C H A P T E R 6 tribute to the prevention of overweight at an early age. However, most of these risk factors are mainly subjective and difficult to change. Therefore, a more objective parameter like the PI in our prediction model can be very helpful in preventive strategies. If the meaning of the PI value is carefully explained to the parents, this might contribute to a greater awareness and risk perception of overweight. The prediction model, as described in this manuscript, can simply be used in practice and added to the resources that health care practitioners use in preventing over-‐ weight in childhood, at the moment. Most interventions, targeted at the prevention and reduction of overweight, are applied from the age of 2 years. Mainly, they are focused on environmental and behavioral factors, like promoting healthy food and drinks, creating sport facilities and safe zones for cycling to school, restrictions on the advertising of soft drinks and energy dense food and demotivating sedentary recreation, like watching TV or playing computer games18. In this manuscript we focused on the prediction of overweight by using the PI in early childhood (0-‐1 year). By using our model, pre-‐ diction and thereby prevention of overweight can already initiated at a very early age, even before it can be diagnosed. In the Netherlands the Youth Health Care is concerned with the healthy physical and psychosocial development of children, between 0 and 19 years of age. With respect to the growth of children in their early years, the Youth Health Care exam-‐ ines children regularly during their visits to the Youth Health Care centers with their parents. During the first year of life, there are approximately 10 measure-‐ ments of the child by the youth health care, thereafter approximately 5 measure-‐ ments until the age of 5 years. By means of these frequent examinations, it is possi-‐ ble to monitor the growth of a child and to intervene at the moment that a child tends to become overweight. Our prediction model can be a useful additional in-‐ strument in the prevention of overweight. If this prediction model could be implemented in the electronic child record, the Youth Health Care physician, pediatrician or nurse can show parents the risk of their child of becoming overweight, taken a cut-‐off point of PIm > PIe + 2SD at the age of 1 year. Only the data of PI at birth, based on birth weight and birth length and the actual age of the child are needed in the risk calculation. By digital registration, it is possible to immediately show the risk of becoming overweight on their com-‐ puter screen. For example, if the child is not at risk, the screen will show a green color; if the child is at risk, the screen will show a red color. To countervail the risk that the parents do not accept the advice of the health care practitioner, because the risk is a calculated risk which does not exist yet, it is of great importance to train the health care practitioners in motivational interviewing. Motivational interviewing assumes that behavior change is affected more by moti-‐ 100
Proefschrift binnenwerk Manon Ernst_DEF.indd
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