The development and implementation of integrated care for childhood overweight and obesity in the Netherlands

Obesity is a complex public health issue representing a major threat to children's health worldwide. In the Netherlands, almost one in six children aged 0-19 years has either overweight or obesity. In 2021, 12.3% of the children aged 4-17 years had overweight and 3.5% had obesity. Preventing and treating childhood overweight and obesity is one of the major Dutch public health ambitions. Childhood overweight and especially obesity are associated with a range of short and long-term physical health and psychosocial health problems. For children with obesity, the risk of adult obesity is particularly high, indicating that childhood obesity is an enduring phenomenon showing considerable continuity with adult obesity. The development of overweight and obesity occurs as a complex interaction between biological factors (such as genetic, hormonal or physiological factors), psychological factors (such as self-image, mood or well-being) and social factors (such as contact with peers, school or authorities). To understand potentially contributing factors in the development of childhood overweight and obesity, the context in which children live need to be considered, such as relationship with parents, family, peers, socio-economic position, society and culture. Therefore, appropriate support and care to the individual child and the family in which the child grows up need to be offered. This can be defined by a collaboration of different organizations and professionals from the healthcare domain and social domain in a network, also called integrated care. In the Netherlands, a ‘National model integrated care for childhood overweight and obesity’ has been developed that sets out a structure that provides a basis for local integrated care for children with overweight and obesity. The Dutch integrated care for childhood overweight and obesity requires a coordinating professional (CP) who coordinates and monitors the coherence of all activities as part of the integrated care. Since CPs play an important role in coordinating and cohering all activities of the integrated care, they need to feel equipped and prepared to adequately provide support and care to children with overweight and obesity and their families. Therefore, it is important that CPs have sufficient competences such as knowledge, skills about and appropriate attitude towards children with overweight and obesity to fulfil their role. At this moment, the integrated care for childhood overweight and obesity is implemented in 42 Dutch municipalities. In 2030 it should have been implemented in all Dutch municipalities. In order to optimize stepwise local implementation of the integrated care, it is essential to closely monitor the activities and process in the municipality. This thesis describes the history and development of the Dutch model for integrated care for childhood overweight and obesity and first insights into implementing this model, thereby focusing on childhood obesity assessments and the crucial role of the CP. These insights will facilitate the further development of the integrated care model and their implementation, which will lead to improved support and care for children with obesity and their families and thereby help improve the health, quality of life and societal participation of these children.