Search

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 < 0.05). 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 non overweight 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.

Objective: Investigate the cross-sectional association between the psychosocial status of mothers and fathers and the BMI z-scores of their 10 to 12-year-old children. Explore whether this association is mediated by children's diet, physical activity, screen time and sleep. Analyze the moderating effect of the educational levels of both the mother and father on the association. Design: In a cross-sectional study design, children's height and weight were measured following a standardized protocol. Parents completed the validated Depression Anxiety and Stress questionnaire, while diet quality, sports participation, time spent in bed and screen time were assessed through child-report using previously validated questions. Participants: The data for this study were obtained from the Amsterdam Born Children and their Development study, involving children aged 10 to 12 years and both of their parents (N = 1315). Results: The majority, 80%, of the parents were highly educated and born in the Netherlands, and 68% of the children had a healthy BMI. Maternal or paternal psychosocial status was not significantly associated with children's BMI z-score (maternal β -0.0037; 95% CI: -0.008 to 0.0007, paternal β 0.0028; 95% CI: -0.007 to 0.002). Screen time mediated the association between paternal psychosocial status and children's BMI z-score (β = 0.010, 95% CI: 0.002; 0.020). Children's diet, physical activity, and sleep did not mediate the association between paternal psychosocial status and children's BMI z-score. Parental educational level was not a moderator. Conclusions: This research is unique in including four energy balance behaviors and including both mothers and fathers' psychosocial status. Children withfathers experiencing poorer psychosocial status engaged in more screen time which partly explained their higher BMI z-score. [ABSTRACT FROM AUTHOR]

Background: Healthy sleep is crucial for the physical and mental wellbeing of adolescents. However, many adolescents suffer from poor sleep health. Little is known about how to effectively improve adolescent sleep health as it is shaped by a complex adaptive system of many interacting factors. This study aims to provide insights into the system dynamics underlying adolescent sleep health and to identify impactful leverage points for sleep health promotion interventions. Methods: Three rounds of single-actor workshops, applying Group Model Building techniques, were held with adolescents (n = 23, 12–15 years), parents (n = 14) and relevant professionals (n = 26). The workshops resulted in a multi-actor Causal Loop Diagram (CLD) visualizing the system dynamics underlying adolescent sleep health. This CLD was supplemented with evidence from the literature. Subsystems, feedback loops and underlying causal mechanisms were identified to understand overarching system dynamics. Potential leverage points for action were identified applying the Action Scales Model (ASM). Results: The resulting CLD comprised six subsystems around the following themes: (1) School environment; (2) Mental wellbeing; (3) Digital environment; (4) Family & Home environment; (5) Health behaviors & Leisure activities; (6) Personal system. Within and between these subsystems, 16 reinforcing and 7 balancing feedback loops were identified. Approximately 60 potential leverage points on different levels of the system were identified as well. Conclusions: The multi-actor CLD and identified system dynamics illustrate the complexity of adolescent sleep health and supports the need for developing a coherent package of activities targeting different leverage points at all system levels to induce system change. [ABSTRACT FROM AUTHOR]

System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10–14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate perceptions of second grade lower vocational students concerning benefits, barriers and strategies of healthy eating and physical activity. Design/methodology/approach: Focus group discussions are conducted with 37 adolescents, from three schools in The Netherlands. A semi-structured questioning-scheme is used. Recorded data are transcribed, analysed using Atlas.ti and arranged in the EnRG-framework. Findings: Adolescents find health and a healthy weight important and like having a choice when it comes to health behaviour. The choices they make, however, are often unhealthy, especially when related to food. The risk perception of these adolescents is low; as long as they feel healthy, they feel no need to change their behaviour. Parents are held responsible for providing opportunities for healthy behaviour. At the same time, parental influence lessens and adolescents start to develop unhealthy habits, usually under the influence of a peer group. Adolescents accept the interference of school, meaning that there are good opportunities for school-based interventions. Research limitations/implications: The number (37) of respondents may not be representative for the different personalities of peer-students. Practical implications: Adolescents need to take on greater responsibility for their own health behaviour, especially in the school setting where they are more autonomous than at home. More information is needed about the perceptions of parents and school staff regarding stimulating healthy dietary and physical behaviour to develop, implement and preserve integral school health interventions successfully. Originality/value: The paper provides information on adolescents' perceptions on their responsibility for their health behaviour, which is needed to develop school-based health intervention consistent with their needs. (Contains 2 tables.)

Background: Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective. Methods: Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5). Results: How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository. Conclusion: This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 < .001 (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. [ABSTRACT FROM AUTHOR]

Objective: To investigate the level of public acceptability of a sugar-sweetened beverage (SSB) tax and its associated factors.Design: Participants completed an online self-administered questionnaire. Acceptability of an SSB tax was measured on a seven-point Likert scale (strongly disagree to strongly agree). Associations between acceptability and sociodemographic factors, weight status, SSB consumption and beliefs about effectiveness (e.g., 'An SSB tax would reduce people's SSB consumption'), appropriateness, socioeconomic and economic benefit, implementation and trust were assessed using multivariable linear regression analyses.Setting: The Netherlands.Participants: Dutch adults aged ≥18 years representative of the Dutch population for age, sex, education level and location (n 500).Results: Of the participants, 40 % supported and 43 % opposed an SSB tax in general. Moreover, 42 % supported (43 % opposed) an SSB tax as a strategy to reduce overweight, and 55 % supported (32 % opposed) an SSB tax if revenue is used for health initiatives. Participants with a low education 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 a lower acceptability of an SSB tax than their counterparts. Beliefs about effectiveness, appropriateness, socioeconomic and economic benefit, implementation and trust were associated with acceptability (P < 0·001).Conclusions: Public acceptability of an SSB tax tends to be higher if revenue is used for health initiatives. The factors associated with acceptability should be taken into consideration. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Since 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. Methods Semi-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. Results We 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. Conclusion Nine 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. [ABSTRACT FROM AUTHOR]

Objective: To 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. Design: Cross-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. Setting: North-western part of the Netherlands. Subjects: Children aged 3-7 years (n 5926). Results: Both '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. Conclusions: The 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: An overweight prevention protocol was used in the ‘Be active, eat right’ study; parents of overweight children (5 years) were offered healthy lifestyle counseling by youth health care professionals. Effects of the protocol on child BMI and waist circumference at age 7 years were evaluated. Methods: A cluster RCT was conducted among nine youth health care centers in the Netherlands. Parents of overweight, not obese, children received lifestyle counseling and motivational interviewing according to the overweight prevention protocol in the intervention condition (n = 349) and usual care in the control condition (n = 288). Measurements were made of child height, weight and waist circumference at baseline and at a two-year follow-up; parents completed questionnaires regarding demographic characteristics. Linear mixed models were applied; interaction terms were explored. Results: The analyzed population consisted of 38.1% boys; mean age 5.7 [sd: 0.4] years; mean BMI 18.1 [sd: 0.6], the median number of counseling sessions in the intervention condition was 2. The regression model showed no significant difference in BMI increase between the research conditions at follow-up (beta −0.16; 95% CI:−0.60 to 0.27; p = 0.463). There was a significant interaction between baseline BMI and research condition; children with a baseline BMI of 17.25 and 17.50 had a smaller increase in BMI at follow-up when allocated to the intervention condition compared to control condition (estimated adjusted mean difference −0.67 [se: 0.30] and −0.52 [se: 0.36]). Conclusion: Mildly overweight children (baseline BMI 17.25 and 17.50) in the intervention condition showed a significantly smaller increase in BMI at follow-up compared to the control condition; there was no overall difference between intervention and control condition. Future research may explore and evaluate improvements of the prevention protocol. Trial Registration: Current Controlled Trials ISRCTN04965410 [ABSTRACT FROM AUTHOR]

Introduction. This study investigates the association between ethnic background and overweight (obesity included) among 5 year olds. Methods. We used baseline data from 5 year olds (n = 7801) and their parents collected for the "Be active, eat right" study. A child was considered to be of non-Dutch ethnic background when at least one of the parents was born abroad. Odds ratios (ORs) were adjusted for sociodemographic characteristics. Results. Compared to children of Dutch ethnic background, for children with a Moroccan ethnic background the OR for being overweight (obesity included) was 2.27 (95% CI 1.48-3.47), for Turkish children the OR was 3.63 (95% confidence interval (CI) 2.46-5.35), for Antillean children the OR was 1.97 (95% CI 1.01-3.86), and for Surinamese children the OR was 0.47 (95% CI 0.20-1.06). Addition of parental overweight decreased the ORs for Moroccan and Turkish children by 10.2% and 12.5%, and addition of watching TV and having breakfast by the child decreased the ORs by 7.9% and 12.2%. Conclusion. Already at a young age, children of Moroccan and Turkish ethnic background are at increased risk for being overweight compared to Dutch children. Parental overweight, watching TV, and not having breakfast by the child are contributing factors in this association. [ABSTRACT FROM AUTHOR]

The article discusses a study which assessed the prevalence of cardiovascular risk factors in severely obese children and adolescents in the Netherlands. The study period was from July 2005 to July 2007 where paediatricians were asked to report all new cases of severe obesity in 2-18 year-old children to the Dutch Paediatric Surveillance Unit. The study found that a high number of severely obese children have cardiovascular risk factors.

Background: The lifestyle-related behaviors having breakfast, drinking sweet beverages, playing outside and watching TV have been indicated to have an association with childhood overweight, but research among young children (below 6 years old) is limited. The aim of the present study was to assess the associations between these four behaviors and overweight among young children. Methods: This cross-sectional study used baseline data on 5-year-old children (n = 7505) collected for the study 'Be active, eat right'. Age and sex-specific cut-off points for body mass index of the International Obesity Task Force were used to assess overweight/obesity. Multivariable logistic regression analyses were applied. Results: For children whom had breakfast <7 days/week and watched TV >2 hours/day, the odds ratio (OR) for having overweight (obesity included) was, respectively, 1.49 (95% confidence interval (CI): 1.13-1.95), and 1.25 (95% CI: 1.03-1.51). There was a positive association between the number of risk behaviors present and the risk for having overweight. For children with 3 or all of the risk behaviors having breakfast <7 days/week, drinking sweet beverages >2 glasses/day, playing outside <1 h/day, watching TV >2 hs/day, the OR for overweight was 1.73 (95% CI: 1.11-2.71) (all models adjusted for children's sex and sociodemographic characteristics). Conclusion: Given the positive association between the number of behavioral risk factors and overweight, further studies are needed to evaluate the effectiveness of behavioral counseling of parents of toddlers in preventing childhood overweight. In the meantime we recommend physicians to target all four behaviors for counseling during well-child visits. [ABSTRACT FROM AUTHOR]

Objective. To identify neighbourhoods with increased prevalence of overweight children and to examine whether the association between neighbourhood and overweight can be explained by demographic characteristics and energy-related behaviours. Method. This cross-sectional study was carried out among 4,072 primary schoolchildren 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, dietary and (in)activity behaviour of their child. With Multivariate Logistic regressions, associations between unhealthy behaviours and neighbourhoods (defined by postal code) with high and low prevalence of childhood overweight were investigated. Results. In three neighbourhoods the prevalence of overweight was significantly higher (16.5% vs. 10.6%, p < 0.05). The odds of living in these neighbourhoods were higher among children watching >2 h television/day (OR: 1.57; 95% CI: 1.15--2.14), not eating breakfast daily (OR: 2.86; 95% CI: 1.93--4.23), drinking >3 glasses/day sugared drinks (OR: 1.23; 95% CI: 1.01--1.50) on weekdays and not participating in organized sports (OR: 1.32; 95% CI: 1.09--1.59). This odds was however lower among children eating <2 fruit/day (OR: 0.83; 95% CI: 0.69--1.00) on weekends. The association between neighbourhood and overweight altered slightly after adjustment for socio-demographic and behavioural characteristics during weekdays (OR: 1.42; 95% CI: 1.05--1.92) and weekends (OR: 1.50; 95% CI; 1.11--2.02). Conclusion. Three neighbourhoods with higher prevalence of overweight were identified. A small part of the association between overweight and neighbourhood is explained by socio-demographic factors and unhealthy behaviours measured in this study. Neighbourhoods with higher overweight prevalence are a priority setting for targeted interventions to prevent overweight. The association between neighbourhood and overweight needs to be explored further to understand the role the neighbourhood can play in tackling overweight. [ABSTRACT FROM AUTHOR]

Objective. To develop a tool to identify children with high risk of adult overweight (AO), especially before developing overweight, based on body mass index (BMI) standard deviation score(s) (SDS) changes between 2-6 years (y) of age. Methods. We fitted a linear spline model to BMI SDS of 762 young Caucasian adults from the Terneuzen Birth Cohort at fixed ages between birth and 18 y. By linear regression analysis, we assessed the increase in explained variance of the adult BMI SDS by adding the BMI SDS at 2 y to the models including the BMI SDS at 4 y, 6 y and both 4 y and 6 y. AO risk was modelled by logistic regression. The internal validity was estimated using bootstrap techniques. Risk models were represented as risk score diagrams by gender for the age intervals 2-4 y and 2-6 y. Results. In addition to the BMI SDS at certain ages, the previous BMI SDS during childhood is positively related to adult weight. Receiver Operating Curves analysis provides insight into sensible cut-offs (AUC varied from 0.76 to 0.83). The sensitivity and specificity for 2-6 y at the cut-off of 0.25 and 0.5 are respectively, 0.76 and 0.74, and 0.36 and 0.93, whereas the PPV is 0.52 and 0.67, respectively. Conclusions. The risk score diagrams can serve as a tool for young children for primary prevention of adult overweight. To avoid wrongly designating children at risk for AO, we propose a cut-off with a high specificity at the risk of approximately 0.5. After external validation, wider adoption of this tool might enhance primary AO prevention. [ABSTRACT FROM AUTHOR]

Background: Intensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness of two intensive one-year inpatient treatments and usual care for severely obese children and adolescents. Methods/Design: Participants are 40 children aged 8-13 and 40 adolescents aged 13-18 with severe obesity (SDS-BMI ≥ 3.0 or SDS-BMI ≥ 2.3 with obesity related co-morbidity). They will be randomized into two groups that will receive a comprehensive treatment program of 12 months that focuses on nutrition, physical activity and behavior change of the participant and their parents. The two programs are the same in total duration (12 months), but differ in inpatient treatment duration. Group A will participate in a 6 month intensive inpatient treatment program during weekdays, followed by six monthly return visits of 2 days. Group B will participate in a 2 month intensive inpatient treatment program during weekdays, followed by biweekly return visits of 2 days during the next four months, followed by six monthly return visits of 2 days. Several different health care professionals are involved, such as pediatricians, dieticians, psychologists, social workers, nurses and physiotherapists. Results will also be compared to a control group that receives usual care. The primary outcome is SDS-BMI. Secondary outcomes include quality of life using the EQ-5D and cardiovascular risk factors. Data will be collected at baseline and after 6, 12 and 24 months. An economic evaluation will be conducted alongside this study. Healthcare consumption will be based on actual resource use, using prospective data collection during 2 years through cost diaries. Quality Adjusted Life Years (QALYs) will be calculated using the EQ-5D. Discussion: This study will provide useful information on the effectiveness and cost-effectiveness of inpatient treatment in severely obese children and adolescents. Valuable information on long term effects, after 2 years, is also included. [ABSTRACT FROM AUTHOR]

Background: We recently reported the age interval 2-6y being the earliest and most critical for adult overweight. We now aim to determine which age intervals are predictive of cardiometabolic risk at young adulthood. Methods and Findings: We analyzed data from 642 18-28 years olds from the Terneuzen Birth Cohort. Individual BMI SDS trajectories were fitted by a piecewise linear model. By multiple regression analyses relationships were assessed between subsequent conditional BMI SDS changes and components of the metabolic syndrome (MetS), skinfold thickness and hsCRP at young adulthood. Results were adjusted for gender and age, and other confounders. Gender was studied as an effect modifier. All BMI SDS changes throughout childhood were related to waist circumference and skinfold thickness. No other significant relationship was found before the age of 2 years, except between the BMI SDS change 0-1y and hsCRP. Fasting blood glucose was not predicted by any BMI SDS change. BMI SDS change 2-6y was strongly related to most outcome variables, especially to waist circumference (β 0.47, SE 0.02), systolic and diastolic blood pressure (β 0.20 SE 0.04 and β 0.19 SE 0.03), and hsCRP (β 0.16 SE 0.04). The BMI SDS change 10-18y was most strongly related to HDL cholesterol (β -0.10, SE 0.03), and triglycerides (β 0.21, SE 0.03). To a lesser degree, the BMI SDS change 6-10y was related to most outcome variables. BMI SDS changes 2-6y and 10-18y were significantly related to MetS: the OR was respectively 3.39 (95%CI 2.33-4.94) and 2.84 (95%CI 1.94-4.15). Conclusion: BMI SDS changes from 2y onwards were related to cardiometabolic risk at young adulthood, the age interval 2-6y being the most predictive. Monitoring and stabilizing the BMI SDS of children as young as 2-6y may not only reverse the progression towards adult overweight, but it may also safeguard cardiometabolic status. [ABSTRACT FROM AUTHOR]

To assess differences in diabetes care and patient outcomes by comparing two multifaceted quality improvement programs in two different countries, and to increase knowledge of effective elements of such programs. Primary care in the ExtraMural Clinic (EMC) of the Department of General Practice of the Vrije Universiteit in Amsterdam, the Netherlands, and the Group Health Cooperative (GHC), a group-model health maintenance organization (HMO) in western Washington State in the United States. Data were collected from 1992 to 1997. In this observational study two diabetes cohorts in which a quality improvement program was implemented were compared. Both programs included a medical record system, clinical practice guidelines, physician educational meetings, audit, and feedback. Only the Dutch program (EMC) included guidelines on the structure of diabetes care and a recall system. Only the GHC program included educational outreach visits, formation of multidisciplinary teams, and patient self-management support. Included were 379 EMC patients, and 2,119 GHC patients with type 2 diabetes mellitus. Main process outcomes were: annual number of diabetes visits, and number of HbA1c and blood lipid measurements. Main patient outcomes were HbA1c and blood lipid levels. Multilevel analysis was used to adjust for dependency between repeated observations within one patient and for clustering of patients within general practices. In the EMC process outcomes and glycemic control improved more than at GHC, however, GHC had better baseline measures. There were no differences between programs on blood lipid control. During follow-up, intensification of pharmacotherapy was noted at both sites. Differences noted between programs were in line with differences in diabetes guidelines. Following implementation of guidelines and organizational improvement efforts, change occurred primarily in the process outcomes, rather than in the patient outcomes. Although much effort was put into improving process and patient outcomes, both complex programs still showed only moderate effects. [ABSTRACT FROM AUTHOR]

Objective: To examine ethnic disparities in maternal prepregnancy obesity and gestational weight gain, and to examine to which extent these differences can be explained by socio-demographic, lifestyle and pregnancy related characteristics.Methods: In a multi-ethnic population-based prospective cohort study among 6444 pregnant women in Rotterdam, the Netherlands, maternal anthropometrics were repeatedly measured throughout pregnancy. Ethnicity, socio-demographic, lifestyle and pregnancy related characteristics were assessed by physical examinations and questionnaires.Results: The prevalence of prepregnancy overweight and obesity was 23.1% among Dutch-origin women. Statistically higher prevalences were observed among Dutch Antillean-origin (40.8%), Moroccan-origin (49.9%), Surinamese-Creole-origin (38.6%) and Turkish-origin (41.1%) women (all p-values <0.05). Only Dutch Antillean-origin, Moroccan-origin, Surinamese-Creole-origin and Turkish-origin women had higher risks of maternal prepregnancy overweight and obesity as compared to Dutch-origin women (p-values <0.05). Socio-demographic and lifestyle related characteristics explained up to 45% of the ethnic differences in body mass index. Compared to Dutch-origin women, total gestational weight gain was lower in all ethnic minority groups, except for Cape Verdean-origin and Surinamese-Creole-origin women (p-values <0.05). Lifestyle and pregnancy related characteristics explained up to 33% and 40% of these associations, respectively. The largest ethnic differences in gestational weight gain were observed in late pregnancy.Conclusion: We observed moderate ethnic differences in maternal prepregnancy overweight, obesity and gestational weight gain. Socio-demographic, lifestyle and pregnancy related characteristics partly explained these differences. Whether these differences also lead to ethnic differences in maternal and childhood outcomes should be further studied. [ABSTRACT FROM AUTHOR]

Despite policy intentions and many interventions aimed at reducing socioeconomic health inequalities in recent decades in the Netherlands and other affluent countries, these inequalities have not been reduced. Based on a narrative literature review, this paper aims to increase insight into why socioeconomic health inequalities are so persistent and build a way forward for improved approaches from a theoretical perspective. Firstly, we present relevant theories focusing on individual determinants of health-related behaviors. Thereafter, we present theories that take into account determinants of the individual level and the environmental level. Lastly, we show the complexity of the system of individual determinants, environmental determinants and behavior change for low socioeconomic position (SEP) groups and describe the next steps in developing and evaluating future effective approaches. These steps include systems thinking, a complex whole-system approach and participation of all stakeholders in system change.

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.

Introduction: The Netherlands Nutrition Centre developed guidelines to improve the availability and accessibility of healthier food products in Dutch canteens. This paper describes the development of an implementation plan to facilitate implementation of Guidelines for Healthier Canteens in Dutch secondary schools. Materials and Methods: In cooperation with stakeholders (i.e., school/caterer managers/employees, school canteen advisors, researchers) and based on theory, we developed an implementation plan in three steps. First, we identified factors that impede/facilitate stakeholders to create a healthier school canteen during 14 interviews. Second, 25 experts discussed and prioritized these identified factors in an expert meeting. Third, we translated these factors into tools to be included in the implementation plan, by making use of behavior change taxonomies and evidence-based implementation strategies. Results: The plan aims to support stakeholders in implementing healthier school canteens and consists of five tools: (1) tailored advice based on an online questionnaire to assess schools' and stakeholders' context and the Canteen Scan (i.e., an online tool to assess the availability and accessibility of food/drink products); (2) communication materials with information and examples; (3) online community for support by sharing experiences/questions; (4) digital newsletter as reminder/support; (5) fact sheet with students' needs/wishes to tailor the canteen. Discussion: This study illustrates how collaboration between science, policy and practice resulted in a tailored implementation plan aimed to support schools to adhere to school canteen policy. This development serves as a good example for researchers, health promotion policymakers, and practitioners how to create an implementation plan that fits the needs of stakeholders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Evenhuis, Vyth, Nassau, Veldhuis, Westerman, Seidell and Renders.)

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 <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5-2.9 times higher in the United States. Women (≥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.

We developed an implementation plan including several components to support implementation of the "Guidelines for Healthier Canteens" in Dutch secondary schools. This study evaluated the effect of this plan on changes in the school canteen and on food and drink purchases of students. In a 6 month quasi-experimental study, ten intervention schools (IS) received support implementing the guidelines, and ten control schools (CS) received only the guidelines. Changes in the health level of the cafeteria and vending machines were assessed and described. Effects on self-reported purchase behaviour of students were analysed using mixed logistic regression analyses. IS scored higher on healthier availability in the cafeteria (77.2%) and accessibility (59.0%) compared to CS (60.1%, resp. 50.0%) after the intervention. IS also showed more changes in healthier offers in the cafeteria (range -3 to 57%, mean change 31.4%) and accessibility (range 0 to 50%, mean change 15%) compared to CS (range -9 to 46%, mean change 9.7%; range -30 to 20% mean change 7% resp.). Multi-level logistic regression analyses on the intervention/control and health level of the canteen in relation to purchase behaviour showed no relevant relations. In conclusion, the offered support resulted in healthier canteens. However, there was no direct effect on students' purchase behaviour during the intervention.

The Netherlands Nutrition Centre has developed 'Guidelines for Healthier Canteens'. To facilitate their implementation, implementation tools were developed: stakeholders' questionnaires, the 'Canteen Scan' (an online tool to assess product availability/accessibility), a tailored advisory meeting/report, communication materials, establishment of an online community, newsletters, and a fact sheet with students' wishes/needs. In this quasi-experimental study, we investigated the effect of these tools in secondary schools on (a) factors perceived by stakeholders as affecting implementation; (b) the quality of implementation. For six months, ten intervention schools implemented the guidelines, supported by the developed implementation tools. Ten control schools received the guidelines without support. School managers, caterers, and canteen employees ( n = 33) reported on individual and environmental factors affecting implementation. Implementation quality was determined by dose delivered, dose received, and satisfaction. Stakeholders ( n = 24) in intervention schools scored higher on the determinants' knowledge and motivation and lower on need for support ( p < 0.05). Dose received (received and read) and satisfaction was highest for the advisory meeting/report (67.9%, 64.3%, 4.17), communication materials (60.7%, 50.0%, 3.98), and fact sheet (80%, 60%, 4.31). Qualitative analyses confirmed these quantitative results. In conclusion, a combination of implementation tools that includes students' wishes, tailored information/feedback, reminders and examples of healthier products/accessibility supports stakeholders in creating a healthier school canteen.

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 (M age  = 11.2, SD age  = 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., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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., (© 2018 The Author(s) Published by S. Karger GmbH, Freiburg.)

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., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

It is unclear whether the socioeconomic inequality in prevalence of overweight and obesity is already present among very young children. This study investigates the association between overweight and socioeconomic status (SES, with maternal educational level as an indicator of SES) among 5-year-old children. This cross-sectional study uses baseline data from 5-year-olds of Dutch ethnicity (n = 5,582) and their mothers collected for the "Be active, eat right" study. Compared to children of mothers with the highest educational level, for children of mothers with the lowest educational level the odds ratio (adjusted for demographic characteristics) for having overweight was 2.10 (95% confidence interval: 1.57-2.82), and for having obesity was 4.18 (95% confidence interval: 2.32-7.55). Addition of maternal and child lifestyle-related characteristics decreased the odds ratios for overweight and obesity by 26.4% and 42.1%, respectively. The results show that an inverse SES-overweight/obesity association is already present at elementary school entry, and that watching TV by mother and child, the child consuming breakfast and, especially maternal weight status, are contributing factors in this association. These results should be taken into account when developing policies to reduce inequalities in (childhood) health.

Background: Body mass index (BMI) is a common indirect method to assess weight status among children. There is evidence that BMI data alone can underestimate overweight-related health risk and that waist circumference (WC) should also be measured. In this study we investigated the agreement between BMI and WC and BMI and the waist-height ratio (WHtR) when used to identify overweight among children., Methods: This cross-sectional population-based study uses baseline data from 5-year-olds (n = 7703) collected by healthcare professionals for the 'Be active, eat right' study., Results: According to age-specific and sex-specific cut-off points for BMI (IOTF, 2000) and WC (Fredriks et al., 2005), the prevalence of overweight (obesity included) was 7.0% and 7.1% among boys, and 11.6% and 10.1% among girls, respectively. For the WHtR the 90th percentile was used as the cut-off point. Among boys, observed proportion of agreement between BMI and WC classification was 0.95, Cohen's kappa 0.58 (95% CI; 0.53-0.63), and proportions of positive and negative agreement were 0.61 and 0.97, respectively. Observed proportion of agreement between BMI and WHtR classification was 0.92, Cohen's kappa 0.46 (95% CI; 0.41-0.51), and proportions of positive and negative agreement were 0.51 and 0.95. Children identified as overweight according to WC were relatively tall, and children classified as overweight according to the WHtR only were relatively short (comparable results for girls)., Conclusions: There is moderate agreement between BMI and measures of WC on the presence of overweight among 5-year-olds. If BMI data and cut-offs continue to be used, then part of the group of children identified as overweight according to WC and the WHtR will be omitted. Follow-up of the children classified as overweight according to BMI only, WC only, and WHtR only, will give indications whether WC should be measured in addition to BMI or whether WC should only be measured in certain subgroups (e.g. relatively tall or short children) to identify and monitor overweight in children. This may improve early identification and prevention of overweight and overweight-related health problems in children.

Background: TV time and total sedentary time have been positively related to biomarkers of cardiometabolic risk in adults. We aim to examine the association of TV time and computer time separately with cardiometabolic biomarkers in young adults. Additionally, the mediating role of waist circumference (WC) is studied., Methods and Findings: Data of 634 Dutch young adults (18-28 years; 39% male) were used. Cardiometabolic biomarkers included indicators of overweight, blood pressure, blood levels of fasting plasma insulin, cholesterol, glucose, triglycerides and a clustered cardiometabolic risk score. Linear regression analyses were used to assess the cross-sectional association of self-reported TV and computer time with cardiometabolic biomarkers, adjusting for demographic and lifestyle factors. Mediation by WC was checked using the product-of-coefficient method. TV time was significantly associated with triglycerides (B = 0.004; CI = [0.001;0.05]) and insulin (B = 0.10; CI = [0.01;0.20]). Computer time was not significantly associated with any of the cardiometabolic biomarkers. We found no evidence for WC to mediate the association of TV time or computer time with cardiometabolic biomarkers., Conclusions: We found a significantly positive association of TV time with cardiometabolic biomarkers. In addition, we found no evidence for WC as a mediator of this association. Our findings suggest a need to distinguish between TV time and computer time within future guidelines for screen time.

Background: The aim of this study is to determine opportunities and barriers regarding the management of overweight and obese children in daily practice, and to show the value of using focus groups when developing an action plan for childhood overweight management in a local context., Methods: Seven focus groups and four semi-structured interviews were conducted with 29 professionals from nine different care disciplines and 7 parents of overweight and obese children aged 4-19 years., Results: After thorough analysis of the focus groups, issues concerning finding the most appropriate care and realising a long-term weight management in daily practice have become clear. Some examples of these issues are: lack of awareness, reluctance to discuss and refer, mutual cooperation, contradictory advice and expectations of treatment and lack of effective support strategies., Conclusion: Focus groups deliver important information on local issues that are important for the development and implementation of a childhood overweight management action plan. And, besides delivering necessary information, focus groups lead to an increased awareness and willingness to improve childhood overweight management in a local context., (Copyright © 2012 S. Karger GmbH, Freiburg.)

Objective: To examine whether the timing of introduction of the allergenic foods cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten is associated with eczema and wheezing in children 4 years of age or younger., Design: Population-based prospective cohort study from fetal life until young adulthood., Setting: Rotterdam, the Netherlands, from April 2002 through January 2006., Participants: A total of 6905 preschool children participating in the Generation R study., Main Exposure: Timing of introduction of cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten collected by questionnaires at 6 and 12 months of age., Main Outcome Measures: Information on the outcomes eczema and wheezing were obtained by questions from the age-adapted version of the "International Study of Asthma and Allergies in Childhood" core questionnaire and questionnaire data on parentally reported physician diagnosis for eczema., Results: Of 6905 children, wheezing was reported in 31% at age 2 years and in 14% at ages 3 and 4 years. Eczema was reported in 38%, 20%, and 18% of children at the ages of 2, 3, and 4 years, respectively. The introduction of cow's milk, hen's egg, peanuts, tree nuts, soy, and gluten before the age of 6 months was not significantly associated with eczema or wheezing at any age after adjustment for potential confounders (P > .10 for all comparisons). The results did not alter after stratification according to the child's history of cow's milk allergy and parental history of atopy., Conclusion: This study does not support the recommendation for delayed introduction of allergenic foods after age 6 months for the prevention of eczema and wheezing.

Objective: To develop a tool to identify children with high risk of adult overweight (AO), especially before developing overweight, based on body mass index (BMI) standard deviation score(s) (SDS) changes between 2-6 years (y) of age., Methods: We fitted a linear spline model to BMI SDS of 762 young Caucasian adults from the Terneuzen Birth Cohort at fixed ages between birth and 18 y. By linear regression analysis, we assessed the increase in explained variance of the adult BMI SDS by adding the BMI SDS at 2 y to the models including the BMI SDS at 4 y, 6 y and both 4 y and 6 y. AO risk was modelled by logistic regression. The internal validity was estimated using bootstrap techniques. Risk models were represented as risk score diagrams by gender for the age intervals 2-4 y and 2-6 y., Results: In addition to the BMI SDS at certain ages, the previous BMI SDS during childhood is positively related to adult weight. Receiver Operating Curves analysis provides insight into sensible cut-offs (AUC varied from 0.76 to 0.83). The sensitivity and specificity for 2-6 y at the cut-off of 0.25 and 0.5 are respectively, 0.76 and 0.74, and 0.36 and 0.93, whereas the PPV is 0.52 and 0.67, respectively., Conclusions: The risk score diagrams can serve as a tool for young children for primary prevention of adult overweight. To avoid wrongly designating children at risk for AO, we propose a cut-off with a high specificity at the risk of approximately 0.5. After external validation, wider adoption of this tool might enhance primary AO prevention.

Objectives: To compare the prevalence of overweight and obesity and nutrition and physical activity behavior between primary school children with and without disabilities., Study Design: Body weight and height were measured in 4072 children from regular primary schools in the city of Zwolle, the Netherlands, and in 85 children from a school for children with disabilities. Furthermore, parents completed a questionnaire on the child's nutrition and physical activity behavior. A χ(2) analysis was used to test categorical variables between groups, and analysis of variance was used for continuous variables., Results: The prevalence of overweight and obesity among disabled children was 30.6% and 10.6%, respectively, which is three and six times higher than in nondisabled children (P < .001). Furthermore, our study shows statistically significant differences in nutrition and physical activity behavior between disabled and nondisabled children., Conclusions: There is a need to promote a healthy lifestyle and to reduce the prevalence of overweight and obesity in disabled children., (Copyright © 2011 Mosby, Inc. All rights reserved.)

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., (Copyright © 2010 S. Karger AG, Basel.)

Background: Complications of overweight amplify with age, and irreversible damage already exists in young persons. Identifying the most sensitive age interval(s) for adult overweight is relevant for primary prevention. The aim of the study was to assess the relative contribution of body mass index (BMI) changes between 0 and 18 years to adult overweight, and to identify the earliest critical growth period., Methods and Findings: Data from 762 subjects in the Terneuzen Birth Cohort with an average of 21 growth measurements per subject from birth until 18 years were used. The main outcome measure was the BMI standard deviation score (SDS) at young adulthood. For each subject BMI SDS was fitted by a piecewise linear model at eight different ages and correlated to adult BMI SDS. The age intervals in between are considered critical according to three criteria, tested by respectively Students' t-tests, multiple linear regression analyses and Pearson's correlation tests. In the age intervals 4 months(m) -1 year(y), 2-6 y, 6-10 y and 10-18 y the BMI SDS change differs between adults with and without overweight (P

Aims: The aim of this pilot study was to investigate the feasibility and effectiveness of placing water coolers on sugar-sweetened beverage sales at secondary schools (age 12-18 years) in the city of Zwolle, the Netherlands., Methods: Six schools, hosting 5,866 pupils, were divided in three intervention and three control schools. In the intervention schools, water coolers were placed in the canteen. Hidden observations were performed in one school to study the intervention's feasibility, and school personnel was interviewed. Beverage sales were monitored before and during the intervention. After the intervention period, 366 class 1 and 2 pupils completed a questionnaire about their drinking habits (response rate 81%)., Results: Placement of water coolers appeared to be a feasible intervention at secondary schools. However, it did not affect sales of sugar-sweetened beverages at schools. Although mean intake of sugar-sweetened beverages at school was high, more than 500 ml/day for boys, and more than 250 ml/day for girls, only a minority of these quantities was purchased at school., Conclusion: We conclude that placing water coolers as a single-issue intervention in secondary school canteens should not be prioritized in the combat against obesity., (Copyright 2010 S. Karger AG, Basel.)

Objective: The worldwide trend towards obesity in childhood is also observed in the Netherlands and one of the consequences may be type 2 diabetes. In this study, we assessed the number of children with type 2 diabetes, diagnosed by paediatricians, in the Netherlands., Methods: In 2003 and 2004 the Dutch Paediatric Surveillance Unit, a nationwide paediatric register, was used to assess new cases of diabetes mellitus. Data on socio-demographic and clinical characteristics were collected by means of a questionnaire. A second questionnaire was sent to the reporting paediatrician if the diagnosis was inconclusive or if the diagnosis was type 1 diabetes in combination with overweight or obesity, according to international criteria., Results: During the 24 months of registration, the paediatricians reported 1142 new cases of diabetes, 943 of which were eligible for analysis. Initially, 14 patients (1.5%) were reported with type 2 diabetes. Only seven of these patients were classified as type 2 diabetes according to the ADA criteria, as information on C-peptides or antibodies was often missing. Based on clinical characteristics, the other seven patients were very likely to have type 2 diabetes. After the second questionnaire, six more patients met the ADA criteria and two were very likely to have type 2 diabetes. Most of the patients were female (95%), 14% were of Turkish and 18% of Moroccan origin., Conclusion: This study shows a discrepancy between the number of patients with type 2 diabetes diagnosed by paediatricians in daily practice and diagnosed according to the ADA criteria. Moreover, a considerable amount of reported patients were misclassified. Finally, 2.4% patients were classified as (very likely) type 2 diabetes. The development of programmes and protocols for prevention, diagnosis and classification applicable in daily practice is warranted.