OVERWEIGHT/OBESITY
Overweight
Children:
Best time to refer to the dietician:
- BMI > 25 kg/m2 and Z-score (BMI-SDS) > 1.5
Relevant information for the dietician:
- Diagnosis: overweight / obesity, other relevant diagnoses needed (blood pressure, blood glucose, insulin resistence, lipid spectrum, joint symptoms and sleeping pattern), any comorbid conditions
- Medication: psychopharmaceuticals, corticosteroids
- Other: height, (changes in) weight, limiting factors.
Aims of the diet:
- maintain or reduce body weight, depending on risk level
- gradually build healthy dietary habits
- improve eating behavior within the family, having the parents/guardians set an example
- increase physical activity
- raise self-esteem
Characteristics of the diet:
- (Low calorie) diet, leading to improving eating behavior
- regular eating pattern
- increase physical activity
Treatment time:
- Care level 3, see “Dietician’s working methods.”
Specific remarks:
- Treatment should involve participation of parents/guardians.
- Treatment should be part of a multidisciplinary approach.
References:
Braet C, Winckel M. Behandelingsstrategieën bij kinderen met overgewicht.
Diemen: Bohn Stafleu Van Loghum; 2001
Bulk-Bunschoten AMW, Renders CM et al. Signaleringsprotocol Overgewicht in de Jeugdgezondheidszorg. Amsterdam: VUmc 2004
Delfos M. Communiceren met kinderen en jeugdigen: Luister je wel naar mij en Ik heb ook wat te vertellen (ISBN 978-90-6665-652-9)
Renders CM, Seidel JC et al. Overgewicht bij kinderen en adolescenten. Maarssen: Elsevier Gezondheidszorg; 2003. Wezel BJ van. Te hoog gewicht bij kinderen. In: Handboek Dieetbehandelingsrichtlijnen, Maarssen: Elsevier gezondheidszorg; 2004
Overweight in Children: was updated by Berdien van Wezel, dietician at Diëtistenpraktijk Van Wezel, also on behalf of the Netwerk Diëtisten Overgewicht en Obesitas (NDOeO).
Overweight
Adults
(Overweight: BMI ≥ 25 kg/m2 and/or waist circumference for men ≥ 102 cm and for women ≥ 88 cm, obesity: BMI ≥ 30 kg/m2 and/or waist circumference for men ≥ 102 cm or for women ≥ 88 cm)
Best time to refer to the dietician:
- Overweight/obesity exists when one of the following is present:
- BMI ≥ 25 kg/m2 and/or waist circumference for men is ≥ 102 cm and for women ≥ 88 cm
- BMI ≥ 25 kg/m2 and comorbidity
- an annually increasing BMI and/or waist circumference
Relevant information for the dietician:
- Diagnosis: overweight/obesity, any comorbid conditions
- laboratory results: glucose, lipids (including triglycerides), blood pressure, HbA1c
- Medication: weight control drugs, psychopharmaceuticals, medication for treating a comorbidity, corticosteroids, antihistamines, antimigraine drugs
- Other: height, (changes in) weight, relevant past medical history
Aims of the diet:
- Reduce body weight by ½-1 kg per week. To reach the greatest health benefit, the goal is to lose 5-15% of the weight in a year. The target weight loss depends on the patient’s health status at the start of treatment, medication use, and other factors.
- Aim for keeping the weight off over the long term.
- Educate about healthy eating habits.
- Provide insight into eating behavior and how to change eating behavior by means of self control techniques based on behavioral therapy.
Characteristics of the diet:
- Low-calorie diet that leads to improvement of eating behaviors
- increase physical activity.
Treatment time:
- The degree of intensity of treatment depends on the severity of the associated health risk and the patient’s need for dietary advice in that regard. For an accurate classification see the Zorgstandaard Obesitas (Obesity Care Standard) (expected in November 2010).
- Care level 3-4, see “Dietician’s working methods.”
Specific remarks:
- The dietician devotes extra attention to diagnosing eating disorders.
References:
CBO. Multidisciplinaire behandelrichtlijn obesitas. Utrecht: 2008 Gezondheidsraad. Werkprogramma (2006). Gezondheidsraad/RGO Den Haag. Gezondheidsraad 2005. Publicatie nr A05/05. Publicatie RGO 50
Han TS, Leer EM van, et al. Waist circumference as a screening tool for cardiovascular risk factors: evaluation of receiver operating characteristics (ROC). Obes Res. 1996 Nov; 4:533-47
Nauta H. Nothing to lose? Cognitive and behavioral therapy for obesity and binge eating disorder. Dissertation. Maastricht: University of Maastricht, 2001.
Pasman WJ. Obesity treatment and weight maintenance. Dissertation. Maastricht: University of Maastricht, 1998.
WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO Tech. Rep.Ser 894, Geneva 2000.
Overweight in Adults was updated by Leontine van Meggelen, dietician at Invorm Praktijk voor Dieet- en Sportvoedingsadviezen and Ellen Govers, dietician at Amstelring, also on behalf of dieticians Netwerk Diëtisten Overgewicht en Obesitas (NDOeO).