A new study from The Children’s Obesity Clinic in Holbaek, Denmark was just published and shows that obesity-related disturbed eating patterns, including meal skipping, rapid eating. comfort eating and overeating were not associated with treatment response using the clinic TCOCT protocol. In fact, 76% of patients in the study showed reduction in their degree of obesity. The study is based on research conducted among 3621 patients aged 3–18 years enrolled in a multidisciplinary obesity treatment programme. Follow‐up data after a median of 12.4 months were available for 2055 patients.
Earlier studies have shown that the TCOCT treatment protocol is successful independent of social class, degree of obesity, an obesity linked genetic risk score, familial predisposition to obesity related complications, glucose tolerance and intake of sugary food and beverages.
We are pleased to interview Professor Jens Christian Holm, who runs The Children’s Obesity Clinic in Holbaek.
Dr Holm, please tell us about your clinic and the TCOCT protocol (what does TCOCT stand for?)
I initiated The Children’s Obesity Clinic in 2007 based on available recommendations and especially on the American published in Paediatrics 2007 by Barlow et al. This means that all our knowledge within the clinic in terms of understanding obesity and its multiple multiple multiple interactions were as best possible grounded in evidence. I took this a few steps further, since I was as a paediatrician experienced in handling patients with various acute and chronic diseases, I introduced a similar way of tackling our patients with obesity as if it was any other patient with any other paediatric disease. This means that we offered consultations with a full multidisciplinary team as well as prioritised the patients in terms of blood sampling, DEXA scans, MR spectroscopy scans etc as we do with all the other patients in our paediatric ward. Further, from the very beginning I introduced a physiological understanding of fat mass as being neuroendocrinology regulated, which have numerous implications in daily clinical practice. This is very similar to our understanding of diabetes where the HCP are should be knowledgeable about pancreatic secretion of insulin and resultant glucose uptake in the muscle and the implications when failing. Similarly, thousands of publications have showed that especially leptin regulation of fat mass is fierce in its ability to maintain and preserve fat mass, which typically results in weight regain. These insights are deeply rooted in our knowledge base and thus used and communicated directly in daily clinical practice. As an example this knowledge tend to externalise the drivers of obesity for the patient and thus reduce shame and self-blame and thereby optimising the patient-HCP relationship overall and also reducing the sensitivity in the patient towards societal stigmatisation and discrimination. There are hundreds of other similar examples of how our clinical practice exhibit many direct and indirect beneficial effects for the patients. Lastly, in those areas where we have been in doubt we have guided ourselves according to the Child Convention from UNICEF, which is very strong values since we all actually do know what is the best for the child! TCOCT means The Children`s Obesity Treatment protocol.
How long have you been refining this treatment model?
The TCOCT model was actually shaped well from the very beginning by integrating the above values. But obviously, it has been refined on the way, but I think it is notably that all over publications including approximately 30 publications on treatment effects are very consistent even though we also have faced budget limitations and all the usual impediments in a hospital setting. We have an enthusiastic team of nurses, dieticians, doctors, secretaries, psychologist and social worker who have always given their most. Our staff have held weekly, monthly and yearly meetings including treatment meetings (specific challenges in specific patients), clinic and educational meetings. Further, we have from the very beginning typed all data into a parallel database so that we can readily access data on all patients. In fact, I initiated the The Danish Childhood Obesity Biobank in 2009 based on this register which incorporate approximately 5000 patients and 2586 controls now. These have been the base for nearly 20 phd studies yielding more than 100 publications which have documented our efforts and results but also provided new insights that we anticipate to help improve treatment in the future. In Denmark, the TCOCT protocol have been spread to more than 70 municipalities where I have trained more than 1000 HCPs according to the TCOCT principles by my TCOCT training seminars (seminar 1-3).
You must be very pleased with these results.
I think that I have surpassed my own expectations back in 2007, since we have managed to publish in peer reviewed journals that 65-85% of our patients reduce their degree of obesity accompanied by reductions in hypertension, dyslipidaemia, sleep apnoea, fatty liver, parental degree of weight loss, appetite, bullying and improving quality of life and body self esteem. These results have been accomplished by the use of a mean of 5 HCP hours per patient per year and results are independent on socioeconomic status, degree of obesity, a genetic risk score on obesity, glucose metabolism, sugary intakes and now disturbed eating behaviours. These results have been achieved both in hospitals and in municipalities across Denmark. These results have thus created demand for the TCOCT model both in Denmark and abroad.
These impressive results must provide hope to families and patients alike.
Thanks for that, I really think hope is highly needed out there. There are so many patients living with obesity and most of them are not receiving adequate advice and treatment, essentially leaving them to themselves, which I find utterly unacceptable of many reasons. I think that the Child Convention should actually help the societies to support not only children, but also adolescents and adults to a better life since obesity and its complications tends to affect, inhibit or even compromise growth and development, but also health and welfare in all patients. I also think that when declaring obesity as a disease, the Hippocratic oath should be taken seriously in all patients with obesity so that all doctors should really think whether obesity is related or even the eliciting cause of the ailments that patients are seeking contact for?
How replicable do you believe your approach is in other parts of Denmark and in other countries?
I think that the TCOCT model is replicable everywhere. It is based on universal values; 1. obesity is a disease, click everywhere. 2. Fat mass regulation, this system is highly preserved in all animals, as an example mice and man share 78% homology in the DNA governing weight regulation even though we evolutionary split up 100 million years ago, click everybody. 3. The best for the children or as we interpret/translate it to the best of our patients is also true everywhere. Every person with obesity is burdened in one way or the other by obesity and all wants to be relieved from it. We have results that the TCOCT protocol works in dozens of municipalities in Denmark, Norway and are commencing in countries like Romania, Russia and probably also in the Arabic region. Our seminars and software is translated to Norwegian, english and is on its way to Russian and Arabic.
Do you have advice for colleagues globally working on developing interventions to treat children and adolescents with obesity?
Yes, I do. First it is always such a pleasure meeting colleagues that are so dedicated to providing care to patients. My advice would be the following; go in deep and explore the implications of 1. Obesity is a disease (do not underestimate it). 2. Fat mass regulation (do not underestimate it). 3. Evaluate the treatment consequence using an approach show what is best for the child and your patient (do not underestimate it). Combined, these values will put you on the right track; don’t compromise 😊
Read the publication here: https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.14678