Preventing childhood obesity

Christophe ROY

Deputy Director

EPODE

2

From FLVS pilot study to EPODE

3

Nord Pas de Calais

Lille

FleurbaixLaventie

Fleurbaix : 2 222 inhabitants

Laventie : 4 444 inhabitants

Paris

FLVS: Fleurbaix Laventie Ville Santé

4

5

Children obesity prevalence

data in FLVS and in CT(Romon & Al., Public Health Nutrition, 2008, Dec 23:1-8)

Years1992 2000 2004

5

10

20

15

Childhood obesity rate (%)

11.4

14.3

NS

P<0.012 / FLVS 2000

8.8%

FLVS

CT

12.6

NS; p= 0.7

17.8%

P<0.0001 / FLVS 2004

From education to education + city involvement

Belgium, 2007

15 towns

Spain, 2007

32 towns

6

EPODE in the world, today

France, 2004

226 towns

OPAL

South Australia, 2009

6 councils

Paideiatrofi

Greece, 2008

5 towns

EPODE

Niños y Niñas

Mexico, 2010

EPODE approach

A coordinated, capacity-building approach for

communities to implement effective and sustainable

strategies to prevent childhood obesity.

Vision statement

Childhood obesity will be reduce by local environments,

childhood settings and family norms all being strongly

supportive of children enjoying healthy eating, active

play and recreation.

9

EPODE philosophy

Based on positive messages, prompting a smooth awareness of the obesity issue, both collectively and individually

No stigmatization of any culture, any food habits, and no stigmatization of any diets, food groups, behaviours and body image

A “Step wise” and Experience-basedlearning process of healthy diet & physical activity.

The EPODE 4 pillars and goal

Creating the political commitment

Mobilizing resources

Coordination and Support services

Evidence-based & evaluation

=> Enable community stakeholders to implement effectiveand sustainable actions to prevent childhood obesity

1

2

3

4

Target groups

Children 0 to 12 years old and their families

Stakeholders who can influence childhood settings, food environments and physical activity environments, and socio cultural norms

1

2

12

EPODE’s Philosophy

4

A smooth awareness of the obesity issue with no stigmatization of any culture, any food habits, and no stigmatization of overweight and obesity

A positive, concrete and “step wise” process targeting all socioeconomic groups with adapted levers

A long-term program aimed at changing the environmentand thus behaviors involving all relevant local stakeholders

EPODE

NATIONAL

COORDINATION

Environment of

families

SCIENTIFIC

COMMITTEENATIONAL

INSTITUTIONAL

SUPPORT

PRIVATE

PARTNERS

LOCAL

STEERING

COMMITTEE

Creation of an environment facilitating

the adoption of healthier lifestyles by

the families

LOCAL

PROJECT

MANAGERS

A federative approach

MAYORS,

Elected

representatives

14

The town is at the heart of the system

•Foster multistakeholder dynamics

The town, at the heart of the system

Town

Family

• Information

• Training

• Communication tools

• Coaching

EPODE NationalCoordination

Team

Schools

Health professionals

Infancy professionals

Shop owners,

local producers

Extra-curricular

professionals

Media

Other local stakeholders

Health organizations

SchoolCatering

Network of

associations

Decision makers

Facilities

15

Mayorand

municipal team

Population

Stakeholders

Sportsassociations

representatives

Welfaredepartment

City sports & leisure

department

Education systemrepresentative

Project manager

And local steering committee

Shop keepersrepresentatives

Local NGOs

City schooldepartment

Local team :• expert GP• dietician• school GP

• school nurse

Schoolcatering

department

Organization at the local level

2. Continuous training and coaching of the local project manager (including

best practices sharing sessions, evaluation of local actions…),

3. Development of Tools:

• Training tools: guidance documents, roadmaps…

• Communication tools related to a theme (twice a year)

1. Resources mobilization, Advocacy and mobilization of National /

Regional stakeholders : Experts, Ministries, health professionals,

local authorities, NGOs, economic players…

5. Permanent communication

National Coordination roleOverall management of the programme

4. Monitoring and evaluation

17 June 2009 17

General public Local stakeholders

Health professionals

PosterDisseminated in the whole

city

Target : population as a

whole

Leaflet 3 / 12 years-oldTarget : families and children aged 3 to 12

Contents : Advice and tips, recommendations for

healthier behaviours

Worksheets «local

stakeholders »Target : local stakeholders:

infancy professionals, shop

owners, NGOs, schools…

File for « worksheets »Contents : Worksheets adapted to

different stakeholders to implement

specific actions

Faxed letter:Contents : Advice and

tips, recommendations for

healthier behaviours

Local Project Managers and

Local steering committees

THEME

An overall guidance

document and

Biannual roadmapsContents : objectives,

information and advice for

the on-going theme

Mobilization worksheetsTarget : All local stakeholders in the framework of the

“Taste of the Season” plan:

Infancy professionals, shop owners, NGOs,

schools…

Each semester, training session, communication tools and

roadmaps are provided to local project managers

18

Fish is all good!

October 08January 08

Playing is already moving!

EPODE themes

PostersDisplayed all around the city

Target : whole population

The 3-12 years old leafletsTarget: families with children aged 3 to 12 years old

Content : advices, tips, consumption benchmarks…

Actions sheets EpodeContent : Sheets dedicated by target of actor to implement specific actions

Monitoring and Evaluation

Dr Sophie Treppoz

Paediatrician, representing the

French Association of Ambulatory

Paediatrics, REPOP coordinator

Pr Alain Duhamel

Biostatistician, Faculty of Medicine

and Biostatistics Training Unit, Lille

University and Hospital Complex

Pr Claude Jaffiol

Emeritus Professor at Montpellier

Academy of Medicine

Monique Valaize

Deputy Mayor for Public Health,

Twinning Committee and

Decentralised Cooperation

Dr Desbonnets

General Practitioner

A multidisciplinary and independent expert board

Dr Jean-Michel Borys

Practitioner in Endocrinology, Diabetology and Nutrition

Natalie Rigal

Child Psychologist

Pr Daniel Rivière

Vice-Chairman of the French Society of Medical Practice and Sport

Pr Monique Romon

Professor of Nutrition, Head of the Nutrition Dept of Lille University and Hospital Complex, Chairman of OSEAN network

Sandrine Raffin

Social Marketing Expert

Benoît Dervaux

Health economist, CNRS, Lille

A role in expertise, advice and

advocacy Expertise role for each theme developed

Discussion and choice of new themes to be developed

Validation of the approach and main messages to be communicated

Expertise role in BMI data collection and results

Advice about data collection methodology

Comments on the results

Advice on other indicators to be collected and communicated

Presentation of specific studies results

Studies led by the experts

Pilot studies led within the EPODE programme

Epode advocacy

Participation in congresses and conferences

Publications

BMI MeasurementsFramework, Process, Communication,

Difficulties and Challenges

BMI measurementsFramework and Process

At National Level

Collaboration with the ministry of National Education

Collaboration with local education administrations

At Local level

Part of the initial training of the Local Project Manager

Collaboration with the National Education GPs and nurses

Or another solution involving other health professionals

Data collection yearly / every 2 years :

Nursery school

(5 yo) TO 5th

grade (10-11 yo)

Nursery school

(5 yo) TO 5th

grade (10-11 yo)

Nursery school

(5 yo) AND 5th

grade (10-11 yo)

Y1 Y3 Y5Y4Y2

Nursery school

(5 yo) TO 5th

grade (10-11 yo)

New

recom

mendation

Pilo

t to

wns

Y1 Y3 Y5

BMI measurementsFramework and Process

At Local level

Information to school directors and to the parents

Data collection in the schools, respecting children decency

Data transfer from Local level -> National level

A collaboration with a biostatistics centre for data processing

Underweight (from 2010) / Normal / Overweight / Obese prevalence

Boys / Girls

Age

School location (ZEP/ non ZEP)

A meeting with the Local Project Manager and the Deputy Mayor to share the results

BMI data collection =

Objectification of

the towns results

Interest in the results

for local politicians and

Local organization« »

Evolution of childhood overweight and obesity

prevalence, between 2005 and 2009 in the pilot towns

* Roubaix : only the 7 common schools between 2005 and 2009 have been included.

** Vitré : 2008 data. The CP, CE1 and CM1 school grades have not been included in 2009.

***In bold : significant "p".

TOTAL towns N % case N total N % case N total p*** % Decrease

Obese 1192 4,81 1051 4,45 0,056

Overweight 3900 15,76 3397 14,38 <0,0001OverweightObese 5092 20,57 4448 18,83 <0.0001 -9,12%24752 23617

2005 2009

Evolution of the prevalence of childhood

Overweight+Obesity between 2005 and 2009 in

EPODE pilot towns

0

5

10

15

20

25

30

2005 2009

Body M

ass I

ndex (

%) Asnières

Beauvais

Béziers

Evreux

Meyzieu

Roubaix*

Royan

Vitré**

Evolution of childhood overweight and obesity

prevalence, between 2005 and 2009 in the pilot

towns Schools located in deprived areas

***In bold : significant "p".

TOTAL towns -

Schools in deprived

areas N % case N total N % case N total p*** % Decrease

Obese 642 6,78 576 6,5 0,4514

Overweight 1601 16,91 1474 16,65 0,6287OverweightObese 2243 23,7 2050 23,15 0,3845 -2%

8855

2005 2009

9466

For the children from schools located in deprived areas, a non-

significant (p=0,3845) downward trend is observed in the

prevalence of childhood overweight (including obesity), from

23,7% in 2005 to 23,15% in 2009:

Overweight: from 16,91% in 2005 to 16,65% in 2009

Obesity: from 6,78% in 2005 to 6,5% in 2009

***In bold : significant "p".

Evolution of childhood overweight and obesity

prevalence, between 2005 and 2009 in the pilot towns

Schools NOT located in deprived areas

TOTAL towns -

Schools NOT in

deprived areas N % case N total N % case N total p*** % Decrease

Obese 550 3,6 475 3,22 0,4514

Overweight 2299 15,04 1923 13,03 0,6287OverweightObese 2849 18,64 2398 16,24 0,3845 -13%

2005 2009

15286 14762

For the children from schools located in non-deprived areas, the prevalence of childhood overweight (including obesity) decreased significantly (p<0,0001), from 18,64% in 2005 to 16,24% in 2009:

Significant decrease (p<0,0001) in overweight prevalence from 15,04% in 2005 to 13,03% in 2009

Non-significant decrease (0,0694) in obesity prevalence from 3,6% to 3,22% in 2009

BMI measurementsPositive aspects and Challenges

Long term collaboration with the ministry of National Education

Real interest in the results for national, local politicians and other local actors

Time and human resources demanding

Variability of data quality

Recurrent concern about obesity care plan

< <

Complementary Monitoring and

Evaluation and Indicators

CollectedInput, Process and Output indicators

Monitoring and Evaluation Framework4 levels, in compliance with the EEN Evaluation

Committee first recommendations

National organization level

Local organization level

Setting level

Child level BMI Data Collection

Tools used to collect or report data

Via pilot studies results

« We move and we like it »

CSO-Sciences Po-INRA Study

Questionnaires consistently passed out to the Local Project Managers during meetings

BMI Data collection

Interviews with local project managers, at least annually

Via annual reports

Press Relation Report

National Coordination reports for FLVS association, towns and partners

Via the evaluation of pilot projects

Data Collected at National Organization LevelSubject / Area Nature of measurement

Political supportAmount and type of Ministries and politicians supporting the

programme

Expert advisoryAmount of meetings organized, experts’ qualifications and

involvement

Networking / Scientific

communicationParticipation in congresses and other events

Human investment Coordination Team human resources

Manpower competence Coordination Team qualifications

Knowledge expertise Experts and Coordination Team expertise

Private partners recruitmentAmount of private partners contacted and supporting the

programme

Communication advocacy / press

Press Relation team report: number and type of press releases,

events and clips

Dissemination indicators: newsletters (number of contacts),

website (traffic)

Funding Evolution of funding

Town commitment to the

programmeEvolution of the amount of towns committing to the programme

Training of local teamsAmount of trainings organised per year, perception of their quality

by the Local Project Managers. Dissemination at local level*

Tools developedAmount, type and quality (Local Project Managers’ perception) of

tools developed

Organisation commitment to the

programmeAmount and type of organisations participating to the programme

OU

TU

TP

RO

CE

SS

INP

UT

* = recent indicator

Data Collected at Local Organization Level

Subject / Area Nature of measurement

Material and methods Kinds of tools developed or used at local level and

methods used to mobilise the general public

Time investmentType of contract for Local Project Managers (full/part

time)

Project Managers’ qualifications Local Project Manager’s qualifications

Knowledge expertiseAssistants to the Local Project Manager (MP, nurse,

dietician…) involvement

Steering committee Detailed qualifications of stakeholders involved*

Structures involved / Fields of

intervention

Amount and type of structures involved / fields of

intervention

Communication materials Dissemination (amount and type) and satisfaction

Labelling Amount and type of EPODE actions labelled

Action sheetsDevelopment of new Action sheets by Local Project

Managers, use of action sheets*

Training of local stakeholdersUtilization at local level of “train the trainer” training

sessions, perception of efficiency*

Multi stakeholders’ participation in

organization/implementation of the

programme

Type of stakeholders involved in the implementation,

Perception of efficiency by Local Project Managers*

OU

TU

TP

RO

CE

SS

INP

UT

* = recent indicator

Data Collected at Setting Level

Subject / Area Nature of measurement

Initial evaluation of potential stakeholdersAmount and type of potential stakeholders to be

involved in the EPODE programme

Targets of interventionsFor specific actions : age and SES of participating

people

Targets of interventions : schoolsIdentification of schools located/not located in priority

education areas (ZEP)

Multi stakeholders’ participation in

organization/implementation of the

programme

Type of stakeholders involved in the implementation,

Perception of efficiency by Local Project Managers*

Social environment

Amount of schools / town implementing the actions “a

fruit for recreation” and school playgrounds

development

People participation to the actions For specific actions : amount and type of participation,

age

Tools dissemination Amount and type of disseminationOU

TP

UT

PR

OC

ES

SIN

PU

T

* = recent indicator

Data Collected at Child Level

Subject / Area Nature of measurement

Social environment

Amount of schools / town implementing the actions “a

fruit for recreation” and school playgrounds

development

People participation to the actions For specific actions : amount and type of participation,

age

Tools dissemination Amount and type of dissemination

Behaviour changes

“We move and we like it“ pilot study : assessment of

changes in food habits and physical activity of a cohort

of 944 children, primary school aged

Evolution of Body Mass Index of children

aged 4-5 to 10-11 years old / 4-5 and 10-

11 yo

Weight and height measured by a health professionalOU

TU

T

PR

OC

ES

SIN

PU

T

* = recent indicator

Evaluation FrameworkPositive aspects and challenges

Some ways to collect data are already efficient

Experts, politicians and partners have a real interest in the results

Define the most relevant indicators in compliance with the EEN Scientific Evaluation and Dissemination Committee recommendations

Design the appropriate instruments

Find the incentive to motivate the local teams to collect data

Produce common international evaluations and publications

< <

Staff in charge of data collection or reportingProfile and time spent

National organization level

Data collection : J Mayer (qualifications : sociology, social marketing)

Estimation of time spent : 4 days per month

Reporting : EPODE team and PR team

Estimation of time spent : 2 days per month

Local organization level

Data Collection : J Mayer

Reporting : Local Project Manager (various qualifications)

Time spent varies according to the LPM

Setting level

Data Collection : J Mayer through the Local Project Manager

Reporting : through the Local Project Manager

Child level

Data Collection : Health professionals

Estimation of time spent : 1/2 day for 3 school classes

Data processing : CHRU Lille

Estimation of time spent : from 2h to 1/2 day per town

Dissemination of resultsWays and reasons

Expert committee

Advice on how to improve ourselves and what to communicate

Municipalities : Deputy Mayor and Local Project Manager

Get advocacy and motivation of local stakeholders

Valorisation of of the National Coordination work and of the Local Project Manager

Communication at local level

Help targeting specific areas

Reports to partners

Get an overview to justify their funding

National and local press communication

Linked to the EPODE congress

Conferences, congresses, publications

ECO 2009

EPODE Congress

17 June 2009 42

EPODE multistakeholder partnership

EPODE :

Multistakeholder Partnership

A response consistent with the recommendations of the WHO and the EU, which appeals to a joint mobilisation of all actors in order to establish a coordinated, integrated and multistakeholder response.

A complementary expertise in order to respond to a multifactorial public health problem

A response that emphasises the role of the actors at all levels, in the search of a sustainable solution

PPP within EPODE in France

An Initiator (FLVS NGO) and a National coordination team

Towns: actors funding the program at the local level

Institutional partners: ministries, national health prevention institutions,

scientific associations

Private sponsors:

A corporate commitment, with a PPP charter

EPODE

Public / Not-for profit Partners at local

and national level

EPODE public / non-for profit partners

Local level

- Town- Local NGOs- Leisure Centres - Hospitals- Health and Infancy professionals- Schools- …

Regional level

- Regional government

- Regional health administration

National level- Ministries- Health Groups (Civil society)

International level (e.g. EU/DG SANCO, WHO)

EPODE

Private / Corporate Partners at local and

national level

EPODE

Local Private Partners

For concrete and and “win-win” collaborations, e.g.:

- With local producers

- Other local actors (town gardener, supermarket & dietician etc.)

An example of EPODE local partnership

« From seed to bread », in Saint-Quentin with the supermarket

1 A long term partnership

2 A commitment of the employee

and the manager of the

supermarket => pedagogical

workshops organized with

children either in the classroom or

in the supermarket’s bakery

3 A balanced partnership : get

political recognition in

compensation, and the motivation

of employees

A Commitment Charter for

EPODE Local Private Partners

Limited to the town’s territory

2 different timeframes

- For specific local actions or projects

- On a continuous basis

Possible frameworks: financial support, in kind support,

pedagogical workshops with children etc.

Communication about the partnership only at local level

No product or brand promotion

EPODE

Private partners at national level

A Coordination entity

Foundations and Health Institutes

Insurance companies

Retailers

Food and Beverages Industries

Health Industries

…

Corporate partners involved

Responsible economic actors:

Placing CSR at the heart of their core business

Being part of a sustainable solution: providing financial support to the EPODE programme on a long term basis

Involved in health prevention Beyond its economical role, the company has a social responsibility

will

Private entities, companies have an expertise, a view and data which may be helpful

Because a company is able to mobilise its employees

Signing a charter of commitment

Participating to partners meetings

Well-framed communication charter :

- Encouraging corporate communication about the

programme

- No product or brand promotion

- No intervention in the content of the programme

Corporate partners involved (2)

54

EPODE European Network

With the support of

Objectives

Raise political, institutional and scientific awareness of the importance of local, long-term and multi-stakeholder approaches for childhood obesity prevention

Enrich existing methodologies and develop guidelines on the EPODE key pillars:

The importance of political involvement for the set up and implementation of similar-programs

Good practices for the evaluation of EPODE-similar community-based interventions

The interest of network expertise and social marketing approaches

Public/private partnerships

Identify and follow up relevant teams willing to implement CBIs using EPODE methodology in other countries

EEN Partners

EEN organizational scheme

EEN Website www.epode-european-network.eu

Contacts and websites

EPODE European Coordination Team

Jean-Michel BORYS, MD, jmborys@proteines.fr

Christophe ROY, croy@proteines.fr

Yann LE BODO, ylebodo@proteines.fr

EPODE existing Websites

www.epode.fr

www.viasano.be

www.thaosalud.com

www.paideiatrofi.gr