Evidence

The challenge of childhood obesity?​

​Obesity is defined by excessive (or abnormally placed) fat mass that may impair health. The prevalence of obesity among children and adolescents has increased significantly in the last 60 years. Today, one-fifth of all Danish school children struggle with obesity, and alongside obesity come numerous complications, both physical, mental, and social. Obesity is evolving on a pandemic scale affecting millions of people both direct and indirectly.

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Untreated, most children and adolescents with obesity will continue to suffer from obesity into adulthood. In addition to severe social stigma, obesity leads to various changes in the body that increase morbidity and result in premature death. For example, 50% of the children and adolescents treated in The Children’s Obesity Clinic have early or actual hypertension, 45 % experience breathing difficulties during sleep, 38% exhibit fatty liver, 28 % have elevated cholesterol levels, 14 % have prediabetes, and 16% exhibit vitamin D deficiency. This clearly reflects the seriousness of this extensive and complex disease and how it affects children and adolescents during growth and development with the potential to impair thriving, both physical, mental, and social.

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The World Health Organisation declared obesity a disease in 1948, the American Medical Association declared obesity as a disease on June 18th, 2013, and the Canadian Medical Association followed on October 9th, 2015. The European Expert Council (Childhood Obesity Task Force under the European Association for the Study of Obesity (EASO)) proposed in 2015 that obesity should be recognized as a chronic disease, which is also the approach in the Danish paediatric recommendations for the treatment of children and adolescents with obesity. As of March 2021, the European Commission has decided to classify obesity as a chronic, severe, progressive, and recurring disease.​

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The Children’s Obesity Clinic

The Children’s Obesity Clinic is a treatment clinic for children and adolescents with obesity, founded in 2007 by Chief Physician in Paediatrics, Research Associate Professor, PhD Jens-Christian Holm at the Paediatric Department, Holbæk Hospital. 

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The Children’s Obesity Clinic focuses on effectively reducing obesity and its complications in children and adolescents, as well as shedding light on the medical, psychological, and social consequences of this disease. Since 2014, The Children’s Obesity Clinic has been recognized as an accredited European Centre for Obesity Management (COM).

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The Childrens Obesity Clinic has achieved and published treatment outcomes that have inspired researchers and clinicians internationally and provide hope for this extremely vulnerable group of children and adolescents in the future.​

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The Holbaek Model's Treatment Principles

The treatment method is built on a family-oriented, person-centrered, and evidence-based interdisciplinary approach delivered by a team of doctors, nurses, dietitians, social workers, and psychologists. It is a professional treatment approach that supports, educates, and assists patients in taking responsibility through a newly developed and pedagogical approach that considers obesity as a chronic disease based on lifelong biological regulation of body fat mass.

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The treatment consists of treatment advices, including all aspects related to obesity, which are specified in a treatment plan consisting of 15-30 points tailored to each child and their family and implemented from the beginning of treatment. On average, 4-5 hours per year are devoted to each child, and currently, over 10,000 children and adolescents with obesity in Denmark have followed the HOLBAEK Model. The HOLBAEK Model is described in the Danish textbook "Det Bedste for Barnet" and is recommended by The Danish Paediatric Society, as updated in 2024.

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Exceptional Treatment Outcomes

​69-90 % of the children and adolescents treated in The Childrens Obesity Clinic reduce their level of obesity after one year of treatment, regardless of sex, age, and social class, and relatively few drop out of treatment (< 10 % in the first year). The HOLBAEK Model is integrated into over 80 % of the municipalities in Denmark and in several paediatric departments, where weight loss is observed in 75 % of cases. Additionally, the treatment improves cholesterol levels, fatty liver, blood pressure, sleep apnea, quality of life, mood, body perception, bullying, appetite, and reduces the parents' degree of obesity.

The latest long-term assessment shows that the weight loss is maintained after six years of treatment, and that muscle mass is increased, which is exceptional in international contexts. The treatment is independent of social class, patients' degree of obesity, familial occurrence of obesity and its related diseases, sugar intake, as well as a genetic risk score consisting of 15 commonly occurring genes associated with the development of obesity in children and adolescents.

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The treatment requires 4.5 hours of healthcare professional time per patient per year. With the recent introduction of the digital solutions, the healthcare professional time expenditure on each patient is expected to be significantly lower.

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A new study from Nature Medicine shows that the HOLBAEK model reduce the degree of obesity in 85 % of patients and at the same time improve more than 142 lipids in the blood stream in children and adolescents living with obesity. Thus, potentially we can better differentiate and evaluate treatment along its way, attached.

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Perspective

Obesity is no longer an individual issue. We, as a society, must take responsibility for obesity, just as we do for other serious chronic diseases. This requires a paradigm shift, so that obesity is regarded and treated on par with other chronic diseases such as asthma, diabetes and cancer.
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