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A mother comes to the doctor with a child too heavy with, say, a twisted ankle. What does this doctor say? "Most GPs will not increase the weight," says Dr. Annemarie Schalkwijk. "This mother comes here with another question, so generalists often have a hard time saying: that's it, I also see that you're too heavy.Although such a single offers a good starting point. can make a connection with the weight. "
Annemarie Schalkwijk (Soest, 1975) graduated last Friday at the Free University of Amsterdam on research on the approach of the university. childhood obesity. Who cares ?, She gave her title. As ambiguous as in the English sense that can not be translated. Who cares for children with obesity? But also: who cares?
Why are GPs so hesitant?
"Sometimes they are afraid of damaging the patient's trust. A large part does not see it as their task: a consultation lasts ten minutes, they have little time. You often hear: why should we take care of this when the child's environment does not change? It is wiped with open tap. Or GPs became disappointed because attempts to let children lose weight failed. This is understandable, but that does not mean you should not continue to report and motivate. "
Since 1980, the number of children in the Netherlands with overweight and obesity has doubled.Almost 14% of primary school children are overweight, a small part of they were even severely overweight (obesity) .At earlier, in 2010, a new guideline for general practitioners came in. He explained that the treatment of overweight children should consist of an individual care plan with a caregiver as a point The help was needed for the whole family, aiming at more exercise, healthy eating and psychological support. "Die Zorgstandaard, Schalkwijk concludes after his research among general practitioners and families in Amsterdam. West, is "impractical." Parents and children are difficult to motivate because they sometimes do not see the health risks themselves.It is not possible for general practitioners to play the role of "supplier Central Health Care "and communication with other health care providers is inadequate.
Half is overweight
Overweight in 2017 had 13.5% of Dutch children aged 4 to 18 years. 2.8% were severely overweight (obese).
Overweight accounts for more than half of all Dutch adults. 14% of adults are obese, 2.5 times more than in the early 1980s, according to the CBS and RIVM.
Morbid Obesity account for one in every 100 Dutch people, these people often develop serious health problems
Obesity increases the risk of diabetes and [19659002] Meanwhile, other caregivers have often taken charge of this central role, but overweight children are still there.
A "naughty problem" is called obesity. A difficult social problem. So many factors play a role, that you do not know where to start. Whether you live in a neighborhood where you can play outside, what kind of school you are in, socio-economic status, but also parenting and the background of the parents themselves play a role. And also the child himself and his behavior. Schalkwijk: "Smoking also lasted thirty years and it was easier because you have to eat every day, food is intertwined with our whole lives and unhealthy food is everywhere."
You spoke to many parents and children for your research. What are they struggling with?
"In the past, we talked about" peace, cleanliness and regularity ", it seems old-fashioned now, but it's always a balance and it's difficult. see with knowledge and skills.What is healthy food? Many parents do not know it. "Can we ever have a cup of chips?" Yes, sometimes you can get some chips, but finding the balance is not self-evident.The lifestyle change is difficult for everyone.Education is again added.Put rules and keep them, constantly maintain the changes – all the world with children knows that it is not easy. "
If you have to do it alone, a healthy lifestyle is very difficult
Annemarie Schalkwijk
If it does not work To lose weights, families are often disappointed and caught in a trap. Is exercise and healthy eating sometimes not too demanding?
"Families often struggle with a combination of problems – financially, psychologically, et cetera. If your head is already full of worries, how can you change your lifestyle? If there is too little money for the sport, you can look for other options: how are you going to school? Can you ride on the bike instead of by car? Or if you go by bus: can you get off at two stops earlier? To map the whole thing, you have to ask a lot of questions and divide it into small blocks. "
Read also: We eat too much sugar, and it's not just our fault
Does your culture make a difference?
We have ensured that all nationalities are represented in the survey, and then you see little difference. In families of Turkish or Moroccan origin, the role of grandfather and grandmother in education can be a hindrance as he continues to pamper the child with sweets . But a father in a Dutch family who does not cooperate makes it just as difficult for a mother who wants to make the family healthy. If you have to do it alone, a healthier lifestyle is very hard to reach, you need support from the environment.
"Parents and children also say that it is important that everyone has the same goal in health care. There is a whole network around him – the central health care provider of youth health, the general practitioner, a pedagogue, a dietician, you name it. Sometimes parents and children have to tell the same story ten times and they receive different advice. And being overweight is not fun to tell.
You describe that of the 327 overweight children who were invited to participate in a program, there were only 28 on the image after a year among general practitioners. Is not it frustrating?
"I have never felt frustrated with families, sometimes I thought: why does one succeed and the other does not work? But small successes are enough to continue. A father with diabetes, a son who is overweight, a mother who makes the connection and who receives the whole family, or a little boy who did not want to go first and with whom the penny fell at that time. to unhealthy temptations all day long, so intrinsic motivation is so important.
Also read the article of opinion of surgeon Frits Berends: Obesity does not solve with Sla & Sports
"J & I said, astonished cooperation in health care, caregivers who are afraid to share information with the general practitioner, or obstacles in ICT and administration, which makes the then a health care provider said, for example: I think the mother is depressed.And then I asked: did you call the doctor? A GP sees the whole family, who knows what In another village, this contact may be more obvious, but you must also know yourself in the city. "
Do you see improvements in recent years?
"Obesity and overweight in children are decreasing, but in the 0 to 2 group not yet, so you need to provide information before pregnancy." In young general practitioners, I see more than 30 years old. Interest in identifying overweight and discussing prevention.When talking to colleagues, I give practical advice: make sure that the scale and the tape measure are in the way of walking so that you can measure and weigh the children during the physical examination.Parents often wonder if it is in order.You can also ask how it is going to school, do you have friends and girlfriends In either case, you have an opening for a conversation.It is unfortunate that the consultation time ends.In the end, every family doctor wants a child to feel good.
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