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Chapter 3
of normal or overweight/obese children aged 5–7 years showed that mothers frequently underestimated the actual weight status of their child, especially mothers from Turkish or Moroccan origin (17). During our multidisciplinary group treatment Go4it, we observed that western adolescents benefited more from the Go4it intervention than non-western adolescents (18). Parental recognition and acknowledgement of their child’s weight are critical steps in the success of interventions aimed at preventing overweight (17).
The first aim of our study was to describe behavioural and social-emotional functioning from an adolescent and parental perspective. The second aim of our study was to explore behavioural and social-emotional functioning in western and non-western obese adolescents. These findings can help us to classify Dutch obese adolescents into different subtypes of behavioural and social-emotional functioning and subsequently offer better tailored treatment programmes.
Patients and Methods
Adolescents who were overweight or obese in the age range of 11-18 years and had been referred to the outpatient paediatric obesity clinic of the VU University Medical Center were invited to participate in the Go4it study, a multidisciplinary group treatment for obese adolescents (18,19). Adolescents were eligible when they met the following inclusion criteria: 1) aged between 11 and 18 years; 2) overweight or obese according to the definition of Cole et al. These are international cut off points for body mass index (BMI) for overweight and obesity by sex between 2 and 18 years, defined to pass through body mass index of 25 and 30 kg/m2 at age 18, obtained by averaging data from Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and United States (20). Exclusion criteria were as follows: non Dutch-speaking, obese as a result of a known syndrome or organic cause (hypothyroidism), mental retardation, physical limitations, and diagnosed type 2 diabetes mellitus. At the first visit, the paediatric endocrinologist measured height and weight and interviewed the adolescents concerning their medical history, weight development and ethnicity (as part of regular care), according to a standard protocol. Subjects were categorized as being of western ethnicity when both parents were Dutch or with at least one parent born outside the Netherlands but inside Europe (including former Yugoslavia and Soviet Union), North America, Oceania, Indonesia, or Japan. Subjects with at least one parent born in Turkey, Africa, Latin America, or Asia were classified as non-western. This is according the classification of the National Institute of Public Health and the Environment (21). Two questionnaires (CBCL and YSR) were administered as part of the regular care of the obesity clinic to assess adolescents’ behaviour and social-emotional functioning. The medical ethical committee of VU University Medical Center approved the protocol. Adolescents, as well as their parents, gave written informed consent.
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