“successful approaches towards obesity prevention”€¦ · Social Marketing approach and...
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“successful approaches towards obesity prevention”
Jacob C. SeidellVU University and VU medical center
Amsterdam, Netherlands
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Logic model for interventions
1 Intervention dose is either 1 or 0 (intervention, control) or $$ (economic input – all schools)2 Capacity is leadership, skills/knowledge, structures, resources3 Relevant environments are schools, homes, neighbourhoods, churches4 Weight, BMI, BMI-z, waist, waist:height, %fat, prevalence of o/w+obesity
InterventionDose1
∆ Community capacity2
∆ Environments3
∆ Knowledge, attitudes, beliefs, perceptions etc
∆ Behaviours ∆ Anthropometry4
INPUTS
POPULATION MEDIATORS
INDIVIDUAL MEDIATORS
OUTCOMES
MODERATORS
Ethnicity, socio-cultural factors, gender, age, SES
∆ QoL
∆ QALYs gained
∆ Policy
= Measured = Modelled
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“Top Down” Approach
“Bottom-up Approach”
Community Organization
Partnerships andResource Identification
EnvironmentalChanges
Local media, Education
Local programs, Nutrition Services
Surveillance
Mass Media/Education
Assured Nutrition Services
Policy
Resources
Pearson TA, Wall S, Lewis C, Jerkins P, Nafziger A, Weinehall L. Describing the "Black Box" of community intervention: Lessons from community-wide cardiovascular disease prevention program in the United States and Sweden. Scand. J. Public Health.
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The pillars of the EPODE methodologyA professional structure to lead the programme (National Coordination Team) and manage 4 key components:
Strong political support
At both national and local levels
(Ministries, mayors…)
Independent Scientific expertiseCollaboration with experts
from different fields : scientific validation of messages, monitoring
and evaluation…
Social Marketing approach
and network creation among local stakeholders, supported
by a well-framed communication strategy
Public / Private partnerships
Designed and managed in collaboration with public, technical, scientific and
private partners
EPODE National Coordination
Team
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The world’s largest obesity and NCDs prevention network
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EIN: An NGO to leverage EPODE’s 20 years of successful experience in
sustainable obesity and NCDs prevention
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SO FAR, 25 programmes in 17 countries!
Member CBPs from around the world
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ASIA-PACIFIC:Taiwan – HealthPromotion BoardSingapore –Health PromotionBoardAustralia – OPALVictorian Australi- PreventionCommunity ModeNew Zealand –Energize
AMERICA:Brazil - Agita Sao PauloChile - Elige Vivir SanoMexico – Districto FederalMexico – Aguascalientes5-PasosMexico – Aguascalientes DIFMexico - Durango 5-PasosMexico - Edomex 5-PasosMexico - Montemorelos 5 PasosMexico - Puebla 5-PasosAruba – Arub A « Riba »
EUROPE:Belgium – VIASANOFrance – EPODE Greece – PAIDEIATROFIPoland - Keep Fit!Portugal – MUNSIRomania – SetsRomania – TraditionsSlovakia – SporttubeSpain – THAOThe Netherlands – JOGGIceland – Everythingaffets us, especially ourselves
Member CBPs from around the world
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COMMUNICATIE
10
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Overweight & Obesity in childrenEvolution in the pilot towns between
2008-2010Baseline measurement in other
Viasano townsin 2010
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Prevalence of overweight and obesity
1st and 3rd kindergartenEvolution 2008/2010
Moeskroen
Marche
Launched in 2007 53800 inhabitants6390 children 3-12 years Launched in 2008
17427 inhabitants in 20122086 children 3-12 years
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Reduction of 22% in the prevalence of overweight in the pilot towns
13
9,46
7,41
0
2
4
6
8
10
12
2008 2010
Marche + MoeskroenChildren in 1st and 3rd kindergarten
-22%
Sample size of 1300 children Sample size of1484 children
Significant(p< 0.05)
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8,23
9,88
5,9
7,83
0
2
4
6
8
10
12
Marche Moeskroen
Children 1st & 3rd kindergarten
2008
2010
Reduction in the prevalence of overweight in Marche & Moeskroen
14
n.s.
Sample size 2008: 328 childrenSample size 2010: 322 children
Sample size 2008: 972 childrenSample size 2010: 1162 children
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9,889,39
7,83
9,06
0
2
4
6
8
10
12
Moeskroen Provincie
Prevalence of overweight in Moeskroen compared to the Province of Hainaut
2008
2010
Province
A better evolution in Moeskroen compared to the Province of Hainaut
15
n.s.
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8,237,49
5,90
8,22
0
2
4
6
8
10
12
Marche Provincie
Prevalence of overweight in Marche compared to the province of Luxemburg
2008
2010
A better evolution in Marche compared to the province of Luxembourg
16
n.s.
Province
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Stability of obesity in the pilot towns
• A normal evolution since it is more difficult to intervene in obesity than in overweight through a prevention programme
17
0
2
4
6
8
10
12
Marche Moeskroen
Children in 1st & 3rd kindergarten
2008
2010
n.s.
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Prevalence of overweight and obesity
1st and 3rd kindergarten/2nd and 6th primary schoolZero measurement 2009/2010
Moeskroen
RochefortMarche
CominesSint-Pieters Woluwe Jette
Pepinster
Luik
Flobecq
Bergen
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In some towns the prevalence is already high at the age of 3!
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11,8515,15
10,92 10,95 8,65 7,31 6,62 7,29 5,139,94
10,43 6,06
6,82 6,574,89 5,77 5,15 3,13
3,21
5,5
0
5
10
15
20
25
30
Prevalence of overweight and obesity in 1st kindergarten in 2009/2010
obesitas
overgewichtObesity
Overweight
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About 1 out of 4 children are overweight or obese at the age
of 12
20
15,91 16,6913,6 14,29 12,46 15,12
10,92 11,11 12,5 11,2614,1
11,36 10,0112,8 11,43
11,31 8,4711,76 9,52 8,09
3,03
10,1
0
5
10
15
20
25
30
Prevalence of overweight and obesity in 6th primaryschool in 2009/2010
obesitas
overgewichtObesityOverweight
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Management of overweight and obesity
•
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EmpowermentMulti-component: Improved diet + more physical activity + behavior change
Mind Behavior change
Experiential learning and peer modelling
Group-based physical activity
Land and water-based activities
Exercise
Long-term central support
mendcentral.org
Do it!Weight maintenance resources (MEND World)
Nutrition targets & education……high-impact demos… made
real in a local supermarketNutrition
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Sacher et al, Obesity, 2010
RCT: three-month outcomes improved at six months; maintained at 12 months
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Feasibility RCT UK roll-out
Number 11 117 10,361
Mean attendance (%) 78 86 79
Retention (%) 91 97 89
90% of children reduce their BMI z-score after MEND 7-13
Program attendance, retention and BMI change: UK
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Physical activity
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Nutrition education and modeling
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Does one treatment package fit all?
A tiered approach is necessary!
<1.04BMI SDS
>1.04BMI SDS
>2.00BMI SDS
>3.00BMI SDS
Gately P, Professor of Exercise and Obesity at Leeds Metropolitan University; Director of More Life (voorheen: CEO of Carnegie Weight Management Centre)
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Weight loss journey
Weight loss15-20%
Residential Camp
Community Camp
Community Club
Self Care
Gately P, Professor of Exercise and Obesity at Leeds Metropolitan University; Director of More Life (voorheen: CEO of Carnegie Weight Management Centre)
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More LifeGately P, Professor of Exercise and Obesity at Leeds Metropolitan University; Director of More Life (voorheen: CEO of Carnegie Weight Management Centre)
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Where are the key problems that we may face in the next decade (greatest challenges)?
• sustainable political commitment• sustainable public-private partnerships• funding for quantitative and qualitative evaluation• affordable local health care
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Where are the roadblocks (greatest difficulties)?
• short-term political interests versus long-term health goals• multisectoral approaches difficult of insufficient co-creation of values for various sectors• infrastructure and funding for long-term qualitative and quantitative evaluations• commercial pressures that undermine healthy choices• political pressures to stress individual responsibility
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What societal impact might the outcomes of this research have?
• Effective integrated sustainable approaches for healthier lifestyles have many other benefits (education, safety, social integration, productivity, environment).• Lower demands on health care.• Improved quality of Life and societal participation
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Recommendations for the future of European obesity research.
• Frameworks and research-tools for the quantitative and qualitative evaluation of integrated approaches (can also be used for other societal problems). Multidiciplinary research teams are needed. • Roadmaps for the development of multisectoral and multistakeholder approaches.• Effective interventions, effective implementation and effective integration.
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European Obesity Research Conference: Thematic Recommendations
Public health and prevention• Develop frameworks for effective implementation and integration of
interventions (including sustainable public-private partnership and sustainable political commitment) and research tools for quantitative and qualitative evaluation of integrated approaches. Develop capacity building through multisectoral action
• Determine characteristics of favourable environments for all ages (especially for physical activity promotion) and key interactions of environment with perceptions of environments and personal/social determinants
• Assess the impact on obesity of the changing economic climate and the impact on inequalities of interventions
• Develop a pan-European surveillance system of obesity, its causes and consequences