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.

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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”.

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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. The numbers are also alarmingly high for children, with more than 42 million children under the age of 5 years being overweight.

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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 14 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.

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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.

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Treatment principles

The Dr Holm 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.

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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. 

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​The new pedagogy is a paradigm shift in itself and counter most of the traditional treatment methodologies, 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 patient's 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.

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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 network 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.

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Dr Holm has based all developments on evidence, beginning with authoritative recommendations and meta-analysis 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.

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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.
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