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1. Introduction
Worldwide, the prevalence of overweight and obesity is still increasing [1,2]. In The Netherlands, 50.2% of the adult population are overweight, 14.5% of whom are obese [3]. The number of children with overweight and obesity in particular has rapidly increased in recent decades [4]. Currently, 13.4% of the children in The Netherlands are overweight and 2.7% are obese. Overweight is caused by an imbalance between energy intake and energy expenditure [5]. Primary factors that may lead to a chronically disturbed energy balance include insufficient levels of physical activity, too much sedentary behaviour [6] and too much high-energy dietary intake [7]. This imbalance can also be influenced by sleep, since sleep deprivation may lead to a decrease in physical activity and an increase in energy intake due to disturbed hormone levels [8,9].
Combined lifestyle interventions (CLIs) support people who are overweight or obese in initiating and maintaining healthier lifestyle behaviours, by increasing physical activity and improving dietary behaviours. CLIs include physical activity, dietary and behavioural components [10] and are typically carried out by general practitioners, practice nurses, physiotherapists, psychologists and/or dieticians [11]. These interventions have been shown to be effective in terms of weight reduction and health improvements compared with standard care or drug treatment [10,12]. Lifestyle effects of CLIs and other types of weight loss interventions, however, have been shown to be rather short-term; relapses are common in long-term weight loss [13].
The main causes of relapse are that it is not easy to incorporate sustainable lifestyle changes into daily behaviour patterns and that intervention success depends heavily on the quality and quantity of external stimuli from professionals. Motivation, as well as well-being and resilience, are strong predictors of sustained healthy lifestyle behaviours and weight loss [13]. In addition, previous CLI studies identified undesirable implementation issues: lack of multidisciplinary collaboration, insufficient coaching skills among primary care professionals, insufficient time to optimize coaching and high intervention costs [14,15].
In comparison to coaching adult participants, supporting lifestyle changes among overweight children may even be more complex. Since parents play a key role in determining their children’s lifestyle behaviour [16], both parents as well as their children are advised to participate in CLIs. However, parents often do not see their child’s weight as a cause for...