D I S C U S S I O N A N D V A L O R I Z A T I O N A D D E N D U M Evidently, we can speak of a negative spiral or vicious circle especially of people with a low social economic situation who are obese and stay in this low social eco-‐ nomic situation. There is a lot of advertising to buy fast food. Fast food is much cheaper than healthy food and there is an abundance of fast food in supermarket shelves. Due to this overwhelming exposure of cheap, tasty, unhealthy food, it is difficult for lots of people to choose for the more expensive healthy food. Hollingworth et al performed an economic analysis of interventions to treat child-‐ hood obesity. This study showed that interventions are potentially cost effective although cost savings and health benefits may not appear until the sixth or seventh decade of life26. From that age on most physical disabilities and health care costs exists. All data show that it is of great importance to prevent people from becoming obese because not only the medical and psychosocial, but also the economic conse-‐ quences, are alarming. In The Netherlands an estimated 505.4 million euros is spent on direct conse-‐ quences of obesity, this is approximately 1.6% of the total healthcare costs of adults above the age of 2027. Prevention programs Prevention at an early age is necessary in reducing the problem of obesity or mal-‐ nutrition and its co-‐morbidities, which will be a threat for the population in the future. Health professionals, who provide primary care for children, are in the cen-‐ ter of the pediatric obesity epidemic and can play a pivotal role in early detection of obesity. Obesity in childhood is one of the most challenging diseases to tackle these days. Once overweight or obesity is manifested, it is very difficult to reduce weight. Also for the Netherlands this tendency prevails and many local, as well as national health programs are focused on reducing the incidence of obesity. Nowadays, lots of preventing programs for overweight have been developed. Most of these programs are focused on healthy food and drinks, stimulating exercise / physical activity and demoralize inactive living. Apparently these programs are not effective enough. Thereby, most programs are aimed at school-‐aged children and adolescents. Fewer programs have younger children as target group. Because school aged children often suffer already from obesity, prevention at a very early age is of great im-‐ portance to prevent overweight and obesity instead of treatment. Multiple studies have investigated the effectiveness and functionality of prevention programs for overweight and obesity in childhood. Cauwenberghe et al found strong evidence of effect for multicomponent interventions on fruit and vegetable intake in children. His finding was based on self-‐reported dietary behavior. Howev-‐ 111
Proefschrift binnenwerk Manon Ernst_DEF.indd
To see the actual publication please follow the link above