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behavioural interventions (34), but also evaluate the psychological well-being of adolescents during treatment.
Our study sample limits the generalizability to children seeking treatment for obesity in a large city of the Netherlands. Our results may not be generalizable to all adolescents with obesity or those treated by general health practitioners in smaller cities in the Netherlands. The majority lived in Amsterdam, where almost 50% of the population is of non-western descent in contrast to other regions of the Netherlands where generally 30% of the population is of non- western descent (www.zorgatlas.nl). Only 34% of our sample was of Dutch origin, the majority of the non-western adolescents were of Turkish descent.
A strength of our study is that we included both parent and self-reported questionnaires.
Very little research on emotional and behavioural problems has been conducted in Dutch obese children. The only study that assessed the CBCL as a secondary outcome in overweight and obese children reported similar total problem scores (internalizing and externalizing scores were not reported) (29). Limitations of both questionnaires are the reliance on self-report and the fact that to the best of our knowledge both questionnaires have not been validated in an obese population.
Our results underscore the relatively high prevalence of emotional and behavioural problems in treatment-seeking adolescents, in concordance with previous studies. Treatment-seeking has also been associated with disturbed eating behaviour, depressive and anxiety symptoms and a higher degree of overweight (6,31,35).This emphasizes the need for psychological support and treatment of these adolescents in clinical practice. It would be worthwhile to replicate our study on a population of overweight children followed in general child health care or who are not clinically-referred.
Conclusions
Obese adolescents perceive serious behavioural problems and social-emotional malfunctioning. Their parents reported even more problems than their children. These results underscore the need for treatment programs that not only focus on healthy weight but also address these behavioural problems and social- emotional malfunctioning.
Behaviour and social-emotional function
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