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Summary An increasing number of governments worldwide have introduced a tax on sugar-sweetened beverages (SSB) for public health. However, the adoption of such a policy is still debated in many other countries, such as in the Netherlands. We investigated Dutch stakeholder views on taxation of SSB and perceived barriers and facilitators to its adoption in the Netherlands. Semi-structured interviews were conducted in 2019 with 27 stakeholders from health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties. Data were analysed using a thematic content approach. The findings reveal that, between and within sectors, stakeholders expressed contradictory views on the effectiveness, appropriateness and (socio)economic effects of an SSB tax. Perceived barriers to the adoption of an SSB tax in the Netherlands included an unfavourable political context, limited advocacy for an SSB tax, a strong lobby against an SSB tax, perceived public opposition, administrative load and difficulties in defining SSB. Perceived facilitators to its adoption included an increasing prevalence of overweight, disappointing results from voluntary industry actions, a change of government, state budget deficits, a shift in public opinion, international recommendations and a solid legal basis. In conclusion, this study shows that several challenges remain to be overcome for the adoption of an SSB tax in the Netherlands. Similar research on stakeholder views in other countries may further inform SSB tax policy processes.

Background Prior research indicates a positive association between socioeconomic position and health literacy levels. We hypothesize comparable socioeconomic gradients for food literacy. This study aims to determine the level of self-perceived food literacy and health promotion literacy among adults with a low and medium level of education and from various subgroups, as well as the association between these food and health literacy levels. Furthermore, this study aims to explore the associations of self-perceived food literacy (SPFL) and health promotion literacy (HPL) in BMI. Methods A cross-sectional study was conducted among employees with a low and medium level of education. Descriptive analyses were performed to compute SPFL and HPL levels. Analyses of variance were performed to test differences between subgroups. The correlation between SPFL and HPL was computed by Pearson’s r. Multivariate linear regression analyses were used to explore 1) the association between SPFL and HPL adjusted for demographic characteristics 2) the associations between SPFL and HPL in BMI. Results The majority (63.1%) of all participants (n = 222) scored low on SPFL and 34.5% scored inadequate or problematic on HPL. No significant educational or weight-status differences were found in SPFL or HPL levels. On most levels, women compared to men and older compared to younger employees scored significantly higher. A small positive correlation between the two mean levels was found, r = .25, P n = 203). Multivariate linear regression analyses showed a significant association between SPFL and HPL (B = .31, 95% CI = .15–.48). No significant associations between SPFL and HPL in BMI were found. Conclusions This study suggests there is room for improvement in SPFL and HPL among adults with a low and medium level of education. Future research should consider comparing low and middle socioeconomic with high socioeconomic groups when exploring food and health literacy. Regarding health promotion activities for adults with a low and medium level of education, it is recommended to focus on improving both food and health literacy. Furthermore, more research is needed to explore direct proxies of weight-status to better understand the role of food and health literacy in overweight patterns.

To ensure that health behavior interventions for children living in low socioeconomic position (SEP) neighborhoods are in line with children’s wishes and needs, participation of the children in the development, implementation, and evaluation is crucial. In this paper, we show how children living in three low-SEP neighborhoods in the Netherlands can be involved in Participatory Action Research (PAR) by using the photovoice method, and what influences this research process. Observations, informal chats, semi-structured interviews, and focus group discussions with children and professionals were done to evaluate the research process. The photovoice method provided comprehensive information from the children’s perspectives. With the help of the community workers, the children identified feasible actions. We found that it is important to constantly discuss the research process with participants, start with a concrete question or problem, and adapt the project to the local context and skills of participants.

Background A community-based approach can be a promising strategy for implementing school-based health promotion aimed at stimulating healthy physical activity and dietary behaviour. Such an approach builds on the community capacity of multiple stakeholders, empowering them to design and implement tailored activities, supported by the whole school community. This paper describes the background and evaluation design of the community-based school intervention ‘Fit Lifestyle at School and at Home’ (FLASH) in four prevocational schools. FLASH includes four strategies for building the community capacity of students, school personnel and parents: 1) identifying leaders in each stakeholder group, 2) stimulating a school culture of participation, 3) having stakeholders design and implement tailored activities and 4) creating a network of local partners for structural embedding. The objective is to monitor the capacity-building processes of the FLASH intervention and to explore if these processes contribute to changes in community capacity. In addition, we will explore if the FLASH intervention is related to changes in PA, dietary behaviours and BMI of students. Methods This study has a mixed methods design and uses a participatory action-oriented approach to monitor and evaluate changes in community capacity, tailored health-promotion activities and implementation processes. Methods include semi-structured interviews, focus groups, journals, document analysis and observational scans of the physical environment. In addition, changes in BMI, physical activity and dietary behaviours of prevocational students will be explored by comparing the four intervention schools to four control schools. Data are collected by questionnaires and anthropometric measurements. Discussion The main strength of this study is its use of mixed methods to evaluate real-life processes of creating a healthy-school community. This will provide valuable information on capacity-building strategies for the structural embedding of health-promotion activities within school settings. The results could help schools become more empowered to adapt and adopt integral health-promotion interventions in daily practice that suit the needs of their communities, that are expected to be sustainable and that could lead to favourable changes in the PA and dietary behaviour of students. Trial registration ISRCTN67201841; date registered: 09-05-2019, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-019-7088-3) contains supplementary material, which is available to authorized users.

Background Healthy sleep duration is essential to health and well-being in childhood and later life. Unfortunately, recent evidence shows a decline in sleep duration among children. Although effective interventions promoting healthy sleep duration require insight into its predictors, data on these factors are scarce. This study therefore investigated (i) which individual (lifestyle), social and cultural factors, and living conditions and (ii) which changes in these factors might be associated with the changes in sleep duration of Dutch primary schoolchildren observed over time. Method Data from the ChecKid study was used, a dynamic cohort study among 4–13-year-old children living in the city of Zwolle, the Netherlands. Associations between changes in sleep duration and individual (lifestyle) factors (i.e., age, sex, physical activity behavior, sugar-sweetened beverage consumption, screen behavior), social and cultural factors (i.e., parental rules, ethnicity), and living conditions (i.e., parental education, presence of screens in the bedroom, household size) were analyzed using multivariable linear regression. Results A total of 1180 children participated, aged 6.6 ± 1.4 years in 2009. Mean sleep duration decreased from 11.4 ± 0.5 h/night in 2009 to 11.0 ± 0.5 h/night in 2012. Older children, boys, children who used screens after dinner, children with greater computer/game console use, and children whose parents had low levels of education had a greater decrease in sleep duration. Conclusions This article reports on one of the first large, longitudinal cohort studies on predictors of child sleep duration. The results of the study can inform future interventions aimed at promoting healthy sleep in primary schoolchildren.

How long does the average person sleep? Here, Kocevska et al. conducted a meta-analysis including over 1.1 million people to produce age- and sex-specific population reference charts for sleep duration and efficiency.We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including >= 100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1-100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40-69 years, 55.5% female) from the United Kingdom and 409,617 people (>= 18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the 'acceptable' sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8-10 h and 18% report daytime sleepiness. In adults (>= 18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6-19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending >= 9 h in bed, whereas poor sleep quality was more frequent in those spending = 41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Background Public acceptability of a sugar-sweetened beverages (SSBs) tax is important for governments in the decision-making process. Therefore, the aim of the present study was to investigate the level of public acceptability of an SSBs tax and its associated factors. Methods Dutch adults representative of the Dutch population for age, sex, educational level and location (n = 500) completed an online self-administered questionnaire. The acceptability of an SSBs tax was measured on a 7-point Likert scale. Associations between acceptability and sociodemographic factors, body mass index, SSB consumption, and beliefs about effectiveness (9 items, e.g. 'An SSBs tax would reduce people's SSB consumption'), appropriateness (7 items), socioeconomic and economic benefit (5 items), implementation (1 item) and trust (3 items) were assessed using multivariable linear regression analyses. Results Of the participants, 40% supported and 43% opposed an SSBs tax in general. Moreover, 42% supported (43% opposed) an SSBs tax as a strategy to reduce overweight and 55% supported (32% opposed) an SSBs tax if revenue is used for health initiatives. Participants with a low educational level (B=-0.82;95%CI = [-1.31,-0.32]), overweight (B=-0.49;95%CI = [-0.89,-0.09]), moderate or high SSB consumption (B=-0.86;95%CI = [-1.30,-0.43] and B=-1.01;95%CI = [-1.47,-0.56], respectively) and households with adolescents (B=-0.57;95%CI = [-1.09,-0.05]) reported lower acceptability of an SSBs tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P Conclusions Public acceptability of an SSBs tax tends to be higher if revenue is used for health initiatives. Sociodemographic factors, body mass index, SSB consumption and several beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust are associated with acceptability. Key messages It should be considered to include a recommendation to use revenue for health initiatives in global guidelines for SSBs taxes. Targeting population subgroups with low levels of support might be an effective strategy for communication campaigns.

This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10&ndash, 14-year-old adolescents using a systems dynamics and participatory approach. The LIKE programme focuses on the transition period from 10-years-old to teenager and was implemented in collaboration with the Amsterdam Healthy Weight Programme (AHWP) in Amsterdam-East, the Netherlands. The aim is to develop, implement and evaluate an integrated action programme at the levels of family, school, neighbourhood, health care and city. Following the principles of Participatory Action Research (PAR), we worked with our population and societal stakeholders as co-creators. Applying a system lens, we first obtained a dynamic picture of the pre-existing systems that shape adolescents&rsquo, behaviour relating to diet, physical activity, sleep and screen use. The subsequent action programme development was dynamic and adaptive, including quick actions focusing on system elements (quick evaluating, adapting and possibly catalysing further action) and more long-term actions focusing on system goals and/or paradigm change. The programme is supported by a developmental systems evaluation and the Intervention Level Framework, supplemented with routinely collected data on weight status and health behaviour change over a period of five years. In the coming years, we will report how this approach has worked to provide a robust understanding of the programme&rsquo, s effectiveness within a complex dynamic system. In the meantime, we hope our study design serves as a source of inspiration for other public health intervention studies in complex systems.

Background: The aim of the study was to assess changes in the health-related quality of life (HRQOL) and weight status of children with overweight and obesity after participating in a 10-week family-based combined lifestyle group intervention in their community. Methods: In total, 340 children with overweight or obesity aged between 7 and 13 years, as well as one of their primary caregivers, took part in this intervention, in a real-world setting. The intervention comprised 20 group sessions for a 10-week period, and focused on improving knowledge, attitudes, social support, and self-efficacy in regard to healthy lifestyles. The Pediatric Quality of Life Inventory 4.0 (PedsQL) and Impact of Weight on Quality of Life-Kids (IWQOL-KIDS) questionnaires were used to determine generic and weight-specific HRQOL. Changes in HRQOL and BMI (standard deviation [SDS] of BMI, objectively measured) were tested using a Wilcoxon signed-rank test, Mann-Whitney U test, and paired t-test. Results: Generic quality of life (Z = -3.58, r = -0.25), weight-specific quality of life (Z = -4.83, r = -0.34), and SDS-BMI (d = 0.21) were all significantly improved after participating in the 10-week intervention. The mean attendance rate was 73.74%. Conclusion: This study demonstrated that participation in the intervention LEFF for children with overweight and obesity was associated with improved generic and weight-specific HRQOL and SDS-BMI.

Background Socioeconomic inequalities in overweight and obesity exist in many European countries. A sugar-sweetened beverages (SSB) tax may contribute to a reduction of these inequalities. However, in the Netherlands, the government decided to not (yet) introduce an SSB tax, although the government has acknowledged its potential to be pro-equity. Understanding how various stakeholder groups perceive the potential effects of an SSB tax on different socioeconomic groups may provide useful insights into equity-related considerations in the debate whether or not to implement an SSB tax. This study aims to gain insight into the perceptions of stakeholder groups in the Netherlands on (1) the effects of an SSB tax on the budgets of lower and higher socioeconomic groups and (2) the impact of an SSB tax on socioeconomic inequalities in dietary intake and health. Methods Semi-structured interviews were conducted in 2019 with 27 participants from various stakeholder groups in the Netherlands (i.e. health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties). Data were analyzed using a thematic content approach. Results Participants from all stakeholder groups indicated that an SSB tax would have a larger impact on the budgets of lower socioeconomic groups. Participants from nearly all stakeholder groups (except trade associations) mentioned that an SSB tax could have greater health benefits among lower socioeconomic groups as these often have a higher SSB consumption and are more likely to be overweight or obese. Some participants mentioned that an SSB tax may have no or adverse health effects among lower socioeconomic groups (e.g. compensation of lower SSB consumption with other unhealthy behaviours). Some participants emphasised that an SSB tax should only be introduced when accompanied by other interventions (e.g. offering healthy alternatives), to make it easier for lower socioeconomic groups to lower their SSB consumption in response to an SSB tax, and to prevent adverse health effects. Conclusions Participants believed an SSB tax could contribute to a reduction in socioeconomic inequalities in dietary intake and health. However, additional interventions facilitating the reduction of SSB consumption in lower socioeconomic groups were recommended.

BackgroundSince 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. However, the key elements of this approach are not clear. The current study aimed to identify key elements of this successful local community-based approach, according to the perspectives of various stakeholders.MethodsSemi-structured interviews were carried out with 29 professionals who were involved in the approach in the period 2010–2018 and have occupations at the strategic (n = 4), tactical (n = 17) and operational level (n = 8). Data was analyzed using the thematic analysis approach.ResultsWe identified nine perceived key elements that contributed to the success of the approach aimed at reducing socioeconomic health inequalities. The respondents indicated the following key elements: (1) collaboration between a variety of local organizations that want to have impact on the health of citizens; (2) support for the approach on the strategic, tactical and operational level of involved organizations; (3) proper communication and coordination, both for the network and within the organizations; (4) embeddedness in organizations’ policies and processes and (5) collaboration with private organizations is of added value, although there is no “one size fits all”. Other key elements are (6) collaboration with citizens, (7) profiling the approach like a brand and (8) moving along with and taking advantage of opportunities. Finally, (9) continuous monitoring and evaluating goals and processes, and learning from the results, is important.ConclusionNine key elements were identified that, according to various stakeholders, contributed to the success of the Zwolle Healthy City approach. These insights are important to further strengthen the Zwolle Healthy City approach but may also help and inspire other local integrated community-based approaches aimed at reducing socioeconomic health inequalities, to improve and adapt the approach within their specific local and dynamic context.

Objective: To examine changes in generic and weight-related, health-related quality of life (HRQoL) in children and adolescents with severe obesity participating in intensive lifestyle treatment, and to examine whether changes in SDS-BMI were associated with changes in HRQoL. Methods: In this prospective observational study, a referred sample of 120 children and adolescents (8-19 years) with severe obesity (SDS-BMI ≥ 3.0, or ≥ 2.3 in combination with obesity-related comorbidity) received an intensive 1-year lifestyle treatment with an inpatient period in a specialized childhood obesity center. A weight-related (IWQOL-Kids) and three generic (KIDSCREEN-52, PedsQL 4.0, and EuroQol) HRQoL questionnaires were administered at baseline (T0), after treatment (T1), and 1 year later (T2). Generalized Linear Mixed Models and partial correlations were used to analyze changes in HRQoL and associations with changes in SDS-BMI. Results: Statistically significant improvements in generic and weight-related HRQoL overall and domain scores were observed at T1and at T2 in comparison with T0, despite partial weight regain from T1 to T2. Larger weight loss at T2 was correlated with larger improvements in physical HRQoL domains. Conclusion: Children and adolescents with severe obesity experienced long-term improvements in generic and weight-related HRQoL after participating in intensive lifestyle treatment, despite partial weight regain.

Background To date, population based surveys aimed at gaining insight in health related behaviour of children have often used either child self-reports or parent proxy reports. It remains unclear however, if surveys using different sources of information from either parents or children are comparable. In addition, (over)weight status of children can lead to under- and over reporting by parents and children as a result of social desirability bias. We aimed at gaining insight in the level of agreement between parents and child reports regarding aspects of certain dietary, physical activity and sedentary behaviours, and whether there are differences in agreement between parents and child reports in healthy-weight and overweight children. Methods Weighted kappa was used to determine the level of agreement between child and parent reports on health-related behaviour in 1998 parent-child dyads. We also stratified for weight status of the children. Information on children’s health related behaviours was obtained by parental and children’s questionnaires, and children’s height and weight were measured. Associations between children’s weight status and children reporting less, reporting more and reporting the same amount of health behaviour as their parents were investigated with multinomial logistic regression analysis. Results The Cohen’s kappa coefficients ranged from almost perfect agreement for the variable means of transportation, fair for the variables breakfast consumption and frequency of outside play to slight for the variables duration of outside play, frequency and duration of TV/DVD viewing and family dinner. Overweight children were significantly more likely to report less breakfast consumption (OR = 2.6 (95% CI: 1.3 – 5.1)) and lower frequency of outside play than their parents (OR = 1.8 (95% CI: 1.1 – 2.9)). Conclusion There can be considerable disagreement between the health related behaviours of children as reported by parents or the children themselves. Based on the present study, it cannot be concluded whether parents’ or children’s reports are more accurate. For future studies, social desirability and recall bias would be best demonstrated in a validation study comparing child and parent self-reports with more objective measures of physical activity and food intake. Electronic supplementary material The online version of this article (10.1186/s40359-018-0227-2) contains supplementary material, which is available to authorized users.

Background: Considering the large economic consequences of severe childhood obesity for the society, we aimed to conduct an economic evaluation comparing two intensive 1-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to standard deviation score BMI (SDS-BMI) and quality-adjusted life years (QALYs). Methods: An economic evaluation from a societal perspective accompanying a randomized controlled trial with a 24-month follow-up. 80 participants (8-19 years) with severe obesity were included. Participants received an intensive 1-year lifestyle treatment with an inpatient period of 2 months (short-stay group) or 6 months (long-stay group). Data were collected at baseline, 6, 12 ,and 24 months and included SDS-BMI and QALYs. Results: SDS-BMI decreased in the first 6 months of treatment, stabilized in the second 6 months, and increased during the 2nd year in both groups. After 24 months, SDS-BMI was similar in both groups, but remained lower than baseline values (mean difference -0.24, 95% CI -0.42; -0.06). There was no difference in QALYs between the groups after 24 months. For SDS-BMI, the probability of the short-stay treatment being cost-effective in comparison with the long-stay treatment was 1 at a willingness-to-pay of 0 EUR/unit of effect, which slowly decreased to 0.54 for larger willingness-to-pay values. Conclusions: Based on the results of this study, the short-stay treatment is considered to be more cost-effective from the societal perspective in comparison with the long-stay treatment. Future research should provide insight in whether the short-stay treatment is cost-effective in comparison with usual care.

Background Taxation of sugar-sweetened beverages (SSBs), as a component of a comprehensive strategy, has emerged as an apparent effective intervention to counteract the rising prevalence of overweight and obesity. Insight into the political and public acceptability may help adoption and implementation in countries with governments that are considering an SSBs tax. Hence, we aimed to conduct a systematic review and meta-analysis to synthesize the existing qualitative and quantitative literature on political and public acceptability of an SSBs tax. Methods Four electronic databases (PubMed, Embase, Scopus, Web of Science) were searched until November 2018. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Qualitative studies were analyzed using a thematic synthesis. Quantitative studies were analyzed using a random-effects meta-analysis for the pooling of proportions. Results Thirty-seven articles reporting on forty studies were eligible for inclusion. Five themes derived from the thematic synthesis: (i) beliefs about effectiveness and cost-effectiveness, (ii) appropriateness, (iii) economic and socioeconomic benefit, (iv) policy adoption and implementation, and (v) public mistrust of the industry, government and public health experts. Results of the meta-analysis indicated that of the public 42% (95% CI = 0.38–0.47) supports an SSBs tax, 39% (0.29–0.50) supports an SSBs tax as a strategy to reduce obesity, and 66% (0.60–0.72) supports an SSBs tax if revenue is used for health initiatives. Conclusions Beliefs about effectiveness and cost-effectiveness, appropriateness, economic and socioeconomic benefit, policy adoption and implementation, and public mistrust of the industry, government and public health experts have important implications for the political and public acceptability of an SSBs tax. We provide recommendations to increase acceptability and enhance successful adoption and implementation of an SSBs tax: (i) address inconsistencies between identified beliefs and scientific literature, (ii) use raised revenue for health initiatives, (iii) communicate transparently about the true purpose of the tax, and (iv) generate political priority for solutions to the challenges to implementation. Electronic supplementary material The online version of this article (10.1186/s12966-019-0843-0) contains supplementary material, which is available to authorized users.

Introduction This study aimed to explore the role of ethnicity and maternal perceived weight status in the association between maternal child feeding practices and childhood Body Mass Index (BMI) at the age of 11–12 years in a multi-ethnic population. Methods We collected data on child feeding practices by the validated Child Feeding Questionnaire (CFQ) among 2398 mothers of adolescents (Mage = 11.2, SDage = 0.6). Multivariate linear analyses were used to determine the cross-sectional association between child feeding practices (‘Restriction’, ‘Pressure to eat’, and ‘Monitoring’), maternal perception of child's weight status, SDS-BMI, and ethnicity. Results ‘Restriction’ (β = 0.16; 95% CI [0.11; 0.20]) and ‘Pressure to eat’ (β = −0.32 [-0.36;-0.28]) were significantly associated with child SDS-BMI. Both associations were strongly influenced by the mother's perception of child's weight status. Besides, non-native Dutch mothers performed significantly higher levels of ‘Restriction’ (M±SD = 12.17 ± 4.41) and ‘Pressure to eat’ (10.75 ± 4.03) compared to native Dutch mothers (11.25 ± 4.15 and 9.99 ± 3.83, respectively). Native Dutch mothers performed higher levels of ‘Monitoring’ (17.15 ± 2.54) compared to non-native Dutch mothers (16.73 ± 3.01). Furthermore, children of non-native Dutch mothers had a 0.15 (0.27; 0.46) higher SDS-BMI. Finally, results showed that the association between ‘Pressure to eat’ and SDS-BMI was stronger in native Dutch mothers (β = −0.20; 95% CI [-0.24; −0.15]) compared to non-native Dutch mothers (β = −0.11; 95% CI [-0.18; −0.04]). Discussion and conclusion Ethnic differences in childhood BMI seemed to be partially attributable to the maternal perception of her child's weight status. Besides, maternal perception of child's weight appeared to play an important role in the association between maternal child feeding practices and childhood SDS-BMI. Hence, our findings contribute to the growing evidence concerning the bi-directional association between child feeding practices and childhood BMI.

Background: As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. Objectives: We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association—that is, whether dietary patterns predict ADHD symptoms or vice versa. Methods: We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. Results: Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = −0.08; 95% CI: −0.11, −0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. Conclusion: Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk. J Nutr 2019;149:642–648.

Energy balance–related behavior on schooldays and beliefs about school-based interventions may differ between students in different educational levels, sexes, and BMI (body mass index) categories. In Zwolle (the Netherlands), 1,084 adolescents (13-15 years) at 9 secondary schools completed a questionnaire. Overweight prevalence (boys 18.1%, girls 19.3%) increased with decreasing educational level, especially in boys. Girls reported healthier behavior than boys regarding daily consumption of fruit (35% vs. 29%), vegetables (58% vs. 48%), ≤1 snack/candy (36% vs. 26%), ≤3 glasses of sugared drinks (80% vs. 73%; all p < .05). Unhealthier dietary behaviors were associated with lower educational level, except for eating sugary and savory snacks. Snacks and sugared drinks consumed at school were mostly brought from home (61.6% and 68.5%, respectively). Overweight students reported less frequent consumption of daily breakfast, snacks, and sugared drinks than nonoverweight students. Of all students, 40% spent ≥1 hour per day cycling to school. Lower educational level students reported less organized sports activities than higher level students, but more outside play and other activities. Overweight was associated with cycling to school (boys) and participating in organized sports (girls). More girls than boys were interested in lessons about healthy nutrition (44.4% vs. 31.7%). To stimulate physical activity, boys suggested more physical education classes (63%), girls advised more variation (47%) and choice (43%). A healthy school canteen (57%) and offering free fruit (67%) were suggested as promising interventions to stimulate healthy behavior. Educational and environmental interventions to tackle unhealthy dietary and physical activity behavior should be developed in collaboration with parents and tailored to educational level and gender.

Background Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used. Methods To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring. Results Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired. Conclusion Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript. Electronic supplementary material The online version of this article (10.1186/s12889-018-5042-4) contains supplementary material, which is available to authorized users.

Objective. In Europe, the demand for informal care is high and will increase because of the ageing population. Although caregiving is intended to contribute to the care recipient's health, its effects on the health of older European caregivers are not yet clear. This study explores the association between providing informal personal care and the caregivers' health. Method. Data were used from the longitudinal cohort (2004/2005-2010/2011) of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 7858). Generalized estimating equations were used to explore the longitudinal association of informal care and the caregiver's health using poor self-rated health (less than good), poor mental health (EURO-D score for depression >= 4), and poor physical health (>= 2 health complaints). Results. Providing informal personal care was significantly associated with poor mental health (OR = .1.23, 95% CI = 1.04-1.47) and poor physical health (OR = 1.18, 95% CI = 1.01-1.38), after adjusting for various socio-demographic and health-related factors. No statistical significant association was found for self-rated health in the adjusted models. Conclusion. Providing informal personal care may negatively influence the caregiver's mental and physical health. More awareness of the beneficial and detrimental effects of caregiving among policy makers is needed to make well-informed decisions concerning the growth of care demands in the ageing population. (C) 2014 Elsevier Inc. All rights reserved.

Objectives To test the hypothesis that greater weight fluctuation between 2 and 6 years is associated with an increase in weight measures (such as body mass index [BMI]) and cardiometabolic risk in young adulthood. Study design Weight fluctuation (determined by BMI SD scores) was measured at least 3 times between the ages of 2 and 6 years in 166 girls and 116 boys from the Terneuzen Birth Cohort. Cardiometabolic risk factors in young adulthood include components of the metabolic syndrome and weight. The extent of weight fluctuation was determined by assessing each individual's SE (or variation) around each individual's linear regression slope (or weight slope). The obtained variation scores were subsequently related to adult BMI, other weight measures, and cardiometabolic risk factors. Results In girls, greater weight fluctuation between 2 and 6 years was statistically significantly related to greater adult weight measures (1.08; 95% CI 1.01-1.15) and nonsignificantly with the metabolic syndrome. For boys weight fluctuation was not associated with adult weight (1.04; 95% CI 0.97-1.11), but weight slope was statistically significantly associated with adult overweight. Conclusions The results suggest that weight fluctuations during early childhood are predictive for adult overweight in girls. For boys weight slope instead of weight fluctuation is predictive for adult overweight.

BACKGROUND: Physical activity (PA) is important in combating childhood obesity. Parents, and thus parental PA, could influence PA in young children. We examined whether the time spent at different intensities of PA and the type of parental PA are associated with the PA of children aged 4-7 years, and whether the associations between child-parent pairs were sex-specific.METHODS: All the participants were recruited from the Groningen Expert Center for Kids with Obesity (GECKO) birth cohort (babies born between 1 April 2006 and 1 April 2007 in Drenthe province, the Netherlands) and were aged 4-7 years during measurement. PA in children was measured using the ActiGraph GT3X (worn at least 3 days, ≥10 h per day). PA in parents was assessed using the validated SQUASH questionnaire.RESULTS: Of the N = 1146 children with valid ActiGraph data and 838 mothers and 814 fathers with valid questionnaire data, 623 child-parent pairs with complete data were analysed. More leisure time PA in mothers was associated with more time spent in moderate-to-vigorous PA (MVPA) in children (Spearman r = 0.079, P CONCLUSIONS: Higher PA in mothers, for instance in leisure activities, is related to higher PA in daughters, and more active fathers are related to more active sons. To support PA in young children, interventions could focus on the PA of the parent of the same sex as the child. Special attention may be needed for families where the parents have sedentary jobs, as children from these families seem to adopt more sedentary behaviour.

ObjectiveTo examine the associations between parental feeding styles and children’s dietary intakes and the modifying effect of maternal education and children’s ethnicity on these associations.DesignCross-sectional study of parental feeding styles, assessed by the Parental Feeding Style Questionnaire, and children’s dietary intakes. Multiple regression analyses were carried out to assess the associations between the parental feeding styles studied (‘control’, ‘emotional feeding’, ‘encouragement to eat’ and ‘instrumental feeding’) and children’s dietary intakes (consumption of fruit, vegetables, water and sugar-sweetened beverages (SSB)). The modifying effect of maternal education and children’s ethnicity on these associations was explored.SettingNorth-western part of the Netherlands.SubjectsChildren aged 3–7 years (n 5926).ResultsBoth ‘encouragement’ and ‘control’ were associated with higher consumption of vegetables and lower consumption of SSB, but only ‘encouragement’ was positively associated with fruit and water intakes. ‘Instrumental feeding’ showed a positive association with SSB and negative associations with fruit, vegetable and water consumption. No significant associations were found for ‘emotional feeding’. Maternal educational level and children’s ethnicity moderated some associations; for example, ‘control’ was beneficial for vegetable intake in all subgroups, whereas the association with SSB was beneficial only in highly educated mothers.ConclusionsThe study shows that both encouraging and controlling feeding styles may improve children’s dietary behaviour, while ‘instrumental feeding’ may have a detrimental effect. Furthermore, maternal educational level and children’s ethnicity influence these associations. The study’s findings could provide a basis for development of interventions to improve parental feeding styles.

Background: High intake of fruit juices and soft drinks contributes to excessive weight gain and obesity in children. Furthermore, parenting practices play an important role in the development of children’s dietary habits. The way parents play this role in the development of their children’s choices of beverages is still unclear. Objectives: To study the associations: (1) of both fruit juices and soft drinks consumption with water consumption of children and (2) The associations between parenting practices towards fruit juices and soft drinks and water consumption of children. Design: Cross-sectional data from 6 to 8 year old children from seven European communities (n = 1187) were collected. Associations among fruit juices, soft drinks, the respective parenting practices and the child’s water consumption were assessed by parental questionnaires. Results: The consumption of water was inversely associated with that of soft drinks but not with the consumption of fruit juices. The child’s water intake was favorably influenced when stricter parenting practices towards soft drinks were adopted (e.g., less parental allowance, low home availability and high parental self-efficacy in managing intake). There was less influence observed of parenting practices towards fruit juices. Fruit juices were consumed more often than soft drinks. Conclusions: Low consumption of soft drinks—and not of fruit juices—was associated with high water consumption in children in the current study. Moreover, parenting practices towards both fruit juices and soft drinks were associated with the water intake of the children, irrespective of their socio-economic status.

Summary Background This study evaluates the association between home environmental characteristics and sweet beverage consumption (i.e. beverages that contain sugar) of 7-year-old children. Methods The population for analysis consisted of n = 2047 parents and their children from the population-based ‘Be active, eat right’ study. Data on sociodemographic characteristics, parental beliefs, parenting practices and child's sweet beverage consumption were obtained by parental report with questionnaires. We performed linear and multinomial regression analyses evaluating associations between characteristics at age 5 years and (i) consumption at 7 years and (ii) consumption patterns between age 5 and 7 years with reference category ‘low consumption’. Results Based on the report from their parents, 5-year-old children drank on average 3.0 (SD:1.4) sweet beverage per day. Children consumed less sweet beverages at age 7 years (beta −0.16, 95% confidence interval [CI] −0.24 to −0.09) when there were less sweet beverages available at home. The multinomial regression model showed that children with parents who discouraged sweet beverage consumption were more likely to decrease their sweet beverage consumption over the study period (odds ratio: 1.24, 95% CI 1.07 to 1.43). Moreover, when there were less sweet beverages available at home, children were less likely to increase their consumption or have a high consumption over the study period (odds ratio: 0.70, 95% CI 0.59 to 0.83 and 0.61, 95% CI 0.54 to 0.70, respectively). Conclusions The results showed that characteristics of the home environment are associated with the consumption of sweet beverages among children. Specifically, the availability of sweet beverages at home is associated with the child's sweet beverage consumption.

Summary Objective To investigate the association between home environmental determinants of fruit and vegetable consumption with childhood overweight separately for low, medium and high social economic status (SES) families. Method A cross-sectional study was carried out in 2006 among 4072 children aged 4–13 years in the city of Zwolle, the Netherlands. Of these children, data were available on measured height and weight, and from a parental questionnaire, on sociodemographic characteristics and children's fruit and vegetables intake. Associations were studied using logistic regression analyses. Results Not eating the recommended amounts of vegetables daily was associated with overweight for children with a low SES background (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 0.66–2.07) and medium SES background (OR: 1.73; 95% CI: 1.20–2.49). Eating

Healthier lifestyles may contribute to prevent overweight in adolescents. Although school-based interventions show promising results, adoption and implementation by secondary schools and involvement of parents is difficult. Our study aims to gain a better understanding of the problem awareness and beliefs of school staff and parents regarding adolescents' overweight and energy balance-related behaviour, their motivation for health-promoting activities and suggested actions in the school environment. Focus group interviews were conducted with three groups of parents and three groups of school staff at three pre-vocational schools in the Netherlands. Comments concerning awareness, motivation to intervene and possible actions were analysed with the Atlas.ti program. Results showed that school staff and parents were aware of overweight as a health problem, but underestimated the prevalence and impact of overweight and unhealthy behaviour in their school. Health-related behaviour of adolescents was considered primarily the responsibility of parents, but the school staff also had a pedagogical responsibility. Parents and school staff agreed that health promotion efforts would have more impact on adolescents' behaviour, when school-based activities were supported by parents and parental efforts were supported by school health promotion. Therefore, parental efforts and school-based activities should be aligned by developing and expressing shared norms about healthy behaviour and parents should be taught how to discuss healthy dietary and physical activity behaviour with their children. To tackle peer group culture and the obese environment, parents' and school staff's efforts should be part of an integrated community approach. © 2013 © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Volgens de CBO-richtlijn Obesitas en de richtlijn Overgewicht voor de jeugdgezondheidszorg moeten kinderen met obesitas naar de kinderarts worden verwezen voor onderzoek naar onderliggende oorzaken en comorbiditeit. Er is weinig bekend over het verdere beloop.Doel. Onderzoeken welke diagnostiek en behandeling kinderartsen inzetten bij kinderen met overgewicht en obesitas. Methode. Vragenlijsten over diagnostiek en behandeling van kinderen met obesitas zijn in juni 2009 naar alle (n = 583) kinderartsen in algemene ziekenhuizen en naar vertegenwoordigers van de academische ziekenhuizen (n = 8) verstuurd. Resultaten. De vragenlijst werd geretourneerd door 290 van de 583 (50%) kinderartsen in 84/99 (85%) van de algemene ziekenhuizen en door alle vertegenwoordigers van de kinderafdelingen van de academische ziekenhuizen (8/8; 100%). Van de 290 kinderartsen behandelen er 88 kinderen met overgewicht en obesitas. De hier beschreven resultaten betreffen deze kinderartsen. Om obesitas bij kinderen vast te stellen gebruikt 41% van de kinderartsen de grenswaarden voor volwassenen van de body mass index (BMI). 34% gebruikt geslacht- en leeftijdspecifi eke BMI-criteria voor kinderen van de International Obesity Task Force. Bijna alle (95%) kinderartsen meten de bloeddruk. Twee derde (58/88; 66%) van de kinderartsen vraagt bij kinderen met obesitas altijd bloedonderzoek aan, meestal (nuchter) vetspectrum (78%) en glucose (69%).59 kinderartsen verwijzen naar 30 verschillende behandelprogramma’s voor dikke kinderen. Conclusie. Er is een grote variatie tussen kinderartsen in diagnostiek en behandeling van obese kinderen. Uniformiteit in diagnostiek en behandeling is van belang om betrouwbaar comorbiditeit vast te stellen en effectiviteit van behandelprogramma’s te kunnen onderzoeken.

In het Terneuzen Onderzoek naar Preventie zijn overgewicht en cardiometabole risicofactoren op jongvolwassen leeftijd bestudeerd in relatie tot de veranderingen in body mass index (BMI) tussen de geboorte en 18-jarige leeftijd. Deze studie is gebaseerd op het Terneuzen Geboorte Cohort, waarbij prospectief verkregen gegevens zijn verkregen via de jeugdgezondheidszorg (JGZ) van GGD Zeeland. Bij de analyses is gebruik gemaakt van de brokenstickmethode en van lineaire en logistische regressieanalyses. Het leeftijdsinterval 2-6 jaar was het meest voorspellend voor overgewicht en de meeste cardiometabole uitkomsten op jongvolwassen leeftijd. Deze resultaten vragen speciale aandacht van de JGZ voor een stijgende BMI-standaarddeviatiescore (SDS) gedurende het leeftijdsinterval 2-6 jaar, ook als er nog geen sprake is van overgewicht. Hierbij kunnen predictie-instrumenten nuttig zijn. Het monitoren en stabiliseren van de BMI SDS gedurende dit leeftijdsinterval draagt waarschijnlijk niet alleen bij aan de preventie van overgewicht op jongvolwassen leeftijd, maar ook aan een goede cardiometabole gezondheidstoestand op latere leeftijd.

OBJECTIVE: TV viewing and computer use is associated with childhood overweight, but it remains unclear as to how these behaviours could best be targeted. The aim of this study was to determine to what extent the association between TV viewing, computer use and overweight is explained by other determinants of overweight, to find determinants of TV viewing and computer use in the home environment and to investigate competing activities.METHOD: A cross-sectional study was carried out among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Data collection consisted of measured height, weight and waist circumference, and a parental questionnaire on socio-demographic characteristics, child's nutrition, physical activity (PA) and sedentary behaviour. Associations were studied with logistic regression analyses, for older and younger children, boys and girls separately.RESULTS: The odds ratio (OR) of being overweight was 1.70 (95% confidence interval (CI): 1.07-2.72) for viewing TV >1.5 h among 4- to 8-year-old children adjusted for all potential confounders. Computer use was not significantly associated with overweight. Determinants of TV viewing were as follows: having >2 TVs in the household (OR: 2.38; 95% CI: 1.66-3.41), a TV in the child's bedroom and not having rules on TV viewing. TV viewing and computer use were both associated with shorter sleep duration and not with less PA.CONCLUSION: Association between TV viewing and overweight is not explained by socio-demographic variables, drinking sugared drinks and eating snacks. Factors in the home environment influence children's TV viewing. Parents have a central role as they determine the number of TVs, rules and also their children's bedtime. Therefore, interventions to reduce screen time should support parents in making home environmental changes, especially when the children are young.

Child Public Health professionals in the Netherlands refer obese children to a pediatrician to check for underlying causes and comorbidity. What happens to these children in terms of diagnostics and treatment when they visit a pediatrician? To get an overview of the diagnostic procedures and treatment methods a questionnaire was developed and sent to all 583 pediatricians in the Netherlands. Data was obtained of 290 pediatricians from 85% of the general hospitals and all (8) academic hospitals. To define childhood obesity Dutch pediatricians most often use the adult Body Mass Index, only 34% use the sex and age specific IOTF-BMI-criteria. 11% of the (non-obese) overweight children visiting a pediatrician have already comorbidities. All pediatricians perform at least weight and height measurements. Waist circumference is measured by only 42%, ninety-five percent measure blood pressure. To treat obese children without comorbidity thirty different intervention programs were reported. A large variation in diagnostics and interventions of childhood obesity exist. Guidelines in pediatric obesity for diagnostics and treatment are urgently needed. © 2013 Elsevier Ireland Ltd.

Background To date, many epidemiologic studies examining associations between obesity and dietary and sedentary/physical activity behaviors have focused on assessing Body Mass Index (BMI) at one point in time. Recent developments in statistical techniques make it possible to study the potential heterogeneity in the development of BMI during childhood by identifying distinct subpopulations characterized by distinct developmental trajectories. Using Latent Class Growth (Mixture) Modelling (LCGMM) techniques we aimed to identify BMI trajectories in childhood and to examine associations between these distinct trajectories and dietary, sedentary and physical activity behaviors. Methods This longitudinal study explored BMI standard deviation score (SDS) trajectories in a sample of 613 children from 4 to 12 years of age. In 2006, 2009 and 2012 information on children’s health related behaviors was obtained by parental questionnaires, and children’s height and weight were measured. Associations with behaviors were investigated with logistic regression models. Results We identified two BMI SDS trajectories; a decreasing BMI SDS trajectory (n = 416; 68 %) and an increasing BMI SDS trajectory (n = 197; 32 %). The increasing BMI SDS trajectory consisted of more participants of lower socio-economic status (SES) and of non-western ethnicity. Maternal overweight status was associated with being in the increasing BMI SDS trajectory at both baseline and follow-up six years later (2006: Odds Ratio (OR), 2.9; 95 % confidence interval (CI) 1.9 to 4.3; 2012 OR, 1.8; 95 % CI 1.2 to 2.6). The increasing BMI SDS trajectory was associated with the following behaviors; drinking sugared drinks > 3 glasses per day, participation in organized sports 2 h per day, though participation in organized sports at follow-up was the only significant result. Conclusions Our results indicate the importance of healthy lifestyle behaviors at a young age, and indicate that maternal BMI is a very important risk factor for the development of childhood overweight. Comprehension of heterogeneity in the development of BMI and associations with modifiable health related behaviors is interesting for prevention by targeting high risk behaviors in early childhood, especially in low SES children, children of non-western ethnicity and children whose mother is overweight. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3757-7) contains supplementary material, which is available to authorized users.

Purpose Breastfeeding has been associated with improved cognition. It remains unclear whether long-chain polyunsaturated fatty acids (LC-PUFAs) play a role in this association. We assessed the association between LC-PUFA concentrations in infant feeding and school performance at age 12. Methods Within a population-based birth cohort, we compared school performance of 277 non-breastfed children and 157 children who had fatty acid composition of their mothers’ breast milk measured. Two indicators of school performance were: (1) the score on a standardized achievement test and (2) the teacher’s advice regarding a child’s potential performance level in secondary education. Linear regression and multinomial logistic regression analyses were performed to assess the independent association between LC-PUFA content of breast milk and school performance. Results Girls, who received breast milk with a relative high content (above the median) of docosahexaenoic acid (DHA), had a higher Cito-test score (β = 2.96 points, 95 % CI 0.24; 5.69) than non-breastfed girls. Among the breastfed girls, each percentage point of higher content of total n-3 LC-PUFA (β = 4.55, 95 % CI 0.43; 8.66) and DHA (β = 7.09, 95 % CI 0.9; 13.3) was associated with a higher Cito-test score. The association between LC-PUFA content and teacher school advice showed a similar pattern. There was no association between LC-PUFA content and school performance in boys. Conclusion Although a large part of the association between infant milk feeding and cognition seems to be explained by sociodemographic and lifestyle-related factors, a relative high content of n-3 PUFAs, especially DHA, in breast milk is associated with better school performance in 12-year-old girls but not in boys. Electronic supplementary material The online version of this article (doi:10.1007/s00394-015-1030-y) contains supplementary material, which is available to authorized users.

BACKGROUND: Intensive inpatient lifestyle treatment may be a suitable alternative for severely obese children and adolescents who do not benefit from ambulatory obesity treatment. The aim was to evaluate the effectiveness of two intensive one-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to SDS-BMI and cardiometabolic risk factors.METHODS: The study was designed as a randomized controlled trial with two active treatment groups. Eighty participants (8-19 years) with severe obesity received treatment at a specialized childhood obesity center in the Netherlands. Severe obesity was defined as a SDS-BMI ≥ 3.0 or a SDS-BMI ≥ 2.3 in combination with obesity-related comorbidity. Participants received an intensive one-year lifestyle treatment with an inpatient period of either two months and biweekly return visits during the next four months (short-stay group) or six months (long-stay group), both followed by six monthly return visits. Outcomes were assessed at baseline, six and 12 months and included SDS-BMI as primary outcome and cardiometabolic risk factors such as SDS-waist circumference, systolic- and diastolic blood pressure, and blood measurements as secondary outcomes. To evaluate differences in the course of the primary- and secondary outcomes over time between the two treatment groups, Generalized Estimating Equations (GEE) were performed.RESULTS: No differences in the course of SDS-BMI or secondary outcomes over time were found between the two treatment groups after one year of treatment. SDS-BMI decreased statistically significantly after one year of treatment compared with baseline in both groups (0.33 (0.48) in the short-stay and 0.52 (0.49) in the long-stay group). Similar results were found for SDS-waist circumference, diastolic blood pressure and HDL-cholesterol.CONCLUSIONS: Since there were no significant differences in effects between the short- and long-stay treatment and considering the burden of the long-stay treatment for children and families, we recommend implementation of the short-stay treatment.TRIAL REGISTRATION: Netherlands Trial Register NTR1678 , registered 20-Feb-2009.

To prevent overweight and obesity the implementation of an integrated community-wide intervention approach (ICIA) is often advocated. Evaluation can enhance implementation of such an approach and demonstrate the extent of effectiveness. To be able to support professionals in the evaluation of ICIAs we studied barriers to and facilitators of ICIA evaluation. In this study ten professionals of two Dutch municipalities involved in the evaluation of an ICIA participated. We conducted semi-structured interviews (n = 12), observed programme meetings (n = 4) and carried out document analysis. Data were analyzed using a thematic content approach. We learned that evaluation is hampered when it is perceived as unfeasible due to limited time and budget, a lack of evaluation knowledge or a negative evaluation attitude. Other barriers are a poor understanding of the evaluation process and its added value to optimizing the programme. Sufficient communication between involved professionals on evaluation can facilitate evaluation, as does support for evaluation of ICIAs together with stakeholders at a strategic and tactical level. To stimulate the evaluation of ICIAs, we recommend supporting professionals in securing evaluation resources, providing tailored training and tools to enhance evaluation competences and stimulating strategic communication on evaluation.

Background Increasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity. Public health interventions may result in differential effects across population groups. Therefore, the EPHE (EPODE for the Promotion of Health Equity) project analysed the added value of community-based programmes, based on the EPODE (Ensemble Prévenons l’Obésité Des Enfants-Together Let’s Prevent Obesity) model, to reduce socio-economic inequalities in energy balance-related behaviours of children and their family-environmental related determinants in seven European communities. This study presents the changes between baseline and follow-up after the one-year interventions and their sustainability one year after. Methods This is a prospective study with a one school-year intervention, followed by one year of follow-up. In all, 1266 children (age 6-8 years) and their families from different socio-economic backgrounds were recruited at baseline. For 1062 children, information was available after one year (T1) and for 921 children after two years (T2). A self-reported questionnaire was completed by the parents to examine the children’s energy balance-related behaviours and family- environmental determinants. Socio-economic status was defined by the educational level of the mother. The Wilcoxon signed-rank test for paired data was used to test the differences between baseline and intermediate, and between intermediate and final, measurements for each of the socio-economic status groups. Results Post-intervention effects in energy-balance related behaviours showed the following improvements among the low socio-economic status groups: increased fruit consumption (Netherlands), decreased fruit juices amount consumed (Romania) and decreased TV time on weekdays (Belgium). Whereas in only the latter case the behavioural change was accompanied with an improvement in a family-environmental determinant (monitoring the time the child watches TV), other improvements in parental rules and practices related to soft drinks/fruit juices and TV exposure were observed. A few of those effects were sustainable, notably in the case of Belgium. Conclusions Inequalities in obesity-related behaviours could be potentially reduced when implementing community-based interventions, tailored to inequality gaps and using the EPODE methodology. Within-group changes varied widely, whereas monitoring of interventions and process evaluation are crucial to understand the observed results. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0438-1) contains supplementary material, which is available to authorized users.

Background. Integrated community-wide intervention approaches (ICIAs) are implemented to prevent childhood obesity. Programme evaluation improves these ICIAs, but professionals involved often struggle with performance. Evaluation tools have been developed to support Dutch professionals involved in ICIAs. It is unclear how useful these tools are to intended users. We therefore researched the facilitators of and barriers to ICIA programme evaluation as perceived by professionals and their experiences of the evaluation tools. Methods. Focus groups and interviews with 33 public health professionals. Data were analysed using a thematic content approach. Findings. Evaluation is hampered by insufficient time, budget, and experience with ICIAs, lack of leadership, and limited advocacy for evaluation. Epidemiologists are regarded as responsible for evaluation but feel incompetent to perform evaluation or advocate its need in a political environment. Managers did not prioritise process evaluations, involvement of stakeholders, and capacity building. The evaluation tools are perceived as valuable but too comprehensive considering limited resources. Conclusion. Evaluating ICIAs is important but most professionals are unfamiliar with it and management does not prioritise process evaluation nor incentivize professionals to evaluate. To optimise programme evaluation, more resources and coaching are required to improve professionals’ evaluation capabilities and specifically the use of evaluation.

Uit de Vijfde Landelijke Groeistudie blijkt dat het percentage kinderen met overgewicht in Nederland van 9-12% in 1997, gestegen is tot 13-15% in 2009. De JGZ is een unieke setting voor preventie, signaleren en adviseren van kinderen met overgewicht. Praktische adviezen voor preventie van overgewicht kunnen al vanaf de geboorte gegeven worden. Signaleren en intervenieren bij kinderen met overgewicht vinden plaats in de jeugdgezondheidszorg. Voor interventie bij kinderen met overgewicht wordt een haalbaar veranderplan opgesteld, waarbij de ouders worden betrokken. Als uitgangspunt dienen de BOFT-elementen uit het Overbruggingsplan: meer Bewegen en Buitenspelen, elke dag Ontbijten, zo min mogelijk gezoete (Fris)dranken en Fastfood, minder voor de Televisie of (spel)computer zitten (maximaal 2 uur per dag) en minder energierijke Tussendoortjes. Conform de CBO-richtlijn Obesitas 2011 worden kinderen met obesitas verwezen naar huisarts/kinderarts. Dit artikel is een aangepaste versie van het artikel Richtlijn ‘Overgewicht’ voor de jeugd gezondheidszorg (A4718), zoals gepubliceerd in het Nederlands Tijdschrift voor Geneeskunde. De JGZ-richtlijn Overgewicht is beschikbaar via www.ncj.nl/bibliotheek/richtlijnen .

Objective:Sleep duration has been related to overweight in children, but determinants of sleep duration are unclear. The aims were to investigate the association between sleep duration and childhood overweight adjusted for family characteristics and unhealthy behaviours, to explore determinants of sleep duration and to determine with sleep competing activities.Method:A cross-sectional study was carried out in 2006 among 4072 children aged 4–13 years in the city of Zwolle, The Netherlands. In these children, data were available on measured height, weight and waist circumference, and from a parental questionnaire, on socio-demographic characteristics, child’s sleep duration, nutrition, physical activity and sedentary behaviour. Associations were studied in 2011 using logistic and linear regression analyses, adjusted for potential confounders.Results:Short sleep duration was associated with overweight for 4–8-year-old boys (odds ratio (OR):3.10; 95% confidence interval (CI):1.15–8.40), 9–13-year-old boys (OR:4.96; 95% CI:1.35–18.16) and 9–13-year-old girls (OR:4.86; 95% CI:1.59–14.88). Among 4–8-year-old girls no statistically significant association was found. Determinants for short sleep duration were viewing television during a meal, permission to have candy without asking, not being active with their caregiver and a late bedtime. For all children, short sleep duration was strongly associated with more television viewing and computer use.Conclusions:Association between sleep duration and overweight is not explained by socio-demographic variables, drinking sugared drinks and eating snacks. Parents have a key role in stimulating optimal sleep duration. Improving parenting skills and knowledge to offer children more structure, and possibly with that, increase sleeping hours, may be promising in prevention of overweight. © 2010 Macmillan Publishers Limited.