History

In 2003, the Dutch Health Council determined that obesity is a chronic disease. That same year, the American Medical Association confirmed what the World Health Organization (WHO) determined about obesity as early as 1948: a chronic disease.

Multidisciplinary guideline

Not long after, the development of the first Dutch multidisciplinary evidence-based guideline for the diagnosis and treatment of obesity in adults and children began. The guideline appeared¹ in 2008. That was also the founding year of the Partnership Overweight Netherlands (PON) in which professional organizations, insurers and patients considered what constitutes good care for obese children and adults. PON received funding from the Ministry of Health, Welfare and Sport. Meanwhile, the updated guideline (2023) is available online (in Dutch) in the guideline database² and summary information can be viewed in the webinar on the guideline in children.

Care standard obesity

The guideline produced the first Dutch Obesity Care Standard in 2010. This guideline contains agreements on the diagnosis and treatment of obesity, based on science (including the national guideline) and national multidisciplinary consensus³.

Attention to prevention

Meanwhile, attention to the importance of prevention increased. This resulted in funding from the Ministry of Health, Welfare and Sport for the Convenant Overgewicht (Overweight Covenant), which later became the Convenant Gezond Gewicht (Healthy Weight Covenant). Starting in 2010, the focus of the Covenant shifted to childhood obesity and the name changed to JOGG (Youth at Healthy Weight, later JOGG - Healthy Youth, Healthy Future). JOGG aims for all children and youth in the Netherlands to grow up in a healthy living environment.

Care for children

In 2013, the Ministry of Health, Welfare and Sports (VWS) decided to pay more attention to children in terms of care as well. The ministry stopped funding the Partnership on Overweight Netherlands and started funding Care for Obesity. This project, like the previous Overweight Netherlands Partnership (PON) hosted by the Vrije Universiteit Amsterdam, aims to promote the implementation of the Obesity Care Standard for children. This resulted in 2018 in the first "National Model for the Chain Approach for Overweight and Obese Children^"4.

Collaboration

From 2019 to 2022, the coalition of five national organizations called Kind naar Gezond Gewicht (KNGG, Child to a Healthier Weight), with funding from the Ministry of Health, Welfare and Sport, worked to scale up, secure and further develop this approach. These five organizations were: JOGG, Vrije Universiteit Amsterdam/Care for Obesity, Nederlands Centrum Jeugdgezondheid, Nederlands Jeugdinstituut and the National Institute for Public Health and the Environment. The implementation organization Kind naar Gezonder Gewicht, which emerged from this, was incorporated as a department within JOGG⁵ in 2021.

This period also saw the start of the periodic revision of both the national umbrella guideline on obesity and the Care Standard Obesity by Care for Obesity (for children) and the Partnership Overweight Netherlands (for adults).

Connection between prevention and care: integral approach

It is becoming increasingly clear that an integral approach of prevention and care is needed to prevent children and adults from developing overweight or obesity and to promote good care and support. Such an approach is called an integral approach or a systems approach ^6,7. An example is the Amsterdam Approach to Healthy ^Weight8 and the approach Samen Gezond 's Hertogenbosch⁹.

Changes in society and for the individual

An integrated approach to healthy weight means that the public, social, medical and private sectors are involved to keep society and residents healthy. Preventive activities include education, creating a healthy living environment and individual support and care for overweight and obesity. Support and care involves both help with behavioral changes in lifestyle (exercise, sleep and nutrition) and attention to underlying psychosocial problems. In this way, professionals help to sustainably improve lifestyle, health, quality of life and social participation of children and socioeconomic health disparities are reduced⁴.

References

1. Quality Institute for Healthcare CBO. (2008). Richtlijn Diagnostiek en behandeling van obesitas bij volwassenen en kinderen. Alphen aan den Rijn: Van Zuiden Communications B.V.
2. Seidell, J.C., Halberstadt, J. Summary of the Children's section of the 'Guideline on overweight and obesity in adults and children. Diagnosis, support and care for people with obesity or overweight combined with risk factors and/or comorbidities' TSG Journal of Health Law 101, 46-52 (2023).
3. Seidell, J., Halberstadt, J. Niemer, S. & Noordam, H. (November 2010). Care standard Obesity. Amsterdam: Partnership Overweight Netherlands.
4. Sijben, M., van der Velde, M., van Mil, E., Stroo, J. & Halberstadt, J. (December 2018). National model chain approach for overweight and obese children. Amsterdam: Care for Obesity.
5. Website of the implementation organization 'Child to Healthier Weight'.
6. Bagnall, A.-M., Radley, D., Jones, R., Gately, P., Nobles, J., Van Dijk, M., ... Sahota, P. (2019). Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC public health, 19(1), 8. doi:10.1186/s12889-018-6274-z.
7. Pan American Health Organization. (2011). Population and individual approaches to the prevention and management of diabetes and obesity. Washington, D.C.: PAHO.
8. Municipality of Amsterdam. Program Information Approach to Healthy Weight.
9. Municipality of 's Hertogenbosch. Together Healthy 's-Hertogenbosch.