Although the subgroup multicomponent treatment programs of moderate to high intensity contained only two studies, these treatment programs appeared to be most effective in treating overweight young children.

The objective of this article is to provide insight in the five-step development process of the best evidence, best practice intervention for obese young children 'AanTafel!'. A set of requirements for intervention development was developed to guide the data inquiry: the use of theory, influencing factors, tailoring, multi-disciplinarity, duration/frequency and evaluation and monitoring. Step I retrieved evidence from clinical guidelines, followed by a systematic review with meta-analysis (Step II) and an extended literature review (Step III). Evidence was consistent with regard to parent-focus, targeting family level, including diet, physical activity and behaviour change techniques and tailoring to age. However, no evidence or inconsistent evidence emerged from the theory-basis, group-versus-individual sessions, face-to-face contact versus Internet-mediated contact, which disciplines to involve and how to involve them, as well as intervention duration and intensity. Hence, practice-based insights from parental interviews (Step IV) and involved therapists were added and subsequently integrated to the intervention 'AanTafel!' (Step V). 'AanTafel!' is a multi-component, multi-disciplinary, family-based, parent-focused, age-specific intervention, which is tailored to individual children and families with a duration of 1 year, and using a combination of individual and group sessions as well as a Web-based learning module. Changes in scientific working principles with regard to data collection, reporting and translation to guidelines are required. Practice and science may benefit from close collaboration in designing, implementing and evaluating interventions.

Objective: Epicardial adipose tissue thickness (EATT) is suggested to play a role in the development of cardiovascular disease. In adolescents it is correlated with BMI z-score, cardiovascular risk factors, and pro-and antiinflammatory markers. EATT of overweight/obese children was compared with EATT of normal weight peers (cross-sectional design). We investigated the association between EATT, cardiovascular risk factors and pro-and anti-inflammatory markers and the effect of a one year, multidisciplinary, treatment program on EATT in overweight/obese children (longitudinal design). Methods: EATT was measured by echocardiography (25 obese, 8 overweight and 15 normal weight children; median age 5.1 years). In the overweight/obese children blood pressure, lipid profile, glucose, insulin, high sensitive CRP, and adiponectin concentrations were measured. In overweight/obese children participating in a multidisciplinary treatment program, measurements were repeated after 4 and 12 months. Results: EATT was significantly higher in the overweight (median 1.38mm) and obese (median 1.57mm) children compared to normal weight children (median 0.87mm). Among obese children EATT was significantly inversely associated with adiponectin (r = −0.485). Conclusions: EATT is increased in overweight/obese children and is inversely associated with adiponectin. Echocardiographic measurement of EATT is easy and might serve as a simple tool for cardio-metabolic risk stratification.

Introduction: Childhood obesity has serious health risks including the development of metabolic syndrome, cardiovascular disease and mortality later in life. The critical growth period from 3 to 7 years provides a window of opportunity for interventions. The goal of this study is to evaluate a one year, multidisciplinary, low-intensity treatment program for young obese children, complemented with web-based modules, called "AanTafel!", on body composition, cardiometabolic risk profile, quality of life (HRQoL), eating behavior and physical activity. Methods: In the pre-post-test design all measures were taken at baseline, 4 months, at the end of treatment and 3 years after baseline. Results: Thirteen boys and 27 girls with median BMI z-score of, respectively, 4.2 and 3.3 aged 3 to 8 started "AanTafel!". Eighty percent (n = 32) completed treatment. BMI z-score decreased with 0.45 (end of treatment) and sustained after 3 years. At the start, 16.7% of the children had all four components of metabolic syndrome which decreased to 0%. HDL cholesterol significantly increased. Concentrations of the markers IL18, e-selectin, and sICAM significantly decreased indicating a reduction of inflammation. Conclusion: "AanTafel!" is effective in improving health of obese young children. The reduction of overweight is clinically relevant and sustained after 3 years.