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Evaluation of the Dutch preventive Youth Health Care (YHC) Overweight Prevention-protocol and Overweight Detection-protocol among 5-year-old children in a cluster randomized trial


Het doel van het samenwerkingsproject ‘Lekker bewegen, goed eten’ is het evalueren van twee werkwijzen voor de Jeugdgezondheidszorg (JGZ).

In groep 2 komen de kinderen bij de schoolarts en wordt vastgesteld of zij normaal gewicht, overgewicht of obesitas hebben (Signaleringsprotocol). Als een kind overgewicht heeft wordt aan het kind en de ouders een aantal vervolggesprekken bij de schoolarts aangeboden (Overbruggingsplan). De extra gesprekken richten zich op de gedragingen die overgewicht verminderen.

Aan de evaluatie doen ongeveer 9000 kinderen van 4 tot 7 jaar met hun ouders mee. Het effect van beide werkwijzen op het gewicht van het kind en de gezondheidsgedragingen wordt onderzocht door een groep kinderen die geen extra gesprekken krijgt te vergelijken met een groep kinderen die wel de extra gesprekken krijgt.


Samenvatting van de aanvraag

Overweight and obesity are main determinants of the ZonMw priority diseases. The prevalence of overweight and obesity among children has at least doubled in the past 25 years, especially in socially disadvantaged and specific ethnic subgroups. Overweight and obesity in childhood track into adulthood moderately to very well. Adverse health effects of adult overweight and obesity and of childhood obesity, resulting in considerable loss of healthy-life expectancy, have been well documented. Obesity in adulthood is associated with increased prevalence of diabetes, cardiovascular disease, distinct types of cancer, and orthopedic problems; also associations with asthmatic disease and psychological disorders have been shown. Obesity in childhood is associated with increased adult morbidity and mortality, even independent of adult weight. Adverse health effects of childhood obesity that already emerge during childhood, such as diabetes type II, increased levels of cardiovascular risk factors, knee complaints, apnea during sleep and psychosocial problems have also been documented. The current study proposes to evaluate a monitoring intervention and a counseling intervention in the setting of Dutch Youth Health Care (YHC), aiming at the prevention of obesity in childhood and at the prevention of overweight and obesity in adulthood. Among the recently prioritized topics for YHC evaluation studies in the ZonMw Prevention program, the evaluation of YHC monitoring and prevention of childhood overweight and obesity have both been rated “top priority”. Dutch Youth Health Care (YHC) may contribute to the prevention of overweight and obesity by the recently developed YHC Overweight Detection-protocol (Signaleringsprotocol Overgewicht) and Prevention-protocol (Overbruggingsplan Overgewicht). The Detection-protocol identifies children with “overweight but no obesity”, and these children and their parents are offered the Prevention-protocol with up to three visits with a program of non-directing behavioral counseling to improve health behaviors and to reduce body fatness. Children with “obesity” will be referred to the family physician. These protocols have proven to be feasible and acceptable. The Prevention-protocol, however, has not yet been subjected to a rigorous effect evaluation. This study contributes to the evaluation of the Detection- and Prevention-protocol, as applied by YHC to 5-year-olds. Experts consider this age group as most relevant since it is early enough to really prevent the development of childhood obesity, while avoiding preschool years with a less established relationship with obesity in later life. Furthermore, at age 5 years, YHC has a very high coverage (97%). We propose a cluster-randomized trial with YHC-teams as unit of randomization. In the Intervention group both the Detection-protocol and the Prevention-protocol will be applied, while in the Control group the Detection-protocol will be applied in combination with “usual care”. Thirty-six YHC teams from six Municipal Health Services will invite, during one school year, 14.400 5-year-olds and their parents to participate in the study with an expected participation rate of 50% (n=7.200). Assuming a prevalence of “overweight, not obesity” of 9% and a dropout of maximally 30%, we expect complete data on 450 children with “overweight not obesity at baseline” of whom 225 belong to the Intervention group and 225 to the Control group. We will evaluate the effects of the Overweight Prevention-protocol among overweight children in terms of measures of body fatness and in terms of overweight-reducing and -inducing behaviors at 2-year follow-up. Secondarily, within the Control group, we will evaluate the fundament of the Screening protocol by evaluation of how normal weight, overweight and obesity according to the Detection-protocol at age 5 years, predict these outcomes at age 7 years, and how this is moderated by the parent-reported overweight-reducing and -inducing behaviors and by participation in weight-management interventions. In addition we will conduct a thorough process evaluation. Intention to treat and secondarily additional per protocol analyses will be applied. We will use multi-level analyses to allow for dependency between the individual measurements within the YHC-teams. Differences in effects and process characteristics for subgroups socially disadvantaged and non-Dutch children will be explored. Finally, a cost-effectiveness analysis will be performed using a societal perspective, including program and parents costs. The primary analysis will be based on the key outcome measures, whereas a secondary analysis will translate the findings into long-term health effects and costs with use of modeling techniques.



Looptijd: 100%
Looptijd: 100 %
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Projectleider en penvoerder:
Verantwoordelijke organisatie:
Erasmus MC