Diagnostic procedures and treatment of childhood obesity by pediatricians: 'The Dutch Approach'

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

Childhood Obesity in the Caribbean

Objective: To determine the prevalence of overweight among school children in Bonaire, an island in the Caribbean, and to obtain clues for prevention of overweight. Methods: In a cross-sectional school-based study, weight and height were measured in all 4–16-year old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and nutrition. Results: The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern. Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day compared to normal weight children (56%). Conclusion: The prevalence of overweight and obesity in children in Bonaire is high. Prevention of overweight should focus on stimulating healthy eating habits and more physical activity. Keywords: Bonaire, Caribbean, child, obesity "La Obesidad Infantil en el Caribe" RESUMEN Objetivo: El objetivo de este estudio fue determinar la prevalencia de sobrepeso entre los niños escolares en Bonaire – una isla en el Caribe – y obtener ideas para la prevención del sobrepeso. Métodos: Se realizó un estudio transversal en una escuela, en el cual se midió el peso y la altura de todos los niños de 4–16 años de edad en Bonaire, (n = 2148). El índice de masa corporal se categorizó de acuerdo con las definiciones dadas por la llamada International Obesity Task Force. A los niños se les aplicó una encuesta sobre el estilo de vida y la nutrición. Resultados: La prevalencia de sobrepeso – incluyendo la obesidad – en los niños fue 24.3%, y en las niñas 31.9%, en tanto que la prevalencia de la obesidad fue 9.9% y 13.7% respectivamente. Aproximadamente la mitad de los niños tenía un patrón alimentario poco saludable. Un número significativo de niños de menos sobrepeso (49%) y menos obesos (45%) era físicamente activo durante > 1 hora/día, en comparación con los niños de peso normal (56%). Conclusión: La prevalencia de sobrepeso y la obesidad en los niños de Bonaire es alta. La prevención de sobrepeso debe centrarse en estimular hábitos saludables de alimentación y mayor actividad física. Palabras claves: Bonaire, Caribeño, niño, obesida

Breastfeeding and food pattern in overweight children in the Caribbean

Background: As in most countries around the globe, overweight and obesity are a major threat to public health on the Caribbean island of Aruba. Increasing evidence confirms that breastfeeding protects against overweight and obesity. However, little is known about the mechanism underlying the association between breastfeeding and obesity. One possibility is that breastfed infants are better able to control their meal size and intervals than formula-fed infants. This might lead to a healthier diet in later life and protect against overweight and obesity.Objective: To determine the relationship between breastfeeding, food pattern and being overweight in the Caribbean. Methods: In a cross-sectional school-based study in 2004-2005, weight and height were measured by two research assistants in 1776 children aged 6-11 years on Aruba, an island in the Caribbean. BMI was defined according to guidelines by the International Obesity Task Force. Parents completed a questionnaire pertaining to breastfeeding and dietary food pattern. Results: 1451/1776 (81.7%) children were breastfed; 851/1766 (47.9%) children were breastfed for <4 months, 227/1776 (12.8%) for 4-6 months and 373/1776 (21.0%) for ≧6 months. Children who were breastfed for ≥4 months had lower odds (OR 0.32, 95%CI 0.25-0.40) of being overweight including obesity than those who either were not breastfed or who were breastfed for <4 months. Children who were breastfed for ≥4 months were more likely to have a structured food pattern of six eating moments a day (OR 7.43, 95% CI 5.87-9.39, P<0.001) and to have breakfast every day (OR 2.86, 95% CI 2.17-3.78, P<0.001) than those who were not or who were breastfed for <4 months. Conclusions: Breastfeeding for ≥4 months is associated with a structured food pattern (six eating moments a day including a daily breakfast) and carries a strikingly lower risk of overweight in children. Promoting prolonged breastfeeding together with a focus on a subsequent structured food pattern could be a cheap method of preventing overweight. © W. S. Maney & Son Ltd 2013

High prevalence of hypertension in obese children in the Caribbean.

Background: The prevalence of obesity is increasing worldwide. Obesity in children and adults leads to diabetes mellitus type 2 and cardiovascular disease. Aim: To determine the prevalence of high blood pressure in overweight and obese children in the Caribbean. Methods: In a cross-sectional study, weight and height were measured in all 5-16-year-old children attending public school in 2008 on Bonaire, an island in the Caribbean. Cut-off values for body mass index (BMI) are defined by the International Obesity Task Force. Blood pressure was measured in all overweight and obese children as well as in a control group with normal weight and compared with reference values from the National High Blood Pressure Working Group on Children. Results: 94% (2023/2152) of all children participated in the study. 17% (335/2023) of the children were overweight (excluding obesity) and a further 12% (246/2023) were obese. Hypertension was found in 13% (67/526) of children of normal weight, in 23% (71/307) of overweight children and in 53% (127/242) of obese children. Compared with normal-weight children, the odds for hypertension were 2.1 (95% CI 1.4-3.0) for overweight children and 7.2 (95% CI 5.0-10.3) for obese children. Conclusion: There is a high prevalence of hypertension in overweight and obese children on Bonaire. As hypertension is a harbinger of cardiovascular disease, early detection and treatment of overweight and obese children is of paramount importance and their blood pressure needs to be measured regularly. © W. S. Maney & Son Ltd 2012