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     Welcome!
A review of the evidence:
      School-based
interventions to address
obesity in children 6-12
      years of age
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The Health Evidence Team


                               Kara DeCorby        Heather Husson       Jennifer Yost
                               Managing Director   Project Manager      Guest Presenter




Maureen Dobbins
Scientific Director
Tel: 905 525-9140 ext 22481
E-mail: dobbinsm@mcmaster.ca




                               Lori Greco          Robyn Traynor        Lyndsey McRae
                               Knowledge Broker    Research Coordinator Research Assistant
What is www.health-evidence.ca?


                     Evidence
                          inform



              Decision Making
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
Knowledge Translation
 Supplement Project
    CIHR-funded KTB-112487
A Review of the Evidence:
School-based Interventions to Address
 Obesity in Children 6-12 Years of Age
• Julie Charlebois
  Health Promotion Consultant

• Paula Waddell
  Health Promotion Consultant
Overview
• Partnerships for Health System
  Improvement Project Goal

• Introduction to Evidence-Informed
  Decision Making

• A Review of the Evidence

• Recommendations

• Next Steps
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
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)
Stages of Evidence-Informed
                     Decision Making

                                                    Step 1: Define

                                                    Step 2: Search

                                                    Step 3: Appraise

                                                    Step 4: Synthesize

                                                    Step 5: Adapt

                                                    Step 6: Implement
Source: National Collaborating Centre for Methods
and Tools (NCCMT)                                   Step 7: Evaluate
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
Step 1: Define

                Research Question 1:
What interventions or strategies are most effective in
low-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
Step 1: Define


             Research Question 2:
  What school-based programs are effective in
increasing 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
Step 2: Search
           START HERE
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"
Step 2: Search (Tracking Tool)
Step 2: Search (Databases and Timeframe)

         Guidelines and Systematic Reviews

Electronic 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 Queries

Time Frame:
      • Searched from 2007 to May 2012
Step 3:
        Appraise


     Quality
Assessment Tool
 for Systematic
   Reviews:
Appraise

Quality Assessment
Tool for Guidelines:
Quality Assessment Summary (Appendix B)


Total: 9 Systematic Reviews & 2 Guidelines
New PICO Question



What school-based programs are effective in
low-income communities/neighbourhoods to
address risk factors related to obesity in
children ages 6-12?
Step 4: Synthesize

Characteristics:
(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
Step 4: Synthesize (Results)

Results were synthesized from 410 articles
describing 364 separate interventions

Results analyzed according to categories:

  √ Physical Health Status Measures (5 Reviews)

  √ Physical Activity Measures (4 Reviews)

  √ Dietary Measures (3 Reviews)

  √ Psychosocial Measures (2 Reviews)
Step 4: Synthesize (Results)

The categories were further sub-divided into one or more of
the 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
Step 4: Synthesize (Recommendations)

Setting and Audience:

TPH should implement obesity prevention interventions in the school
setting.

TPH should implement obesity prevention interventions targeting children
ages 6–12 (elementary school aged).

TPH should deliver obesity prevention interventions to mixed gender
groups.

TPH should implement obesity prevention interventions in schools in lower
socio-economic neighbourhoods to increase physical activity levels and
improve dietary intake.

TPH should implement obesity prevention interventions that target all
children versus interventions that target high risk populations who are
already overweight or have risk factors of becoming overweight.
Step 4: Synthesize (Recommendations)

Dietary-based Interventions:

TPH should not implement dietary-based interventions alone to improve
anthropometric measures.

TPH should implement dietary-based interventions to improve dietary
intake and/or behaviour (vs. anthropometric measures alone).

TPH should implement environmental or policy-based interventions such
as breakfast and/or fruit and vegetable distribution programs to improve
dietary intake.

TPH should not implement environmental or policy-based interventions
focussing on system-wide nutritional change to improve anthropometric
measures.
Step 4: Synthesize (Recommendations)

Physical Activity-based Interventions:

TPH should implement physical activity-based interventions that decrease
sedentary behaviours to improve anthropometric measures.

TPH should implement physical activity-based interventions that focus on
extended physical education classes and activity breaks to improve
anthropometric measures.

TPH should not implement physical activity-based interventions involving
fitness enhancement to improve anthropometric measures.

TPH should implement physical activity-based interventions to increase
physical activity measures including physical activity and /or sedentary
levels. The use of activity breaks is one intervention that has been shown
to be successful.
Step 4: Synthesize (Recommendations)



Physical Activity-based Interventions: (continued)

TPH should not implement physical activity curriculum alone to increase
physical activity levels.

TPH should implement environmental or policy-based interventions to
increase physical activity levels (e.g., playground game equipment and
activity cards provided, playground painted with florescent marking
designs and games by students).
Step 4: Synthesize (Recommendations)


Multi-risk Approach:

TPH should implement a combination of physical activity and
dietary-based interventions to improve anthropometric
measures as well as physical and dietary behaviours.
Step 4: Synthesize (Recommendations)

Multi-component Approach:

TPH should incorporate a multi-component approach to obesity
prevention including behavioral, environmental, and educational
components including health education, enhanced physical education,
and promotion of healthy food options. In particular, the education
component should be multi-risk.

TPH should not implement either physical activity or dietary-based
education in isolation due to its limited impact as an obesity prevention
intervention.
Step 4: Synthesize (Recommendations)

Other Intervention Components:

TPH should include psychosocial/psychoeducational components in
physical activity and dietary-based interventions (e.g. activities
increasing knowledge/attitudes/preferences, self-esteem, well-being
and/or quality of life).

TPH should implement physical activity and/ or dietary-based
interventions lasting at least 3 months.

TPH should incorporate a family component into all obesity prevention
interventions.

TPH should aim for a high level of parental involvement in obesity
prevention interventions (e.g. behaviour change goal for parents).
Step 4: Synthesize (Recommendations)

Other Intervention Components: (continued)

TPH should use peer leaders in interventions focussing on obesity
prevention.

TPH should use incentives in interventions focussing on increasing fruit
and vegetables consumption (e.g. rewards provided when fruit and
vegetable servings are eaten at school).

TPH should continue to partner with school staff and intervention
specialists in the school setting in order to maximize the impacts of
obesity prevention interventions.

Overall, TPH should address harm or unintended effects when
planning, implementing and evaluating obesity prevention interventions.
Step 5: Adapt


Assessment of Applicability
and Transferability
Next Steps


•   Applicability and transferability tool
•   Examine current TPH programs for gaps and
    opportunities
•   Develop pilot project


Ongoing:
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
Thank you

Julie Charlebois
Health Promotion Consultant
Toronto Public Health
jcharle@toronto.ca

Paula Waddell
Health Promotion Consultant
Toronto Public Health
pwaddell@toronto.ca

Health Evidence
info@health-evidence.ca
Questions?
Posting Board
For 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.

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

  • 1. This webinar has been made possible with support from the Canadian Institutes of Health Research Welcome! A review of the evidence: School-based interventions to address obesity 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. Participant Side Panel Housekeeping 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. The Health Evidence Team Kara DeCorby Heather Husson Jennifer Yost Managing Director Project Manager Guest Presenter Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: dobbinsm@mcmaster.ca Lori Greco Robyn Traynor Lyndsey McRae Knowledge Broker Research Coordinator Research Assistant
  • 4. What is www.health-evidence.ca? Evidence inform Decision Making
  • 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. Knowledge Translation Supplement Project CIHR-funded KTB-112487
  • 7. A Review of the Evidence: School-based Interventions to Address Obesity in Children 6-12 Years of Age
  • 8. • Julie Charlebois Health Promotion Consultant • Paula Waddell Health Promotion Consultant
  • 9. Overview • Partnerships for Health System Improvement Project Goal • Introduction to Evidence-Informed Decision Making • A Review of the Evidence • Recommendations • Next Steps
  • 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. 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. Stages of Evidence-Informed Decision Making Step 1: Define Step 2: Search Step 3: Appraise Step 4: Synthesize Step 5: Adapt Step 6: Implement Source: National Collaborating Centre for Methods and Tools (NCCMT) Step 7: Evaluate
  • 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. Step 1: Define Research Question 1: What interventions or strategies are most effective in low-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. Step 1: Define Research Question 2: What school-based programs are effective in increasing 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. Step 2: Search START HERE
  • 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. Step 2: Search (Tracking Tool)
  • 19. Step 2: Search (Databases and Timeframe) Guidelines and Systematic Reviews Electronic 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 Queries Time Frame: • Searched from 2007 to May 2012
  • 20.
  • 21.
  • 22.
  • 23. Step 3: Appraise Quality Assessment Tool for Systematic Reviews:
  • 25. Quality Assessment Summary (Appendix B) Total: 9 Systematic Reviews & 2 Guidelines
  • 26. New PICO Question What school-based programs are effective in low-income communities/neighbourhoods to address risk factors related to obesity in children ages 6-12?
  • 27. Step 4: Synthesize Characteristics: (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
  • 28. Step 4: Synthesize (Results) Results were synthesized from 410 articles describing 364 separate interventions Results analyzed according to categories: √ Physical Health Status Measures (5 Reviews) √ Physical Activity Measures (4 Reviews) √ Dietary Measures (3 Reviews) √ Psychosocial Measures (2 Reviews)
  • 29. Step 4: Synthesize (Results) The categories were further sub-divided into one or more of the 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
  • 30. Step 4: Synthesize (Recommendations) Setting and Audience: TPH should implement obesity prevention interventions in the school setting. TPH should implement obesity prevention interventions targeting children ages 6–12 (elementary school aged). TPH should deliver obesity prevention interventions to mixed gender groups. TPH should implement obesity prevention interventions in schools in lower socio-economic neighbourhoods to increase physical activity levels and improve dietary intake. TPH should implement obesity prevention interventions that target all children versus interventions that target high risk populations who are already overweight or have risk factors of becoming overweight.
  • 31. Step 4: Synthesize (Recommendations) Dietary-based Interventions: TPH should not implement dietary-based interventions alone to improve anthropometric measures. TPH should implement dietary-based interventions to improve dietary intake and/or behaviour (vs. anthropometric measures alone). TPH should implement environmental or policy-based interventions such as breakfast and/or fruit and vegetable distribution programs to improve dietary intake. TPH should not implement environmental or policy-based interventions focussing on system-wide nutritional change to improve anthropometric measures.
  • 32. Step 4: Synthesize (Recommendations) Physical Activity-based Interventions: TPH should implement physical activity-based interventions that decrease sedentary behaviours to improve anthropometric measures. TPH should implement physical activity-based interventions that focus on extended physical education classes and activity breaks to improve anthropometric measures. TPH should not implement physical activity-based interventions involving fitness enhancement to improve anthropometric measures. TPH should implement physical activity-based interventions to increase physical activity measures including physical activity and /or sedentary levels. The use of activity breaks is one intervention that has been shown to be successful.
  • 33. Step 4: Synthesize (Recommendations) Physical Activity-based Interventions: (continued) TPH should not implement physical activity curriculum alone to increase physical activity levels. TPH should implement environmental or policy-based interventions to increase physical activity levels (e.g., playground game equipment and activity cards provided, playground painted with florescent marking designs and games by students).
  • 34. Step 4: Synthesize (Recommendations) Multi-risk Approach: TPH should implement a combination of physical activity and dietary-based interventions to improve anthropometric measures as well as physical and dietary behaviours.
  • 35. Step 4: Synthesize (Recommendations) Multi-component Approach: TPH should incorporate a multi-component approach to obesity prevention including behavioral, environmental, and educational components including health education, enhanced physical education, and promotion of healthy food options. In particular, the education component should be multi-risk. TPH should not implement either physical activity or dietary-based education in isolation due to its limited impact as an obesity prevention intervention.
  • 36. Step 4: Synthesize (Recommendations) Other Intervention Components: TPH should include psychosocial/psychoeducational components in physical activity and dietary-based interventions (e.g. activities increasing knowledge/attitudes/preferences, self-esteem, well-being and/or quality of life). TPH should implement physical activity and/ or dietary-based interventions lasting at least 3 months. TPH should incorporate a family component into all obesity prevention interventions. TPH should aim for a high level of parental involvement in obesity prevention interventions (e.g. behaviour change goal for parents).
  • 37. Step 4: Synthesize (Recommendations) Other Intervention Components: (continued) TPH should use peer leaders in interventions focussing on obesity prevention. TPH should use incentives in interventions focussing on increasing fruit and vegetables consumption (e.g. rewards provided when fruit and vegetable servings are eaten at school). TPH should continue to partner with school staff and intervention specialists in the school setting in order to maximize the impacts of obesity prevention interventions. Overall, TPH should address harm or unintended effects when planning, implementing and evaluating obesity prevention interventions.
  • 38. Step 5: Adapt Assessment of Applicability and Transferability
  • 39. Next Steps • Applicability and transferability tool • Examine current TPH programs for gaps and opportunities • Develop pilot project Ongoing: 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
  • 40. Thank you Julie Charlebois Health Promotion Consultant Toronto Public Health jcharle@toronto.ca Paula Waddell Health Promotion Consultant Toronto Public Health pwaddell@toronto.ca Health Evidence info@health-evidence.ca
  • 42. Posting Board For 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.