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Intensive Inpatient Treatment for Severely Obese Children and Adolescents: Costs and

Effects

Makkes, S.

2015

document version

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Link to publication in VU Research Portal

citation for published version (APA)

Makkes, S. (2015). Intensive Inpatient Treatment for Severely Obese Children and Adolescents: Costs and Effects.

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156 /ŶƚƌŽĚƵĐƟŽŶ ŚŝůĚŚŽŽĚŽďĞƐŝƚLJŚĂƐďĞĐŽŵĞĂŵĂũŽƌŐůŽďĂůŚĞĂůƚŚĐŚĂůůĞŶŐĞŽǀĞƌƚŚĞƉĂƐƚƚŚŝƌƚLJLJĞĂƌƐ͘ dŚĞ ƉƌĞǀĂůĞŶĐĞ ŽĨ ŽǀĞƌǁĞŝŐŚƚ ĂŶĚ ŽďĞƐŝƚLJ ŚĂƐ ŝŶĐƌĞĂƐĞĚ ƐƵďƐƚĂŶƟĂůůLJ ŝŶ ĐŚŝůĚƌĞŶ ĂŶĚ ĂĚŽůĞƐĐĞŶƚƐďĞƚǁĞĞŶϭϵϴϬĂŶĚϮϬϭϯŝŶďŽƚŚĚĞǀĞůŽƉĞĚĂŶĚĚĞǀĞůŽƉŝŶŐĐŽƵŶƚƌŝĞƐ͘ĞƐƉŝƚĞĂ ůĞǀĞůŝŶŐŽīŝŶƚŚĞƉƌĞǀĂůĞŶĐĞŽĨĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJ͕ĂƐƐĞĞŶƌĞĐĞŶƚůLJŝŶƐŽŵĞĐŽƵŶƚƌŝĞƐ͕ƚŚĞƌĞ ŝƐĂǁŽƌƌŝƐŽŵĞŝŶĐƌĞĂƐĞŝŶƚŚĞƉƌĞǀĂůĞŶĐĞŽĨƐĞǀĞƌĞĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJ͘ ^ĞǀĞƌĞĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJĐĂŶŚĂǀĞŶĞŐĂƟǀĞĐŽŶƐĞƋƵĞŶĐĞƐŽŶďŽƚŚƚŚĞĐŚŝůĚ͛ƐƉŚLJƐŝĐĂůĂŶĚ ƉƐLJĐŚŽƐŽĐŝĂůŚĞĂůƚŚ͘ŚŝůĚƌĞŶĂŶĚĂĚŽůĞƐĐĞŶƚƐǁŝƚŚƐĞǀĞƌĞŽďĞƐŝƚLJŚĂǀĞĂŶŝŶĐƌĞĂƐĞĚƌŝƐŬ ŽĨ ƐĞǀĞƌĂů ĐŚƌŽŶŝĐ ĚŝƐĞĂƐĞƐ ƐƵĐŚ ĂƐ ĚŝĂďĞƚĞƐ ŵĞůůŝƚƵƐ ƚLJƉĞ Ϯ͕ ĐĂƌĚŝŽǀĂƐĐƵůĂƌ ĚŝƐĞĂƐĞƐ ĂŶĚ ŵƵƐĐƵůŽƐŬĞůĞƚĂůĂŶĚƌĞƐƉŝƌĂƚŽƌLJƉƌŽďůĞŵƐ͘/ŶĂĚĚŝƟŽŶƚŽƚŚĞƐĞƉŚLJƐŝĐĂůĐŽŶƐĞƋƵĞŶĐĞƐ͕ůŽǁ ƐĞůĨͲĞƐƚĞĞŵĂŶĚďĞŚĂǀŝŽƌĂůƉƌŽďůĞŵƐĂƌĞĐŽŵŵŽŶůLJƐĞĞŶŝŶŽďĞƐĞĐŚŝůĚƌĞŶ͘^ĞǀĞƌĞůLJŽďĞƐĞ ĐŚŝůĚƌĞŶ ĂŶĚ ĂĚŽůĞƐĐĞŶƚƐ ĂůƐŽ ƌĞƉŽƌƚ ĂŶ ŝŵƉĂŝƌĞĚ ƋƵĂůŝƚLJ ŽĨ ůŝĨĞ ;YŽ>Ϳ͕ ǁŝƚŚ YŽ>ͲƐĐŽƌĞƐ ƐŝŵŝůĂƌƚŽŝŶĚŝǀŝĚƵĂůƐĚŝĂŐŶŽƐĞĚǁŝƚŚĐĂŶĐĞƌ͘dŚĞƉƌĞƐĞŶĐĞŽĨƐĞǀĞƌĞŽďĞƐŝƚLJŝŶĐŚŝůĚŚŽŽĚ ŝƐ ƚŚĞƌĞĨŽƌĞ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ŝŶĐƌĞĂƐĞĚ ĚŝƌĞĐƚ ĐŽƐƚƐ ĂƐ Ă ƌĞƐƵůƚ ŽĨ ŝŶĐƌĞĂƐĞĚ ƵƟůŝnjĂƟŽŶ ŽĨ ŚĞĂůƚŚĐĂƌĞ ƐĞƌǀŝĐĞƐ͘ ,ĞĂůƚŚĐĂƌĞ ƐĞƌǀŝĐĞƐ ŝŶĐůƵĚĞ ĨŽƌ ĞdžĂŵƉůĞ ƚŚĞ ƉƌĞƐĐƌŝƉƟŽŶ ŽĨ ĚƌƵŐƐ͕ ĞŵĞƌŐĞŶĐLJƌŽŽŵǀŝƐŝƚƐ͕ŽƵƚƉĂƟĞŶƚǀŝƐŝƚƐ͕ĂŶĚŝŶƉĂƟĞŶƚƚƌĞĂƚŵĞŶƚ͘ dŽĐŽƵŶƚĞƌĂĐƚƚŚĞŶĞŐĂƟǀĞƉŚLJƐŝĐĂůͲ͕ƉƐLJĐŚŽƐŽĐŝĂůŚĞĂůƚŚ͕ĂŶĚĞĐŽŶŽŵŝĐĐŽŶƐĞƋƵĞŶĐĞƐ͕ŝƚ ŝƐŶĞĐĞƐƐĂƌLJƚŽƚƌĞĂƚĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJ͘^ŝŶĐĞďĂƌŝĂƚƌŝĐƐƵƌŐĞƌLJŝƐŶŽƚĐƵƌƌĞŶƚůLJĐŽŶƐŝĚĞƌĞĚ ĂŶĂƉƉƌŽƉƌŝĂƚĞƚƌĞĂƚŵĞŶƚŽƉƟŽŶĨŽƌĐŚŝůĚƌĞŶĂŶĚĂĚŽůĞƐĐĞŶƚƐŝŶƚŚĞEĞƚŚĞƌůĂŶĚƐ͕ŝŶƚĞŶƐŝǀĞ ůŝĨĞƐƚLJůĞ ƚƌĞĂƚŵĞŶƚ ŝƐ ƚŚĞ ŽŶůLJ ǀŝĂďůĞ ƚƌĞĂƚŵĞŶƚ ŽƉƟŽŶ ĨŽƌ ƚŚĞ ŵĂũŽƌŝƚLJ ŽĨ ĐŚŝůĚƌĞŶ ĂŶĚ ĂĚŽůĞƐĐĞŶƚƐ ǁŝƚŚ ƐĞǀĞƌĞ ŽďĞƐŝƚLJ ŝŶ ƚŚĞ EĞƚŚĞƌůĂŶĚƐ͘ tŚĞŶ ĂŵďƵůĂƚŽƌLJ ƚƌĞĂƚŵĞŶƚ ŝƐ ŝŶƐƵĸĐŝĞŶƚůLJĞīĞĐƟǀĞ͕ƚƌĞĂƚŵĞŶƚǁŝƚŚĂŶŝŶƉĂƟĞŶƚƉĞƌŝŽĚŝŶĂƐƉĞĐŝĂůŝnjĞĚĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJ center can be indicated.

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ĞƐŝŐŶŽĨƚŚĞƐƚƵĚLJ ŚĂƉƚĞƌϮŽĨƚŚŝƐƚŚĞƐŝƐĚĞƐĐƌŝďĞƐƚŚĞĚĞƐŝŐŶŽĨ,>/K^ĂŶĚƚŚĞŝŶƚĞŶƐŝǀĞŽŶĞͲLJĞĂƌůŝĨĞƐƚLJůĞ ƚƌĞĂƚŵĞŶƚŝŶĚĞƚĂŝů͘dŚĞƐƚƵĚLJǁĂƐĚĞƐŝŐŶĞĚĂƐĂƌĂŶĚŽŵŝnjĞĚĐŽŶƚƌŽůůĞĚƚƌŝĂůǁŝƚŚƚǁŽĂĐƟǀĞ ƚƌĞĂƚŵĞŶƚŐƌŽƵƉƐ͘dŚĞŝŶƚĞƌǀĞŶƟŽŶƐŝŶƚŚŝƐƐƚƵĚLJĐŽŵƉƌŝƐĞĚĂŶŝŶƚĞŶƐŝǀĞŽŶĞͲLJĞĂƌůŝĨĞƐƚLJůĞ ƚƌĞĂƚŵĞŶƚǁŝƚŚĂŶŝŶƉĂƟĞŶƚƉĞƌŝŽĚŽĨĞŝƚŚĞƌƚǁŽŵŽŶƚŚƐĂŶĚďŝǁĞĞŬůLJƌĞƚƵƌŶǀŝƐŝƚƐĚƵƌŝŶŐƚŚĞ ŶĞdžƚĨŽƵƌŵŽŶƚŚƐ;ƐŚŽƌƚͲƐƚĂLJŐƌŽƵƉͿŽƌƐŝdžŵŽŶƚŚƐ;ůŽŶŐͲƐƚĂLJŐƌŽƵƉͿ͘dŚĞƐĞĐŽŶĚŚĂůĨLJĞĂƌŽĨ ƚŚĞƚƌĞĂƚŵĞŶƚĐŽŶƐŝƐƚĞĚŽĨƐŝdžŵŽŶƚŚůLJƌĞƚƵƌŶǀŝƐŝƚƐŝŶďŽƚŚŐƌŽƵƉƐ͘ŽƚŚŝŶƚĞƌǀĞŶƟŽŶƐǁĞƌĞ ƉƌŽǀŝĚĞĚĂƚƚŚĞƐĂŵĞƐƉĞĐŝĂůŝnjĞĚĐŚŝůĚŚŽŽĚŽďĞƐŝƚLJĐĞŶƚĞƌŝŶ,ŝůǀĞƌƐƵŵ͕ƚŚĞEĞƚŚĞƌůĂŶĚƐ͘ dƌĞĂƚŵĞŶƚĨŽĐƵƐĞĚŽŶĐŚĂŶŐĞŽĨŶƵƚƌŝƟŽŶ͕ƉŚLJƐŝĐĂůĂĐƟǀŝƚLJĂŶĚďĞŚĂǀŝŽƌŽĨƚŚĞƉĂƌƟĐŝƉĂŶƚƐ ĂŶĚƚŚĞŝƌƉĂƌĞŶƚƐ͕ĂŌĞƌǁŚŝĐŚƚŚĞƉĂƌƟĐŝƉĂŶƚƐǁĞƌĞĨŽůůŽǁĞĚƵƉĨŽƌĂŶŽƚŚĞƌLJĞĂƌ͘dŚĞƐƚƵĚLJ ƉŽƉƵůĂƟŽŶ ĐŽŶƐŝƐƚĞĚ ŽĨ ϴϬ ƉĂƌƟĐŝƉĂŶƚƐ ;ϴͲϭϵ LJĞĂƌƐͿ ǁŝƚŚ ƐĞǀĞƌĞ ŽďĞƐŝƚLJ͘ ůů ƉĂƌƟĐŝƉĂŶƚƐ ǁĞƌĞƌĞĨĞƌƌĞĚ ƚŽ ƚŚĞ ƐƉĞĐŝĂůŝnjĞĚ ĐŚŝůĚŚŽŽĚ ŽďĞƐŝƚLJ ĐĞŶƚĞƌďLJƚŚĞŝƌ ůŽĐĂů ƉĞĚŝĂƚƌŝĐŝĂŶ ǁŚŽ ĐŽŶƐŝĚĞƌĞĚĂŵďƵůĂƚŽƌLJŽďĞƐŝƚLJƚƌĞĂƚŵĞŶƚƚŽďĞŝŶƐƵĸĐŝĞŶƚůLJĞīĞĐƟǀĞĨŽƌƚŚĞŵ͘

Cardiometabolic risk factors

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