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Ernstige obesitas bij kinderen: een zaak van gewicht

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Tijdschrift voor kindergeneeskunde

Samenvatting

De prevalentie van overgewicht en vooral obesitas op de kinderleeftijd neemt snel toe. Bovendien blijken de zwaarste kinderen steeds zwaarder te worden. De definitie van overgewicht en obesitas bij kinderen is minder eenvoudig dan bij volwassenen door de groei en puberteitsontwikkeling. Inmiddels is er brede internationale consensus dat de BMI de meest optimale, enkelvoudige maat is voor het bepalen van overgewicht en obesitas. Hiervan zijn goede Nederlandse en internationale referentiewaarden beschikbaar. Kinderen en adolescenten hebben aan obesitas gerelateerde morbiditeit die gereduceerd kan worden door gewichtsreductie. Actieve interventie van obesitas op de kinderleeftijd is noodzakelijk omdat spontane regressie meestal niet optreedt. Een kind met obesitas heeft een grote kans om een volwassene met obesitas te worden. Zolang evidence-based behandelmethoden niet beschikbaar zijn, zullen interventies bij ernstige obesitas bij kinderen gebaseerd moeten zijn op best practices of practice-based richtlijnen. Bij obesitas, en zeker ernstige obesitas, dient behandeling, zoals bij iedere chronische aandoening, voldoende langdurig te worden gegeven. Bij recidive dient opnieuw intensief te worden behandeld. Voor bariatrische chirurgie is in de kindergeneeskunde vooralsnog geen plaats.

Summary

The prevalence of overweight and obesity in minors increases rapidly. Also, the heaviest children show higher weights than before. Defining overweight and obesity in minors is more complicated than in adults, due to the influence of growth and puberty. A broad international consensus has been reached on BMI being the most optimal and simple standard for determining overweight and obesity. Established BMI reference values are available both on a Dutch and international scale. Children and adolescents suffer from obesity-related morbidities, which can be reduced by weight loss. Active intervention is required in obese minors as spontaneous regression does not usually occur. An obese minor is very likely to become an obese adult. As long as evidence based treatment options are unavailable, intervention in cases of severe obesity in minors will have to be based on best practices or best-practise-based guidelines. Obesity, and especially severe obesity, requires sufficiently prolonged treatment as do all chronic disorders. Cases of weight regain require repeated intensive treatment. Bariatric surgery is not yet an option in pediatric obesity treatment.

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Literatuur

  1. Lobstein T, Baur L, Uauy R; IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4-104.

    Google Scholar 

  2. Fredriks AM, Buuren S van, Wit JM, Verloove-Vanhorick S. Body index measurements in 1996-7 compared with 1980. Arch Dis Child. 2000;82:107-12.

    Google Scholar 

  3. Must A, Strauss RS. Risk and consequences of childhood and adolescent obesity. Int J Obes Relat Metab Disord. 1999;23:S2-11.

    Google Scholar 

  4. Pinhas-Hamiel O, Dolan LM, Daniels SR, et al. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr. 1996;128:608-15.

    Google Scholar 

  5. Guo SS, Roche AF, Chumlea WC. The predictive value of childhood body mass index values for overweight at 35 yrs. Am J Clin Nutr. 1994;59:810-9.

    Google Scholar 

  6. Wilde J de, Hurk K van den, Hirasing RA. Monitoring van overgewicht bij jeugdigen van 0-19 jaar in de G30. Leiden: TNO Kwaliteit van Leven, 2005.

  7. Guillaume M. Defining obesity in childhood: current practice. Am J Clin Nutr. 1999;70:126S-30S.

    Google Scholar 

  8. Hurk K van den, Dommelen P van, Wilde JA de, et al. Prevalentie van overgewicht en obesitas bij jeugdigen 4-15 jaar in de periode 2002-2004. Leiden: TNO Kwaliteit van Leven, 2006.

  9. Guillaume M, Lissau I. Epidemiology. In: Burniat W, Cole T, Lissau I, Poskitt, eds. Child and adolescent obesity. Cambrdige: Cambridge University Press, 2002.

  10. Roelants M, Hoppenbrouwers K. Prevalentie van obesitas bij kinderen en jongeren op basis van body mass index. Tijdschr Jeugdgezondheidszorg. 2002;5:88-92.

    Google Scholar 

  11. Flegal KM, Troiano RP. Changes in the distribution of body mass index of adults and children in the US population. Int J Obes Relat Metab Disord. 2000;24:807-18.

    Google Scholar 

  12. Freedman DS, Khan LK, Dietz WH, et al. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa Heart Study. Pediatrics. 2001;108:712-8.

    Google Scholar 

  13. Caprio S. Insulin resistance in childhood obesity. J Pediatr Endocrinol Metab. 2002;15(Suppl 1):487-92.

    Google Scholar 

  14. Dietz WH, Gross WL, Kirkpatrick JA. Blount disease (tibia vara): another skeletal disorder associated with childhood obesity. J Pediatr. 1982;101: 735-7.

    Google Scholar 

  15. Drake AJ, Smith A, Betts PR, et al. Type 2 diabetes in obese white children. Arch Dis Child. 2002;86: 207-8.

    Google Scholar 

  16. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175-82.

    Google Scholar 

  17. Laitinen J, Taponen S, Martikainen H, et al. Body size from birth to adulthood as a predictor of self-reported polycystic ovary syndrome symptoms. Int J Obes Relat Metab Disord. 2003;27:710-5.

    Google Scholar 

  18. Renders CM, Delemarre-van de Waal HA, Dekker JM, Hirasing RA. Insulineresistentie en diabetes mellitus type 2 bij kinderen met overgewicht. Ned Tijdschr Geneeskd. 2003;147:2060-3.

  19. Schwimmer JB, Deutsch R, Rauch JB, et al. Obesity, insulin resistance, and other clinocopathological correlates of pediatric non-alcoholic fatty liver disease. J Pediatr. 2003;143:500-5.

    Google Scholar 

  20. Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346:802-10.

    Google Scholar 

  21. Freedman DS, Zuguo M, Srinivasan SR, et al. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150:12-7.

    Google Scholar 

  22. Becque MD, Katch VL, Rocchini AP, et al. Coronary risk incidence of obese adolescents: reduction by exercise plus diet intervention. Pediatrics. 1988;81:605-12.

    Google Scholar 

  23. Rocchini AP, Katch V, Anderson J, et al. Blood pressure in obese adolescents and effect of weight loss. Pediatrics. 1988;82:16-23.

    Google Scholar 

  24. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-9.

    Google Scholar 

  25. Boeck M, Lubin K, Kasparian D, et al. Initial experience with long term inpatient treatment in morbidly obese children. Ann NY Acad Sci. 1993; 699:257-9.

    Google Scholar 

  26. Braet C, Tanghe A, Bode PD, et al. Inpatient treatment of obese children: a multicomponent programme without stringent caloric restriction. Eur J Pediatr. 2003;162:391-6.

    Google Scholar 

  27. Rolland-Cachera MF, Thibault H, Souberbielle JC, et al. Massive obesity in adolescents: dietary interventions and behaviours associated with weight regain at 2 y follow-up. Int J Obes Relat Metab Disord. 2004;28:514-9.

    Google Scholar 

  28. Dao HH, Frelut ML, Oberlin F, et al. Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. Int J Obes Relat Metab Disord. 2004;28:290-9.

    Google Scholar 

  29. Knöpfli BH, Radtke T, Lehmann M, et al. Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys. J Adolesc Health. 2008;42:119-27.

    Google Scholar 

  30. Medisch Wetenschappelijke Raad van het Kwaliteitsinstituut voor de Gezondheidszorg CBO. Richtlijn Diagnostiek en behandeling van obesitas bij volwassenen en kinderen. Utrecht: CBO, 2008.

  31. Gezondheidsraad. Overgewicht en obesitas. Den Haag: Gezondheidsraad, 2003.

  32. Yanowski JA, Yanowski SZ. Treatment of pediatric and adolescent obesity. JAMA. 2004;289:1851-3.

    Google Scholar 

  33. Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of morbid obesity. Obes Facts. 2008;1:52-9.

    Google Scholar 

  34. Treadwell JR, Sun F, Schoelles K. Systematic review and meta-analyses of bariatric surgery for pediatric obesity. Ann Surg. 2008;248:763-76.

    Google Scholar 

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Authors
  1. O. H. van der Baan-Slootweg
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  2. M. N. Nollet
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  3. F. R. Weller
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  4. M. A. Benninga
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  5. W. M. C. van Aalderen
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Additional information

O.H. van der Baan-Slootweg, kinderarts-sociale pediatrie, M.N. Nollet, student, KBCZ Heideheuvel, Hilversum, en Emma Kinderziekenhuis, AMC Amsterdam. Dhr. dr. F.R. Weller, longarts, KBCZ Heideheuvel, Hilversum. Dhr. dr. M.A. Benninga, kinderarts-gastro-enteroloog, dhr. prof. dr. W.M.C. van Aalderen, kinderarts-pulmonoloog, Emma Kinderziekenhuis, AMC Amsterdam. O.H. van der Baan-Slootweg, KBCZ Heideheuvel, Soestdijkerstraatweg 129, 1213 VX Hilversum,

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van der Baan-Slootweg, O.H., Nollet, M.N., Weller, F.R. et al. Ernstige obesitas bij kinderen: een zaak van gewicht. KIND 78, 106–113 (2010). https://doi.org/10.1007/BF03089886

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