeel van de nieuwe richtlijn is in lijn met het Landelijk model ketenaanpak voor kinderen met overgewicht en obesitas uit 2018 en ook met gerelateerde richtlijnen en zorgstandaarden: het behandelaanbod dient aan te sluiten bij de wensen, behoeften en mogelijkheden van kind en gezin. Voorafgaand aan de behandeling is het daarom belangrijk om niet alleen inzicht te krijgen in (bio)medische factoren, maar ook in psychosociale factoren (kenmerken van het kind, het gezin en de context waarin zij leven) en leefstijlfactoren (voeding, bewegen en slapen).Bij de behandeling van kinderen en volwassenen is het bovendien belangrijk om een ketenaanpak/netwerkaanpak te hanteren die is ingebed in een integrale aanpak en die ook inzet op preventie gericht op een gezonde leefomgeving voor iedereen.

Background It is unknown whether weight class is associated with impairment of health-related quality of life (HRQOL) for children in the Netherlands. The aim of this study was to explore generic and weight-specific HRQOL in a clinical cohort of children with overweight, obesity or severe obesity aged 4–19 years in the Netherlands. Methods 803 children from three clinical cohorts participated: mean age 11.5 (SD 2.9) years, 61.1% girls. The influence of weight class was explored in a subgroup of 425 children (25.2% with overweight, 32.5% obesity and 42.3% severe obesity), of whom the exact International Obesity Task Force (IOTF) BMI class was known. Generic HRQOL was measured by the PedsQL child report. Weight-specific HRQOL was measured by the IWQOL-Kids child or parent report. Average total, subscale and item scores were reported and the influence of the IOTF BMI class analyzed by multiple linear regression, corrected for age and sex. Results Children with severe obesity had lower generic and weight-specific HRQOL scores than those with obesity or overweight. IOTF BMI class was negatively associated with item scores from all subscales, especially physical, social and emotional problems. Children with overweight reported similar HRQOL total, subscale and item scores to children with obesity.

IntroductionHealthcare professionals (HCPs) play an important role in childhood overweight and obesity care, yet they often feel ill-equipped to manage this complex and sensitive health problem. As part of Dutch integrated care for childhood overweight and obesity, a training for coordinating professionals (CPs) was designed and carried out. This study evaluates the training based on the four levels of Kirkpatrick’s model of training evaluation: (1) reaction, (2) learning, (3) behaviour, and (4) results.MethodEleven CPs who completed the training participated in this mixed-methods study. First, completed questionnaires on the four levels were analysed with Qualtrics. Next, the transcripts of semi-structured interviews on levels 1, 3 and 4 were analysed in MAXQDA using thematic analysis. ResultsOn level 1, participants were satisfied with the training as it stimulated their professional and personal development, for instance awareness of prejudices about people with overweight and obesity. Barriers, improvements and needs from the training varied between participants based on their background. On level 2, CPs improved knowledge about integrated care and its practice, skills for providing overweight and obesity care, coaching attitudes, and trust and commitment towards local integrated care. On level 3, the extent to which the learnings were practised depended on the experience and local context of the CP. Last, on level 4 CPs mentioned noticing post-training practical results for themselves, the child and the family, integrated care partners, and the participants’ organisation.Conclusion This study evaluated a training for CPs for the support and care they provide to children with overweight and obesity and their families as part of Dutch integrated care. The training contributed to improve knowledge, skills and attitudes of CPs. This study recommends sufficient implementation of local integrated care to optimally practise what was learned. More on-time evaluations of the training and taking the perspective of the organisation into account is needed. This would improve the training and give CPs confidence to adequately provide support and care to children with overweight and obesity and their families.

Background: Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. The aim of this study was to add knowledge for further development of a psychosocial and lifestyle assessment for childhood obesity. Methods: Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within the Dutch integrated care approach. Data were analysed using template analyses, complemented with open coding in MAXQDA.Results: The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects. Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals. Conclusions: This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.

Background: Many healthcare professionals (HCPs) feel uncomfortable and incompetent to talk about weight with children with overweight and obesity and their parents. To optimally target interventions that can improve obesity care for children, we assessed the self-efficacy (SE) and perceived barriers (PBs) of Dutch HCPs in regard to talking about weight and lifestyle when treating children with overweight or obesity. In addition, we analyzed interdisciplinary differences.Methods: A newly developed, practice- and literature-based questionnaire was completed by 578 HCPs of 7 different professions. Kruskal-Wallis, t-tests and chi-square tests were used to analyze interdisciplinary differences on SE, PBs and the effort to discuss weight and lifestyle despite barriers. Results: On average for the total group, the reported strength of SE was 7.2 (range 3-10; scale 1-10), and the median number of different PBs was 4.0 (range 0-12; out of 17). The majority of HCPs (94.6%) reported that they perceived one or more barriers.HCPs who perceived too many barriers to discuss the weight and lifestyle of the child in the majority of cases (9.6%), reported a lower SE (mean 6.3), as compared to professionals who were likely to discuss these topics (mean SE 7.3 p < 0.01), although a similar number of PBs. In total, 14.2% (n = 82) of all HCPs either rated their SE below 5 or reported that they did not address weight and lifestyle due to PBs in the majority of cases.Conclusions: Although on average Dutch HCPs rated their self-efficacy fairly good, for a subgroup major improvements are necessary to lower perceived barriers and improve their self-efficacy, aiming to improve the quality of care for Dutch children with obesity.

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention. Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches. Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved. Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.

Introduction: During the COVID-19 pandemic, lockdown measures were implemented with large impact on lifestyle behaviors and well-being of children (including adolescents). The impact on children with severe obesity, who plausibly are at even larger risk, has not yet been described. Aim of this study was to investigate the impact of COVID-19 lockdown on eating behaviors, physical activity, screen time and quality of life (QoL) of children with severe obesity. Methods: In this mixed-methods study, questionnaires and semi-structured telephone interviews were used to investigate impact of COVID-19 during the first wave in the Netherlands (April 2020) on children with severe obesity (adult BMI-equivalent ≥35kg/m2) treated at our obesity center. The Dutch Eating Behavior Questionnaire - Child, Pediatric Quality of Life Inventory, and Dutch Physical Activity Questionnaire were filled out by their families pre-pandemic and during lockdown. Changes over time in percentile scores, weekly physical activity and screen time were assessed. Qualitative analyses were performed according to the Grounded Theory. Results: We included 83 families, of which 75 participated in the interviews. Their children’s characteristics were mean age 11.5years (SD 4.6), 52% female, mean BMI SD score 3.8 (SD 1.0), indicating severe obesity. On group level, no changes in scores for emotional, restrained, external eating, and QoL nor in screen time were observed (Δ scores +9.2, +3.9, +0.3; and +3.0, respectively; -0.3 hr/wk; all p>0.05). Weekly physical activity decreased (Δ -1.9 hr/wk, p=0.02). Age, pre-existent psychosocial problems and pre-pandemic questionnaire scores were associated with improved or deteriorated questionnaire scores in specific subgroups. For example, children who did not fulfill WHO physical activity criteria pre-pandemic showed a further decline from 2.8 to 0.7 h/wk (p=0.001). Children with high emotional and external eating during lockdown had the lowest QoL scores (p-values Conclusion: This study shows differential response profiles to COVID-19 lockdown in children with severe obesity. Although on group level lifestyle scores averaged out, a substantial part of families reported deterioration in physical activity and eating behaviors. Children with pre-existent psychosocial problems, high external or emotional eating scores were most at risk. Health care professionals should target these vulnerable children to minimize short- and long-term negative physical and mental health consequences.

BACKGROUND: Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight.METHODS: Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted.RESULTS: Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways, or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed, but context and situation specific.CONCLUSION: This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children's previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.

Recent data from surveys in the USA have shown that 37.7% of adult individuals and 17.0% of children currently have obesity, with no sign of a reduction despite federal and local obesity prevention strategies. In particular, severe obesity seems to be increasing. Obesity, therefore, remains a major public health problem that requires drastic action.

In order to facilitate the development and implementation of a national standard of integrated chronic disease management for overweight and obesity the Ministry of Health, Welfare and Sport initiated the formation of the Partnership Overweight Netherlands (PON). The 16 partners of the PON are organizations of health care providers, health insurance companies and patient organisations. The PON supports these partners in improving the care for people with obesity. This should lead to improvement of the health and quality of life of the involved patients. An important instrument for reaching this objective, is the Dutch multidisciplinary clinical ‘Guideline for the diagnosis and treatment of obesity in adults and children’ that will be implemented with support of the PON. In addition the PON encourages relevant organizations in early detection and to start preventative interventions for people with a high risk for overweight and obesity.

OBJECTIVE: The aim of this article is to share the Dutch experience of a nation-wide approach to reduce the prevalence of overweight and obesity. This is an practice example of national health policy.METHODS: The Ministry of Health facilitates three complementary initiatives to tackle overweight and obesity: i) the Knowledge Centre Overweight (KCO) (since 2002) to enhance knowledge about prevention and treatment of overweight, ii) the Covenant on Overweight (CO) (since 2005), a public-private partnership, iii) the Partnership Overweight Netherlands (PON) (since 2008), to facilitate the development and implementation of a chronic disease management model.RESULTS: The KCO has a platform with 20 partners that functions as a sounding board. It consists of specialists in the area of overweight and obesity. Moreover KCO has a well-visited website: www.overgewicht.org. The CO with 20 partners from the (local) government, private and public sector has instigated various activities regarding the settings home, school, work, and recreation. The PON has the commitment of 18 partners (organisations of health care providers, health insurance companies and patient organisations) and facilitates the implementation of the national clinical guideline for the diagnosis and treatment of obesity.CONCLUSION: In the Netherlands relevant stakeholders work together at all levels. The ambition is to make this the first integrated, practice-and evidence-based, national approach for tackling overweight and obesity.

In het onderzoek ‘Toeleiding naar en voltooiing van leefstijlinterventies voor kinderen met overgewicht en obesitas’ blijkt dat succesvolle toeleiding en voltooiing van leefstijlinterventies niet een kwestie is van de aan- of afwezigheid van één bepaalde factor, maar dat het succesvol starten en afronden van een interventie pas plaatsvindt wanneer de relevante factoren overwegend faciliterend zijn en/of opwegen tegen de belemmerende factoren. Het is uiteindelijk de positieve balans tussen de ervaren barrières en de faciliterende factoren die ervoor zorgt dat mensen een programma voltooien. Barrières zijn onderdeel van het uitdagende leven van deze gezinnen en niet eenvoudig oplosbaar. De kunst is om de barrières daar waar mogelijk te verkleinen én de faciliterende factoren te versterken. Dit onderzoek, wat uitgevoerd is in opdracht van de Amsterdamse Aanpak Gezond Gewicht, levert daartoe belangrijke handvatten

Purpose: In light of the increasing prevalence of overweight and obesity, understanding the experiences, strategies and challenges encountered when trying to achieve substantial, sustainable weight loss is an important area to investigate. We systematically evaluated qualitative studies focusing on the accounts of individuals who have achieved sustained weight loss to create a comprehensive picture of the experience of sustainable weight loss. Methods: Included studies were peer-reviewed studies that qualitatively assessed the views and experiences of adults who previously had or currently have overweight or obesity who successfully lost weight and who subsequently maintained or regained weight. The evidence was systematically synthesized, which enabled the formulation of clear themes and recommendations. Results: The 15 chosen studies included the accounts of 294 individuals. We found that continuous monitoring and goal setting, driven by sustained motivation and encouraging experiences, while resisting ever present challenges and enduring discouraging experience encapsulates the experience of sustained, substantial weight loss. Conclusions: This review aims to provide a comprehensive understanding of the experiences, strategies and challenges encountered when trying to achieve substantial, sustained weight loss. Additional research taking into account findings from this review and others of its kind will enhance the formulation of treatment protocols.