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TRANSCRIPT
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EPODE: a multi-stakeholder approach in tackling
childhood obesity
Institute of Medicine, Washington, 24 February 2011Reducing Disparities in Life Expectancy
Yann LE BODO, EPODE International Coordinator, PROTEINES
EPODE International Coordination
2
Introduction
ü EPODE was developed to upscale the encouraging results from a pilot study(1) conducted in Northern France between 1992 and 2004 (FLVS)
ü EPODE (Together let’s prevent childhood obesity) is a methodology developed in 2003 by a Health communication and social marketing Agency (PROTEINES), consistent with the French National Plan for Nutrition and Health(2)
ü The methodology is a coordinated approach now implemented in several countries across the globe, gathering multiple stakeholders (public and private) at international, state and local levels
(1) Romon & Al., Public Health Nutrition, 2009; 12: 1735–1742(2) www.mangerbouger.fr/pnns/
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Contents
1. Obesity prevention in the FLVS Study
2. EPODE methodology
3. EPODE results in the French Pilot towns and socioeconomic disparities
4. EPODE International Network
4
1. Childhood Obesity Prevention in the FLVS study
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A pilot study in Northern France
FleurbaixLaventie
Paris
Nord Pas de Calais
ü Objective: measure the effectiveness of an integrated community prevention programme on the prevalence of children overweight including obesity, over 12 years
ü Overall period: 1992 to 2004
ü Location: Fleurbaix and Laventie Towns (6600 inhabitants)
ü Methods: Cross-sectional studies (n=804, response rate 81%) - interventions performed in two steps:
è 1st intervention (1992-2000) focused on nutrition education in schools
è 2nd intervention (2000-2004) involved the whole population (children, families and local stakeholders) in integrated community actions targeting physical activity and nutrition
66
Children overweight prevalence data in FLVS and in CT
Years1992 2000 2004
5
10
20
15
Childhood overweight rate (%)
11.4%
14.3% (1)
NS
P<0.012 / FLVS 2000
8.8% (2)
FLVS
CT
12.6%
NS; p= 0.7
17.8% (2)
P<0.0001 / FLVS 2004
From education to education + city involvement
(1) Heude & Al, Diabetes Metab. 2003 Jun;29(3):235-40.(2) Romon & Al., Public Health Nutrition, 2009; 12: 1735–1742
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Overweight Prevalence according to socio-economic criteria in 2004 in FLVS and CT (1)
5.6 5.7
Upper SESNS
7.0
16.9
Middle SESp<0.01
15.2 15.2
26.9
Lower SESp<0.01
FLVS
CT
(1) Romon & Al., Public Health Nutrition, 2009; 12: 1735–1742
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Study conclusions - the importance of:
ü The target: the family
ü Local authorities / Local leaders
ü A local project manager
ü Actions in schools as a first step to create awareness but to becompleted with a multistakeholder approach for better and sustainable efficiency
ü A public / private partnership
ü A regular communication
ü An evaluation of the results through children BMI measurement
ü Long-term actions: IT TAKES TIME!
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2. EPODE Methodology
Together lets’ prevent childhood obesity
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EPODE Methodology
ü EPODE is a coordinated, capacity-building approachfor communities
ü EPODE’s four pillars are:1. A strong Political commitment at multiple levels, 2. Resources including PPP schemes,3. Support services including social marketing expertise,
4. An sound Evidence base and continuous evaluation
ü EPODE’s goal is to enable community stakeholders to implement effective and sustainable strategies to prevent childhood obesity at the local level
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Target groupsChildren 0 to 12 years old and their families
Stakeholders who can influence childhood settings, food environments and physical activity environments, socio economic policies and socio cultural norms
1
2
Community level
FAMILIES
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EPODE CENTRAL COORDINATION
Environment of families
INDEPENDENT SCIENTIFIC COMMITTEE
NATIONAL INSTITUTIONAL
SUPPORT
PRIVATE PARTNERS
(Sponsors, NGOs, Scientific groups…)
LOCAL STEERING
COMMITTEE
LOCAL PROJECT
MANAGERS
In each state /region a multi-level
and multi-stakeholder approach
MAYORS, Elected
representatives
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13
13
2009-10
FLVS STUDY (France)
Launch of EPODE Programme in FranceA methodology based on social marketing,
mobilizing local stakeholders in a sustainable way
EPODE European Network
With the support of DG Health and Consumers, facilitating the implementation of EPODE-similar programmes in other European Countries
1992
2004
2008
Launch of THAO (Spain) and VIASANO (Belgium) Programmes2006
Launch of PAIDEIATROFI (Greece) Programme
2008
2004
Launch in South Australia and Mexico
2011
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2. EPODE Results in French pilot towns and socioeconomic disparities
1. Evolution of children overweight prevalencebetween 2005 and 2009
2. Importance of central seasonal campaignscomplemented by tailored actions locally
3. Transferability and sustainability of EPODE implementation across Europe
15
EPODE in 2004
è Pilot towns involved since 2004
è Committed for 5 years
è Around 500 000 inhabitants
N=23617
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
Bod
y M
ass
Index
(%
) AsnièresBeauvaisBéziersEvreuxMeyzieuRoubaix*RoyanVitré**
N=24752
From 2005 to 2009 prevalence of overweight and obesity in children decreased by 9.12%***(1)
Total, P<0,0001
*** p<0,0001(1) Romon & Al., Nutrition clinique et métabolisme, Vol 24, N° S1 - décembre 2010, p. 58.
From 2005 to 2009 prevalence of overweight and obesity in children decreased overall by 9.12% but with socioeconomic disparities (1)
NS23,1523,7<0,000116,2418,64<0,000118,8320,57OB+OW (%)
NS16,6516,91<0,000113,0315,04<0,000114,4815,76Overweight (%)
NS6,56,78NS3,223,6NS4,454,81Obesity (%)
5,823,385,862,275,82,7Refusal (%)
8855946614762152862361724752Sample size
p20092005p20092005p20092005Years
Disadvantaged areaNon-disadvantaged areaTotal population
(1) Romon & Al., Nutrition clinique et métabolisme, Vol 24, N° S1 - décembre 2010, p. 58.
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BMI Z-score distribution in the population
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Z-score de BMI
20052009
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
-2 -1 0 1 2
Z-score de BMI
20052009
BMI Z-score distribution according to average SES level
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
-2 -1 0 1 2
Z-score de BMI
20052009
Non-disadvantaged area Disadvantaged area
0
0,05
0,1
0,15
0,2
0,25
0,3
0,35
0,4
0,45
-2 -1 0 1 2Z-score de BMI
20052009
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Comparison with other French surveys
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Overweight prevalence evolution in EPODE pilot towns compared to national studies
0
5
10
15
20
25
année 1999 année 2006 année 2004 année2009 année 1999 année 2006
INCA EPODE examens de santé
***
NSNS
* : P<0,0001
NS: non significant
1999 2006 2004 2009 1999 2006
(3-14 years; N=989/983) (4-11 years; N=24752 / 23617) (6-15 years; N=3551 / 1953)
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To conclude
ü In France, globally childhood overweight and obesity prevalence is no longer increasing and even decreases in certain age groups, except in disadvantaged populations
ü An even more encouraging evolution is observed in the EPODE French pilot towns, with an overall significant decrease of children overweight and obesity prevalence, and a stabilization in disadvantaged populations
ü Challenge => accelerate actions targeting disadvantaged populations
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A faxed letter
Mobilisation sheet
Mobilisation sheet
Press release
8 action sheets1 action sheet
1 action sheet
1 action sheet2 action sheets
Since 2004 in France, each 6-9 Months, themed social marketing campaigns tailored at local level
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Transferability and sustainability of EPODE implementation across Europe
EPODE - France
10
127
167
226
0
50
100
150
200
250
2004 2006 2008 2010
VIASANO - Belgium
2
13
16
0
5
10
15
20
2004 2006 2008 2010
THAO - Spain
5
32
42
0
10
20
30
40
50
2004 2006 2008 2010
PAIDEIATROFI - Greece
5
13
02468
101214
2004 2006 2008 2010
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Support and recognitionü Institutional support
è Support from the EU institutions through the EPODE European Network (European Commission DG SANCO, Grant Agreement 2007327, June 2008)
è Endorsement from Governments in all EPODE regions/Sates
è Reference in the WHO report on population-based prevention strategies for childhood obesity (Report of the WHO forum and
technical meeting, December 2009)
ü EPODE Books / references in the Literatureè Preventing childhood obesity: evidence, policy and practice (Wiley-
Blackwell, 2010)
è Epidemiology in public health practice (Wageningen UP, 2010)
è Principles and practice of Social Marketing: an international perspective (Cambridge UP, 2010)
è Preventing childhood obesity: EPODE European Network Recommendations (Lavoisier, 2010, in press)
ü Invited speakers to scientific conferencesè More than 30 major international Congresses and Conferences
over the last 3 years including:§ International/European Congresses on Obesity (2007-11)§ WHO forum and technical meetings (2008-09)§ International Congresses for Health Promotion (2009-10)§ World Social Marketing Conference (2008)
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4. EPODE International Network (EIN)
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EIN Objectives
ü Accelerate dissemination and facilitate the sustainable implementation of large-scale community-based interventions aimed at preventing childhood obesity at international level
ü Build greater evidence on what works to prevent childhood obesity through CBIs
ü Upscale the scope of expertise, best practice sharingand coaching for member programmes
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EIN stakeholders
1. Existing large scale and sustainable Community-based Interventions (CBI) aimed at preventing childhood obesity and non-communicable diseases;
2. Teams in states or regions interested in implementing future large scale CBI with the EPODE methodology;
3. Leading scientific experts involved in obesity & NCDs prevention;
4. Political representatives and policy makers;
5. The corporate sector;
6. Other key stakeholders;
7. Media and the general public
ØA coordinationstructure and resources platform for CBI members
ØAn International Advisory Board(Scientific Platform)
ØA Ministers’ and Parliamentary Club (PoliticalPlatform)
ØA public-private partnershipplatform
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An international
network of experts and professionals
International Scientific
communication and Advocacy activities
Training and
experience-sharingworkshops gathering CBI programmes coordinators
Organization of
meetings and visitsof EPODE settings at International level
Advice and support, including on-site visits
EPODE International
Network
Access to International
EPODE Materialsdeveloped on various topics
Transfer of EPODE methodology
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EPODE International CoordinationYann LE BODO, International Coordinator , [email protected]
Jean-Michel BORYS, MD, International Director, [email protected]
Pauline HARPER, Director Advisory, [email protected]
Léa WALTER, Assistant Coordinator, [email protected]
Websites
www.epode.fr
www.viasano.be
www.thaoweb.com
www.paideiatrofi.org
www.epode-european-network.com
www.health.sa.gov.au
Contacts - Websites