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Background
Overweight and obesity in youth is a worldwide problem (1). In the United States, about 32% of the youth (2-19 years) is overweight or obese, while 17% is obese (2). In Europe, prevalence ranges from 16-22% for overweight including obesity, and from 4 to 6% for obesity (3). In the Netherlands, 13% of the youth is overweight, and 2% is obese (4). Repeating national evidence shows that in the Netherlands the prevalence of obesity and overweight are highest among non-western ethnic minority groups as Moroccan, Turkish and Surinamese South Asian (4,5). In Dutch children from the Turkish origin, prevalence rates are 2 to 3 times higher than in native Dutch children and also increase faster among Turkish children than among native Dutch children (4,5). In 2013, 11.7% of the Dutch population consisted of non-western immigrants. In Amsterdam, where the VU University Medical Center is located, this percentage was much higher with 34.9%.
Childhood overweight has both health and psychological consequences. Several studies showed that obese adolescents have a higher prevalence of psychopathology (behavioural and emotional problems) than normal-weight adolescents (6-9) with a higher prevalence in children seeking clinical treatment (8). Pruder and Munsch concluded that the most frequently implicated psychosocial factors in obese children and adolescents are externalizing problems (impulsivity and attention-deficit hyperactivity disorder) and internalizing behavioural problems (depression and anxiety) (10). These social, emotional, and behaviour problems can have a negative impact on the behaviours related to establishing or maintaining a healthy weight status (i.e. dietary intake and physical activity) (11,12). Previous studies found that healthy adolescents (11-18 years old) reported more behavioural and emotional problems than their parents (13,14). Only a few studies examined both parent and child reports among obese adolescents. These studies reported no mean differences between self-reported and parent-reported behavioural and emotional problems (6-8). However, in our obesity clinic, we noticed that parents were more worried than their children about their children’s health. Besides obesity also ethnicity can play an important role in social and psychosocial wellbeing. Janssen et al., showed that Turkish immigrant adolescents reported more problems than their Dutch and native Turkish peers (15). As far as we know there is no study available about the effect of ethnicity on behaviour problems and social-emotional function in obese adolescents. Kocken et al., showed that the belief that genetic factors cause overweight was held significantly more often by Turkish parents than by Dutch parents (16). Although overweight and obesity were 3 times as high in the children of this Turkish response group, parental beliefs in this group about overweight prevention and management did not reflect a sense of urgency about changes in their child’s behaviour (16). An explanation for this can be the underestimation of the current weight status of their child. Observations in a multi-ethnic sample
Behaviour and social-emotional function
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