J. Halberstadt

The Global Burden of Obesity and the Challenges of Prevention

The prevalence of obesity is increasing at an alarming rate in many parts of the world. About 2 billion people are overweight and one third of them obese. The plight of the most affected populations, like those in high-income countries in North America, Australasia and Europe, has been well publicized. However, the more recent increases in population obesity in low- and middle-income countries that are now increasingly being observed have been less recognized. Based on the existing prevalence and trend data and the epidemiological evidence linking obesity with a range of physical and psychosocial health conditions, it is reasonable to describe obesity as a public health crisis that severely impairs the health and quality of life of people and adds considerably to national health-care budgets. Intersectoral action to manage and prevent obesity is urgently required to reverse current trends.

Tackling the problem of overweight and obesity: the Dutch approach.

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.

An integrated health care standard for the management and prevention of obesity in The Netherlands

The Partnership Overweight Netherlands (PON) is a collaboration between 18 partners, which are national organizations of health care providers, health insurance companies and patient organizations. The PON published an integrated health care standard for obesity in November 2010. The integrated health care standard for obesity involves strategies for diagnosis and early detection of high-risk individuals as well as appropriate combined lifestyle interventions for those who are overweight and obese and, when appropriate, additional medical therapies. The PON works towards a standard that transcends traditional boundaries of conventional health care systems and health care professions but, instead, focuses on competences of groups of health professionals who organize care from a patient-oriented perspective.

The role of self-regulating abilities in long-term weight loss in severely obese children and adolescents undergoing intensive combined lifestyle interventions (HELIOS); rationale, design and methods

BackgroundAdequate treatment of severe childhood obesity is important given its serious social, psychological and physical consequences. Self-regulation may be a crucial determinant of treatment success. Yet, little is known about the role that self-regulation and other psychosocial factors play in the long-term outcome of obesity treatment in severely obese children and adolescents.In this paper, we describe the design of a study that aims to determine whether the ability to self-regulate predicts long-term weight loss in severely obese children and adolescents. An additional objective is to identify other psychosocial factors that may modify this relation.Methods/designThe study is designed as a prospective observational study of 120 severely obese children and adolescents (8–19 years) and their parents/caregivers undergoing an intensive combined lifestyle intervention during one year. The intervention uses behavior change techniques to improve the general ability to self-regulate.Measurements will be taken at three points in time: at baseline (start of treatment), at the end of treatment (1 year after baseline) and at follow-up (2 years after baseline). The primary outcome measurement is the gender and age-specific change in SDS-BMI.The children’s general self-regulation abilities are evaluated by two behavioral computer tasks assessing two distinct aspects of self-regulation that are particularly relevant to controlling food intake: inhibitory control (Stop Signal Task) and sensitivity to reward (Balloon Analogue Risk Task). In addition to the computer tasks, a self-report measure of eating-specific self-regulation ability is used. Psychosocial factors related to competence, motivation, relatedness and outcome expectations are examined as moderating factors using several questionnaires for the patients and their parents/caregivers.DiscussionThis study will provide knowledge about the relation between self-regulation and long-term weight loss after intensive lifestyle interventions over a two-year period in severely obese children and adolescents, a growing but often overlooked patient group. We aim to investigate to what extent (changes in) the general ability to self-regulate predicts weight loss and weight loss maintenance. This study will also contribute to the knowledge on how this association is modified by other psychosocial factors. The results may contribute to the development of more successful interventions.Trial registrationNetherlands Trial Register (NTR1678, registered 20-Feb-2009)

Cost-effectiveness of intensive inpatient treatments for severely obese children and adolescents in the Netherlands; a randomized controlled trial (HELIOS)

BackgroundIntensive 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/DesignParticipants 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.DiscussionThis 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.Trial registrationNetherlands Trial Register (NTR): NTR1678

Obesity: The obesity epidemic in the USA — no end in sight?

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

Health-related quality of life in children and adolescents with severe obesity after intensive lifestyle treatment and at 1-year follow-up

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.

Kwaliteit van leven als uitkomstmaat in de zorg voor kinderen (4-19 jaar) met obesitas

SamenvattingObesitas bij kinderen heeft niet alleen effecten op de fysieke gezondheid, maar hangt ook samen met psychosociale problematiek zoals depressie en angst, een laag zelfbeeld en sociale afwijzing door pesten en stigmatisering. Bij interventies gericht op obesitas moet daarom niet alleen op het gewicht worden gelet, maar ook op de kwaliteit van leven. In dit artikel wordt de vraag behandeld welke vragenlijsten het meest geschikt zijn om gezondheids-gerelateerde kwaliteit van leven te meten bij leefstijlinterventies voor kinderen (4-19 jaar) met obesitas. Op basis van een uitgebreid literatuuronderzoek wordt geconcludeerd dat de IWQOL-Kids op dit moment de meest geschikte vragenlijst lijkt om verandering in gewichtsgerelateerde kwaliteit van leven te meten na een leefstijlinterventie. De generieke vragenlijst PedsQL 4.0 is geschikt als aanvullend meetinstrument. Beide vragenlijsten kunnen worden ingezet in de diagnostiekfase, bij het bepalen van aandachtspunten voor de behandeling en als uitkomstmaat.AbstractQuality of life as patient reported outcome of lifestyle interventions for children (4-19 years) with obesityAim:To determine which health related quality of life questionnaires are appropriate for use in The Netherlands as a patient reported outcome measure of lifestyle interventions for children (4-19 years) with obesity and discuss other uses of quality of life as part of care for childhood obesity.Method:trough a literature review available health related quality of life questionnaires and their relevant psychometric characteristics were identified. A further selection of the questionnaires was made based on the evaluation of usability for Dutch healthcare practice.Results:The disease-specific IWQOL Kids questionnaire and the generic PedsQL 4.0 questionnaire comply with relevant psychometric requirements and criteria for use in healthcare practice. The IWQOL-Kids is more sensitive in detecting the effects of lifestyle interventions.Conclusion:In addition to body weight as an outcome measure, the IWQOL-Kids questionnaire at the moment seems the most appropriate questionnaire to measure possible changes in quality of life after a lifestyle intervention. The generic questionnaire PedsQl 4.0 is suited as an additional outcome measure. Both questionnaires can be used for diagnostic assessment, for determining what to focus treatment on and for evaluation of treatment effects.

Proefschrift: Long-term weight management in children and adolescents with severe obesity: psychological aspects

Geen ouder wil dat zijn of haar kind ernstig obees en ongezond is. Toch kampen alleen al in Nederland meer dan achttienduizend kinderen en adolescenten (ongeveer 0,5%) met ernstige obesitas. Vanwege de nadelige gevolgen van obesitas op sociaal, psychologisch en fysiek vlak, is adequate langdurige gezondheidszorg vereist. Een goede obesitasbehandeling leidt, middels aanpassingen in de leefstijl, tot verbetering van de gezondheid en verlaging van het risico