Dietary Patterns in Early Childhood and the Risk of Childhood Overweight:The GECKO Drenthe Birth Cohort

Limited and inconsistent evidence exists on the associations between dietary patterns and overweight during childhood. The present study describes dietary patterns of three-year-old Dutch children and associations between childhood overweight and body mass index (BMI) development between 3 and 10 years. In the GECKO Drenthe birth cohort (N = 1306), body height and weight were measured around the age of 3, 4, 5, and 10 years, and overweight was defined according to Cole and Lobstein. A validated food frequency questionnaire (FFQ) was used to measure diet at 3 years. Dietary patterns were derived using principal components analysis (PCA). Using logistic regression analyses, pattern scores were related to overweight at 3 and 10 years. A linear mixed-effect model was used to estimate BMI-SDS development between 3 to 10 years according to quartiles of adherence to the pattern scores. Two dietary patterns were identified: (1) ‘minimally processed foods’, indicating high intakes of vegetables/sauces/savory dishes, and (2) ‘ultra-processed foods’, indicating high intakes of white bread/crisps/sugary drinks. A 1 SD increase in the ‘ultra-processed foods’ pattern score increased the odds of overweight at 10 years (adjusted OR: 1.30; 95%CI: 1.08, 1.57; p = 0.006). The ‘minimally processed foods’ pattern was not associated with overweight. Although a high adherence to both dietary patterns was associated with a higher BMI-SDS up to 10 years of age, a stronger association for the ‘ultra-processed foods’ pattern was observed (p < 0.001). A dietary pattern high in energy-dense and low-fiber ultra-processed foods at 3 years is associated with overweight and a high BMI-SDS later in childhood

Changes in the Health-Related Quality of Life and Weight Status of Children with Overweight or Obesity Aged 7 to 13 Years after Participating in a 10-Week Lifestyle Intervention

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

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

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. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1678

Development of an action programme tackling obesity-related behaviours in adolescents:a participatory system dynamics approach

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.</p

Development of an action programme tackling obesity-related behaviours in adolescents:a participatory system dynamics approach

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.</p

A system dynamics and participatory action research approach to promote healthy living and a healthy weight among 10–14-year-old adolescents in Amsterdam: The LIKE programme

This paper describes the design of the LIKE programme, which aims to tackle the complex problem of childhood overweight and obesity in 10–14-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’ behaviour relating to diet, physical activity, sleep an

Leefstijlgeneeskunde: reddingsboei of los touw?

Many chronic non-communicable diseases are at least partly caused by unhealthy lifestyles; an example is type 2 diabetes mellitus (T2DM). Lifestyle interventions have been shown to substantially reduce the risk of T2DM in high-risk patients. The risk reduction diminishes over time, but a long-term (> ten years) reduction is still achieved. Better compliance with the intervention and higher quality of lifestyle counselling during a longer period of time are predictors of improved long-term risk reduction. In patients with established T2DM, lifestyle intervention can be of great benefit as well. This can result in remission in a substantial proportion of the patients (12-46%) over a one-year period. A Mediterranean diet, which is low in both refined, starch-rich foods and high-sugar drinks, seems to result in the best outcomes. However, again the compliance and quality of lifestyle counselling are of crucial importance. Lifestyle medicine deserves serious attention in clinical practice. Veel chronische, niet-overdraagbare aandoeningen worden voor een belangrijk deel door een ongezonde leefstijl veroorzaakt. Een voorbeeld hiervan is diabetes mellitus type 2 (DM2). Leefstijlinterventies bij personen met een sterk verhoogd risico op DM2 laten zien dat dat risico aanzienlijk kan worden verminderd. De risicoreductie neemt wat af in de tijd, maar deze is nog aanwezig op de termijn van meer dan 10 jaar. Een betere volgzaamheid van de interventie en een betere en langdurigere begeleiding hierbij leiden tot een grotere risicoreductie. Ook bij mensen die al DM2 hebben kan verandering van leefstijl gunstige effecten hebben: op de termijn van 1 jaar kan de aandoening bij een behoorlijk deel (12-46%) van de patiënten in remissie komen. Een mediterraan voedingspatroon, waarin geraffineerde, zetmeelrijke producten en suikerhoudende drank worden verminderd, lijkt de beste resultaten te bieden. Maar ook hier zijn de mate van therapietrouw en de kwaliteit van de begeleiding van doorslaggevend belang. Leefstijlgeneeskunde verdient serieuze aandacht in de klinische praktijk