A review of the evidence: School-based Interventions to Address Obesity Prevention in Children 6-12 Years of Age


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Health Evidence hosted a 90 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on School-based Interventions to Address Obesity Prevention in Children 6-12 Years of Age presenting key messages, and implications for practice on Thursday, November 22nd, 2012 at 1:00 pm EST.

Kara DeCorby, Managing Director and Knowledge Broker for Health Evidence, lead the webinar, which included interactive discussion with Julie Charlebois and Paula Waddell, the authors of this review.

This webinar focused on interpreting the evidence in the following review:

Charlebois, J., Gowrinathan, Y., & Waddell, P. (2012). A Review of the Evidence: School-based Interventions to Address Obesity Prevention in Children 6-12 Years of Age. Toronto Public Health. Toronto, Ontario. (http://health-evidence.ca/documents/Final Report Sept 24-12.pdf)

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A review of the evidence: School-based Interventions to Address Obesity Prevention in Children 6-12 Years of Age

  1. 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome!A review of the evidence: School-basedinterventions to addressobesity in children 6-12 years of age You will be placed on hold until the webinar begins. The webinar will begin shortly, please remain on the line.
  2. 2. Participant Side PanelHousekeeping in WebEx Use Q&A to post comments/questions during the webinar  ‘Send’ questions to All (not privately to ‘Host’) Connection issues  Recommend using a wired Internet connection (vs. wireless), to help Q&A prevent connection challenges WebEx 24/7 help line: 1-866-229-3239
  3. 3. The Health Evidence Team Kara DeCorby Heather Husson Jennifer Yost Managing Director Project Manager Guest PresenterMaureen DobbinsScientific DirectorTel: 905 525-9140 ext 22481E-mail: dobbinsm@mcmaster.ca Lori Greco Robyn Traynor Lyndsey McRae Knowledge Broker Research Coordinator Research Assistant
  4. 4. What is www.health-evidence.ca? Evidence inform Decision Making
  5. 5. Why use www.health-evidence.ca? 1. Saves you time 2. Relevant & current evidence 3. Transparent process 4. Supports for EIDM available 5. Easy to use
  6. 6. Knowledge Translation Supplement Project CIHR-funded KTB-112487
  7. 7. A Review of the Evidence:School-based Interventions to Address Obesity in Children 6-12 Years of Age
  8. 8. • Julie Charlebois Health Promotion Consultant• Paula Waddell Health Promotion Consultant
  9. 9. Overview• Partnerships for Health System Improvement Project Goal• Introduction to Evidence-Informed Decision Making• A Review of the Evidence• Recommendations• Next Steps
  10. 10. Partnerships for Health System Improvement• Health Evidence was awarded a CIHR grant• Health Evidence is partnering with three Ontario public health units• Exploring how to best enhance capacity for and facilitate contexts conducive to EIDM in public health
  11. 11. What is Evidence-Informed Decision Making?The process of distilling and disseminating the best available evidence from research, practice and experience and using that evidence to inform and improve public health policy and practice National Collaborating Centre for Methods and Tools (NCCMT)
  12. 12. Stages of Evidence-Informed Decision Making Step 1: Define Step 2: Search Step 3: Appraise Step 4: Synthesize Step 5: Adapt Step 6: ImplementSource: National Collaborating Centre for Methodsand Tools (NCCMT) Step 7: Evaluate
  13. 13. Model of EIDM in Public Health Community Community and Health Issues, Political Local Context Preferences and Actions Public Health Expertise Research Public Health Evidence Resources National Collaborating Centre for Methods and Tools DiCenso, A., Ciliska D., Haynes B., & Guyatt, G. 2005
  14. 14. Step 1: Define Research Question 1:What interventions or strategies are most effective inlow-income communities/neighbourhoods to address risk factors related to obesity? P (Population): Low-income Communities I (Intervention): Best Intervention C (Comparison): N/A O (Outcome): Factors influencing healthy weights and obesity prevention
  15. 15. Step 1: Define Research Question 2: What school-based programs are effective inincreasing physical activity participation in higher needs elementary schools? P (Population): Children in higher needs elementary schools I (Intervention): School-based physical activity programs C (Comparison): N/A O (Outcome): Increasing participation in physical activity
  16. 16. Step 2: Search START HERE
  17. 17. Step 2: Search (Search Terms) Research Question #1:“obesity; obesity and low income; obesity and low income and program; obesity and low income and physical activity and nutrition" Research Question #2:"school and physical activity programs; school and physical activity and programs and high risk"
  18. 18. Step 2: Search (Tracking Tool)
  19. 19. Step 2: Search (Databases and Timeframe) Guidelines and Systematic ReviewsElectronic Databases: • Guideline Advisory Committee (GAC) • National Guidelines Clearinghouse (NGC) • Turning Research into Practice (TRIP) Database (Guidelines and Systematic Reviews) • Health Evidence • Centre for Reviews and Dissemination (CRD) • Eppi-Centre • Cochrane Collaboration • PubMed Clinical QueriesTime Frame: • Searched from 2007 to May 2012
  20. 20. Step 3: Appraise QualityAssessment Tool for Systematic Reviews:
  21. 21. AppraiseQuality AssessmentTool for Guidelines:
  22. 22. Quality Assessment Summary (Appendix B)Total: 9 Systematic Reviews & 2 Guidelines
  23. 23. New PICO QuestionWhat school-based programs are effective inlow-income communities/neighbourhoods toaddress risk factors related to obesity inchildren ages 6-12?
  24. 24. Step 4: SynthesizeCharacteristics:(Appendix C)- Author, Date, Place of Publication Outcomes:- # of Primary Studies, Type of (Appendix D) Studies- Theoretical Basis - Author, Year, Place of Publication- Settings - Outcome Measures- Target Audience - Results- Intervention Length - General Implications- Mode of Delivery - Comments/Limitations- Provider- Parent/Guardian Involvement
  25. 25. Step 4: Synthesize (Results)Results were synthesized from 410 articlesdescribing 364 separate interventionsResults analyzed according to categories: √ Physical Health Status Measures (5 Reviews) √ Physical Activity Measures (4 Reviews) √ Dietary Measures (3 Reviews) √ Psychosocial Measures (2 Reviews)
  26. 26. Step 4: Synthesize (Results)The categories were further sub-divided into one or more ofthe following topics: √ Dietary-based Interventions √ Physical Activity-based Interventions √ Psychosocial/psychoeducational Variables √ Duration √ Family and Community Involvement √ Intervention Delivery Based on Setting and Provider √ Tailored Programs √ Education Only Interventions √ Multi-component Interventions √ Environmental or Policy-based Interventions √ Peer Leaders and Incentives
  27. 27. Step 4: Synthesize (Recommendations)Setting and Audience:TPH should implement obesity prevention interventions in the schoolsetting.TPH should implement obesity prevention interventions targeting childrenages 6–12 (elementary school aged).TPH should deliver obesity prevention interventions to mixed gendergroups.TPH should implement obesity prevention interventions in schools in lowersocio-economic neighbourhoods to increase physical activity levels andimprove dietary intake.TPH should implement obesity prevention interventions that target allchildren versus interventions that target high risk populations who arealready overweight or have risk factors of becoming overweight.
  28. 28. Step 4: Synthesize (Recommendations)Dietary-based Interventions:TPH should not implement dietary-based interventions alone to improveanthropometric measures.TPH should implement dietary-based interventions to improve dietaryintake and/or behaviour (vs. anthropometric measures alone).TPH should implement environmental or policy-based interventions suchas breakfast and/or fruit and vegetable distribution programs to improvedietary intake.TPH should not implement environmental or policy-based interventionsfocussing on system-wide nutritional change to improve anthropometricmeasures.
  29. 29. Step 4: Synthesize (Recommendations)Physical Activity-based Interventions:TPH should implement physical activity-based interventions that decreasesedentary behaviours to improve anthropometric measures.TPH should implement physical activity-based interventions that focus onextended physical education classes and activity breaks to improveanthropometric measures.TPH should not implement physical activity-based interventions involvingfitness enhancement to improve anthropometric measures.TPH should implement physical activity-based interventions to increasephysical activity measures including physical activity and /or sedentarylevels. The use of activity breaks is one intervention that has been shownto be successful.
  30. 30. Step 4: Synthesize (Recommendations)Physical Activity-based Interventions: (continued)TPH should not implement physical activity curriculum alone to increasephysical activity levels.TPH should implement environmental or policy-based interventions toincrease physical activity levels (e.g., playground game equipment andactivity cards provided, playground painted with florescent markingdesigns and games by students).
  31. 31. Step 4: Synthesize (Recommendations)Multi-risk Approach:TPH should implement a combination of physical activity anddietary-based interventions to improve anthropometricmeasures as well as physical and dietary behaviours.
  32. 32. Step 4: Synthesize (Recommendations)Multi-component Approach:TPH should incorporate a multi-component approach to obesityprevention including behavioral, environmental, and educationalcomponents including health education, enhanced physical education,and promotion of healthy food options. In particular, the educationcomponent should be multi-risk.TPH should not implement either physical activity or dietary-basededucation in isolation due to its limited impact as an obesity preventionintervention.
  33. 33. Step 4: Synthesize (Recommendations)Other Intervention Components:TPH should include psychosocial/psychoeducational components inphysical activity and dietary-based interventions (e.g. activitiesincreasing knowledge/attitudes/preferences, self-esteem, well-beingand/or quality of life).TPH should implement physical activity and/ or dietary-basedinterventions lasting at least 3 months.TPH should incorporate a family component into all obesity preventioninterventions.TPH should aim for a high level of parental involvement in obesityprevention interventions (e.g. behaviour change goal for parents).
  34. 34. Step 4: Synthesize (Recommendations)Other Intervention Components: (continued)TPH should use peer leaders in interventions focussing on obesityprevention.TPH should use incentives in interventions focussing on increasing fruitand vegetables consumption (e.g. rewards provided when fruit andvegetable servings are eaten at school).TPH should continue to partner with school staff and interventionspecialists in the school setting in order to maximize the impacts ofobesity prevention interventions.Overall, TPH should address harm or unintended effects whenplanning, implementing and evaluating obesity prevention interventions.
  35. 35. Step 5: AdaptAssessment of Applicabilityand Transferability
  36. 36. Next Steps• Applicability and transferability tool• Examine current TPH programs for gaps and opportunities• Develop pilot projectOngoing:Knowledge Brokering within Toronto Public Health • CDIP Consultants, Healthy Communities Consultants • CDIP child staff • Healthy Communities school youth team staff • Other TPH PHSI project staff
  37. 37. Thank youJulie CharleboisHealth Promotion ConsultantToronto Public Healthjcharle@toronto.caPaula WaddellHealth Promotion ConsultantToronto Public Healthpwaddell@toronto.caHealth Evidenceinfo@health-evidence.ca
  38. 38. Questions?
  39. 39. Posting BoardFor a copy of the presentation please visit our posting board: http://forum.health-evidence.ca/Login with your health-evidence username and password or register if you aren’t a member yet.