Page 13 - Go4it

Consequences of obesity in youth
The high numbers of obesity in children and adolescents is worrisome because obesity causes physical and mental health problems as well as social problems. Obesity in childhood is associated with among others orthopaedic complications, asthma, insulin resistance and an increased risk of metabolic syndrome. This syndrome is a group of cardiovascular risk factors including increased waist circumference, hypertension, dyslipidaemia and impaired fasting glucose levels (8). Type 2 diabetes mellitus is increasingly being diagnosed in obese children (8-11). Children with obesity are likely to remain obese and are at increased risk to become obese adults compared to children of normal weight (12,13). Obesity in adulthood is associated with increased morbidity and mortality (14).
Behavioural and social-emotional functioning and quality of life
Obesity is a stigmatising and socially an unaccepted condition in childhood (10). Obesity is associated with lower quality of life (QoL), higher prevalence of psychopathology (10,15-19), negative psychosocial health (i.e. lack of self- esteem) and more frequent clinical treatment. Other more frequent psychosocial complaints in obese children and adolescents are externalizing problems (impulsivity and attention-deficit hyperactivity disorder) and internalizing behavioural problems (depression and anxiety) (20). These social, emotional, and behaviour problems can have a negative impact on energy balance-related behaviours (i.e. dietary intake and physical activity) (21,22) leading to an even further increase in weight.
Treatment of obese adolescents
In 2004, at the start of our pilot study, usual care of adolescent obesity in the Netherlands was referral to a dietician in the home care setting. For extreme obese children and adolescents, an intensive combined lifestyle inpatient intervention, focusing on nutrition, physical activity and behavior change of the participants and their parents, is available (23). Surgery is an option for extreme obese adolescents with multiple co-morbidities who have not responded to traditional behavioral and pharmacologic interventions but only in a research setting (24). Medical management in obese adolescents was and is still not recommended in the Netherlands.
An outpatient treatment program aimed at attaining a healthy lifestyle was not available at that time. For this reason, the departments of paediatric endocrinology, nutrition and dietetics, medical psychology and public and occupational health of the VU University Medical Center in Amsterdam, developed a multidisciplinary intervention program (Go4it) for obese adolescents.
General introduction
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