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Childhood Obesity: Behind the Doors of the Epidemic.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Childhood Obesity: Behind the Doors of the Epidemic./
Author:	Heijden, Laila B van der.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2019,
Description:	259 p.
Notes:	Source: Dissertations Abstracts International, Volume: 82-11, Section: B.
Contained By:	Dissertations Abstracts International82-11B.
Subject:	Hospitals. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28229892
ISBN:	9798597048659

Childhood Obesity: Behind the Doors of the Epidemic.
Heijden, Laila B van der.

Childhood Obesity: Behind the Doors of the Epidemic. - Ann Arbor : ProQuest Dissertations & Theses, 2019 - 259 p.

Source: Dissertations Abstracts International, Volume: 82-11, Section: B.

Thesis (Ph.D.)--Wageningen University and Research, 2019.

This item must not be sold to any third party vendors.

Childhood obesity is reaching alarming proportions and is currently one of the most important public health problems. It is associated with significant physical and psychosocial health consequences, both in the short and long term. In Chapter 1 (General Introduction) we provided some general background information about the childhood obesity epidemic. Although much is already known on this topic, important research questions remain to be answered in the field of childhood obesity. Therefore, in this thesis we looked below the tip of the childhood obesity iceberg, and dived into a few important issues encountered in daily clinical practice.PART I of this thesis focused on consequences of childhood obesity: Childhood obesity and beyond.In Chapter 2 we described the results of a cross-sectional study investigating the healthrelated quality of life (HRQoL) in children and adolescents at the start of hospital-based obesity treatment. We showed that children with an increasing degree of obesity present with a lower HRQoL, especially in the physical domains of HRQoL. By analyzing both selfreports and parent-proxy reports, we concluded that significant differences exist between parent-proxy reports and child self-reports on 'Bodily Pain/Discomfort' and 'General Health Perceptions' (lower child scores), and 'Behavior' and 'Family Cohesion' (higher child scores). Thus, in order to gain a complete picture of functioning, it is preferable to obtain HRQoL data from the children's point of view supplemented with data from the parents' perspective, as children and parents may not necessarily share similar views about the overall impact of overweight.Chapter 3 covers the results of studying the expression of adiponectin and leptin receptors on circulating immune cells in obese children pre- and post-lifestyle intervention compared to normal weight control children. We demonstrated that circulating leukocyte subsets show distinct adipokine receptor expression profiles. These distinct adipokine receptor profiles may partly explain the differential impact of adipokines on leukocyte subsets. Next, we showed that leukocyte subset numbers and adipokine receptor expression profiles were largely similar in obese children and controls. From this we can conclude that adipokine signalling in childhood obesity is primarily modulated by circulating adipokine levels, instead of adipokine receptor expression.In Chapter 4 we described the results of a study conducted to evaluate ambulatory blood pressure measurement (ABPM) patterns in a population of overweight and obese children and adolescents, in order to estimate the prevalence of (hidden) abnormal blood pressure patterns. A high prevalence of abnormal ABPM patterns (white coat hypertension, elevated blood pressure, masked hypertension, ambulatory hypertension) was detected, with only 54.9% of the population classified as normal blood pressure using ABPM. In addition, an abnormal circadian variation was highly prevalent: isolated night-time BP load ≥25% with normal daytime ABPM was found in almost one quarter 25% of the participants, and 40.2% of the participants lacked the physiologic nocturnal SBP dip. Finally, office blood pressure measurement was often poorly correlated with a subject's actual ABPM pattern. Thus, this study confirms the high prevalence of abnormal blood pressure in obese children and adolescents, and it also underscores the unreliability of office blood pressure measurement and the need for blood pressure monitoring by APBM.Moving to PART II of this thesis, we elaborated on the treatment of childhood obesity: Way beyond weight.In Chapter 5 we summarised the effects of our multidisciplinary multicomponent weight loss intervention in Hospital Gelderse Vallei, specifically comparing overweight/obese children with overweight/obese adolescents. Children showed significant larger BMI Z-score differences than adolescents (BMI Z-score difference end versus start of treatment -0.33 [SD 0.48] in children, -0.09 [SD 0.28] in adolescents) and more often a clinically relevant BMI Z-score decrease of >0.25 (48% versus 26%, p=0.10). The prevalence of abnormal blood pressure, disturbances in glucose homeostasis, and metabolic syndrome decreased in the total group. Children showed a more favourable effect than adolescents, confirming the importance of early start of treatment. The dropout rate in our study was 30% in children and 41% in adolescents. This points to the need of a careful assessment of initial expectations including identification of barriers to follow-up, as a screening before treatment commences, followed by individualised care.Although several intervention programmes for children result in a decrease in BMI Z-score in the short term, from literature and experience we know that preventing relapse remains an important challenge. Therefore, we performed a systematic review and meta-analysis on maintenance programmes in childhood obesity, which is presented in Chapter 6 of this thesis. The aim of this review was to summarise the existing knowledge on programmes and initiatives aimed at long-term maintenance of a healthy or reduces weight in children and adolescents following initial treatment of overweight. Chapter 6A provides the overview and design of this systematic review, and in Chapter 6B we p resented t he fi ndings. We found that the BMI Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. Thus, although there is limited quality data to recommend one maintenance intervention over another, in general continued treatment does have a stabilising effect on BMI Z-score.

ISBN: 9798597048659Subjects--Topical Terms:

616081
Hospitals.
Subjects--Index Terms:

Overweight

Childhood Obesity: Behind the Doors of the Epidemic.
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520 $a Childhood obesity is reaching alarming proportions and is currently one of the most important public health problems. It is associated with significant physical and psychosocial health consequences, both in the short and long term. In Chapter 1 (General Introduction) we provided some general background information about the childhood obesity epidemic. Although much is already known on this topic, important research questions remain to be answered in the field of childhood obesity. Therefore, in this thesis we looked below the tip of the childhood obesity iceberg, and dived into a few important issues encountered in daily clinical practice.PART I of this thesis focused on consequences of childhood obesity: Childhood obesity and beyond.In Chapter 2 we described the results of a cross-sectional study investigating the healthrelated quality of life (HRQoL) in children and adolescents at the start of hospital-based obesity treatment. We showed that children with an increasing degree of obesity present with a lower HRQoL, especially in the physical domains of HRQoL. By analyzing both selfreports and parent-proxy reports, we concluded that significant differences exist between parent-proxy reports and child self-reports on 'Bodily Pain/Discomfort' and 'General Health Perceptions' (lower child scores), and 'Behavior' and 'Family Cohesion' (higher child scores). Thus, in order to gain a complete picture of functioning, it is preferable to obtain HRQoL data from the children's point of view supplemented with data from the parents' perspective, as children and parents may not necessarily share similar views about the overall impact of overweight.Chapter 3 covers the results of studying the expression of adiponectin and leptin receptors on circulating immune cells in obese children pre- and post-lifestyle intervention compared to normal weight control children. We demonstrated that circulating leukocyte subsets show distinct adipokine receptor expression profiles. These distinct adipokine receptor profiles may partly explain the differential impact of adipokines on leukocyte subsets. Next, we showed that leukocyte subset numbers and adipokine receptor expression profiles were largely similar in obese children and controls. From this we can conclude that adipokine signalling in childhood obesity is primarily modulated by circulating adipokine levels, instead of adipokine receptor expression.In Chapter 4 we described the results of a study conducted to evaluate ambulatory blood pressure measurement (ABPM) patterns in a population of overweight and obese children and adolescents, in order to estimate the prevalence of (hidden) abnormal blood pressure patterns. A high prevalence of abnormal ABPM patterns (white coat hypertension, elevated blood pressure, masked hypertension, ambulatory hypertension) was detected, with only 54.9% of the population classified as normal blood pressure using ABPM. In addition, an abnormal circadian variation was highly prevalent: isolated night-time BP load ≥25% with normal daytime ABPM was found in almost one quarter 25% of the participants, and 40.2% of the participants lacked the physiologic nocturnal SBP dip. Finally, office blood pressure measurement was often poorly correlated with a subject's actual ABPM pattern. Thus, this study confirms the high prevalence of abnormal blood pressure in obese children and adolescents, and it also underscores the unreliability of office blood pressure measurement and the need for blood pressure monitoring by APBM.Moving to PART II of this thesis, we elaborated on the treatment of childhood obesity: Way beyond weight.In Chapter 5 we summarised the effects of our multidisciplinary multicomponent weight loss intervention in Hospital Gelderse Vallei, specifically comparing overweight/obese children with overweight/obese adolescents. Children showed significant larger BMI Z-score differences than adolescents (BMI Z-score difference end versus start of treatment -0.33 [SD 0.48] in children, -0.09 [SD 0.28] in adolescents) and more often a clinically relevant BMI Z-score decrease of >0.25 (48% versus 26%, p=0.10). The prevalence of abnormal blood pressure, disturbances in glucose homeostasis, and metabolic syndrome decreased in the total group. Children showed a more favourable effect than adolescents, confirming the importance of early start of treatment. The dropout rate in our study was 30% in children and 41% in adolescents. This points to the need of a careful assessment of initial expectations including identification of barriers to follow-up, as a screening before treatment commences, followed by individualised care.Although several intervention programmes for children result in a decrease in BMI Z-score in the short term, from literature and experience we know that preventing relapse remains an important challenge. Therefore, we performed a systematic review and meta-analysis on maintenance programmes in childhood obesity, which is presented in Chapter 6 of this thesis. The aim of this review was to summarise the existing knowledge on programmes and initiatives aimed at long-term maintenance of a healthy or reduces weight in children and adolescents following initial treatment of overweight. Chapter 6A provides the overview and design of this systematic review, and in Chapter 6B we p resented t he fi ndings. We found that the BMI Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. Thus, although there is limited quality data to recommend one maintenance intervention over another, in general continued treatment does have a stabilising effect on BMI Z-score.
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