Evidence

​Childhood obesity - how big is the challenge?​

​Obesity is not only a problem of individuals, but conveys considerable global, economical, and societal threats and challenges. Obesity should be treated as a disease as declared by WHO in 1948, by the American Medical Association and the American Heart Association in 2013, by the Canadian Medical Association in 2015, and as recommended by the EASO Childhood Obesity Task Force in 2015.

This implies that obese children and youths must be offered a professional medical health care service in accordance with the Hippocratic Oath and thus the Convention on the Rights of the Child by the UNICEF: ‘State Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health”.

The prevalence of obesity has increased tremendously over the past decades. WHO currently estimates that 1.9 billion people worldwide are overweight and 600 million are obese. Also for children, the numbers are alarmingly high, with more than 42 million children under the age of 5 years being overweight.

Danish children and adolescents with overweight and obesity included in treatment with an average age of 12 years are heavily burdened; 51% exhibit prehypertension or overt hypertension, 31% exhibit hepatic steatosis, 27% exhibit dyslipidemia, 68% exhibit muscular steatosis, 50% exhibit sleep apnoea and 14% exhibit pre-diabetes.

Obesity in childhood tracks into adult life and increases the risks of obesity, cardiovascular disease, type 2 diabetes, and more than 20 forms of cancers in adulthood. Obesity has been calculated to account for 9% of all morbidity and mortality for cancers, 35% of all cardiovascular disease and 85% of all type 2 diabetes. The obesity epidemic is thus expected to result in a decrease in life expectancy and is regarded as one of the greatest challenges of health in the 21st century.

The Children’s Obesity Clinic

Since 2008, The Children’s Obesity Clinic – initiated and developed by Paediatrician, PhD, Associate Professor, Consultant Jens-Christian Holm – has included more than 4200 children with obesity into ‘the Children’s Obesity Clinic Treatment which is a multidisciplinary program based on current guidelines and standards for best-practice and authoritative recommendations. We strive constantly to develop and refine our treatment in order to optimize treatment results in regards to obesity and its related complications.

Treatment principles

The Holbæk obesity treatment method is a chronic care, multidisciplinary, best-practice, outpatient, childhood obesity treatment protocol involving health care professionals, including paediatricians, dieticians, nurses, psychologists, social workers, secretaries, and research technicians.

At the first visit, the child and family are introduced to the treatment protocol, which is a family-centred approach involving behaviour-modifying techniques, where the child and family receive an individually tailored and thorough plan of lifestyle advices. This individually tailored plan is presented to each child and family comprising 10-25 treatment plan points concerning sources and amounts of nutrition, sugar and fat intake, level and type of physical activity and inactivity, psychosocial functions, eating behaviours, hygiene, allowances, and sleep patterns. To date, more than 4200 children or adolescents and their families have started treatment

​The new pedagogy is a paradigm shift in itself and counter most of the traditional treatment methodolgies, especially those based on motivation as being central in treatment. Dr Holm argues that a central focus on motivation tend to distract and burden the patients treatment course. A treatment based on motivation tends to produce a patient that is to blame, which is unfair since it is the neuroendocrinological regulation of fat mass that actively defend and maintain fat mass over time, leaving the idea about motivation as a false statement. Further, motivational based treatment tends to give the patient the responsibility of treatment and have thus not understood that obesity is a disease where the health care professional has the treatment responsibility, like any other chronic disease.

Extraordinary results

​To date, The Children’s Obesity Clinic has treated more than 4200 unselected children with obesity. The first results showed a reduction in BMI SDS in 69 % after one year and 62% after 2 years, with a retention rate of 90% and 75%, respectively. Recent data from The Children’s Obesity Clinic document that this weight loss is maintained over the course of at least 3,5 years. Furthermore, the method has documented improvements in lipid levels, degree of hypertension, hepatic steatosis, the presence of visceral fat, sleep apnoea and improvements in quality of life, body image, appetite and bullying.

Dr Holm has accomplished forming a large networks unique in the atmosphere where we work closely together, ambitious and enthusiastic, with the goals of addressing and improving the challenges of childhood obesity. This has attracted more than 25 talented MDs contributing, highlighting, and emphasising the research needed to act in conjunction with the Convention on the Rights of the Child by UNICEF in order to provide proper care for children with obesity.

Dr Holm has based all developments on evidence, beginning with authoritative recommendations and metaanalyses to scientific results that has been published by the networks stimulated and developed by Dr Holm. The Danish Childhood Obesity Biobank has to date included more than 7000 children and adolescents with and without obesity, which has produced more than 25 PhD and research year projects. The Danish Childhood Obesity Biobank is thus the superstructure which has produced this evidence folder and more in collaboration with especially Professor Torben Hansen from The Novo Nordisk Foundation Centre for Basic Metabolic Research, where research consortia like TARGET, BIOCHILD, and MicroBliver are central.

Perspective

Overweight is no longer just an individual issue. We must, as society, take responsibility for overweight, exactly as we do with other chronic diseases. This requires a paradigm shift so that severe overweight is considered and treated in line with other chronic diseases such as asthma, diabetes and cancer.

​Selected scientific articles authored by Dr Holm

Comorbidities in children and adolescents with overweight and obesity

27% exhibit dyslipidemia (Appendix 1)

31% exhibit liver and 66% exhibit muscle steatosis (Appendix 2, Appendix 3, Appendix 4, and Appendix 5)

50% exhibit pre- or overt hypertension (Appendix 6 and Appendix 7)

10,4% exhibit subclinical hypothyroidism (Appendix 8)

16,5% exhibit vitamin D deficiency (Appendix 9)

Treatment in the primary sector with the following effects:

74% of patients exhibit weight loss (Appendix 10)

Improvement of quality of life (Appendix 11)

Reduction in blood pressure (Appendix 12)

Treatment in the secondary sector with the following effects:

69% and 75% exhibit weight loss (Appendix 13 and Appendix 14)

Reduction in cholesterol levels (Appendix 15)

Reduction in blood pressure (Appendix 16 and Appendix 17)

Reduction of fatty liver and muscle fat (Appendix 18)

Improvement of quality of life (Appendix 19)

Weight loss in parents (Appendix 20)

Improvements in 9 out of 10 in cholesterol levels/degree of obesity/body composition (Appendix 21)

Equally effective treatment response despite familiar predispositions to obesity related comorbidities (Appendix 22)

Equally effective treatment response despite impaired glucose metabolism (Appendix 23)

Equally effective treatment response despite a genetic risk score composed of 15 commonly occurring with impact on development of obesity in children and youth (Appendix 24)

Danish recommendations based on this method (Appendix 25)

Medication to children and adolescents with obesity

Patients with MC4R mutations can be treated with medicine (Appendix 26)

Inconsistencies in dosage of medication in children and youth with obesity  (Appendix 27)​

Genetic aspects of childhood obesity

Identification of 3 new genes with impact on obesity in children and youth (Appendix 28)

Genetic risk score describing insulin sensitivity, metabolic disease and altered fat distribution (Appendix 29)

Genetics and thyroid hormones (Appendix 30)

Genetics, birth weight and cardiovascular disease later in life (Appendix 31)

Maternal and fetal genetic effects on birth weight and their relevance to cardio-metabolic risk factors (Appendix 32)

Pregnancy and early growth

Affected birth weight and length of pregnancy (Appendix 33)

Obesity related markers of gestational diabetes (Appendix 34)

Association between birth weight, degree of obesity, and body composition (Appendix 35 and Appendix 36)

Other effects of childhood obesity

The gut microbiome can induce obesity (Appendix 37)

Physical activity in children and adolescents with obesity (Appendix 38)

Investigation of sensory-specific satiety (Appendix 39)

Markers of childhood obesity

Reference values for markers of obesity and comorbidities (Appendix 40, Appendix 41, and Appendix 42)

Changes in markers of obesity and comorbidities following obesity treatment (Appendix 43, Appendix 44, Appendix 45, and Appendix 46).

Relation between high blood glucose and comorbidities (Appendix 47 and Appendix 48)

Regarding obesity as a chronic disease and the lack of available treatment options

Position statement for declaring obesity as a chronic disease in Europe (Appendix 49)

Lack of available treatment clinics in Denmark (Appendix 50)​​

Proposal for new diagnostic criteria for obesity (Appendix 51)

Treatment and ethic

The ethics in childhood obesity treatment (Appendix 52)

Contact​

Dr Holm
Kalundborgvej 114
4300 Holbæk

Phone: +45 61469960

E-mail: contact@drholmcourses.com

Dr Holm

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Dr Holm
CVR 28050542

Dr Holm Health ApS
CVR 39247488

Dr Holm App ApS
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