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EPODE - Preventing childhood obesity in communities - Mr Christophe Roy

The document summarizes the EPODE approach for preventing childhood obesity through community-based programs. It describes how the EPODE model originated from a study in Fleurbaix and Laventie, France that saw significant decreases in childhood obesity rates. EPODE now operates in multiple countries using a coordinated approach involving local stakeholders like schools, health professionals, city leadership and families to implement sustainable strategies promoting healthy eating and physical activity for children ages 0-12. The goal is to reduce childhood obesity by changing local environments and social norms.

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Christophe ROY Deputy Director EPODE Preventing childhood obesity
From FLVS pilot study to EPODE 2
FLVS: Fleurbaix Laventie Ville Santé Nord Pas de Calais Paris Fleurbaix Laventie Lille Fleurbaix : 2 222 inhabitants Laventie : 4 444 inhabitants 3
4
Children obesity prevalence data in FLVS and in CT (Romon & Al., Public Health Nutrition, 2008, Dec 23:1-8) Childhood obesity 20 rate (%) 17.8 % 15 P<0.0001 / FLVS 2004 14.3 12.6 NS 10 11.4 8.8% NS; p= 0.7 CT P<0.012 / FLVS 2000 FLVS 5 From education to education + city involvement Years 1992 2000 2004 5
EPODE in the world, today France, 2004 226 towns Spain, 2007 Belgium, 2007 32 towns 15 towns EPODE Niños y Niñas OPAL Mexico, 2010 South Australia, 2009 6 councils Paideiatrofi Greece, 2008 5 towns 6
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.
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-based learning process of healthy diet & physical activity. 9
The EPODE 4 pillars and goal 1 Creating the political commitment 2 Mobilizing resources 3 Coordination and Support services 4 Evidence-based & evaluation => Enable community stakeholders to implement effective and sustainable actions to prevent childhood obesity
Target groups 1 Children 0 to 12 years old and their families 2 Stakeholders who can influence childhood settings, food environments and physical activity environments, and socio cultural norms
EPODE’s Philosophy  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 environment and thus behaviors involving all relevant local stakeholders 4 12
A federative approach SCIENTIFIC NATIONAL COMMITTEE INSTITUTIONAL SUPPORT Creation of an environment facilitating the adoption of healthier lifestyles by the families PRIVATE PARTNERS EPODE NATIONAL COORDINATION MAYORS, Elected representatives LOCAL PROJECT Environment of MANAGERS families LOCAL STEERING COMMITTEE
The town, at the heart of the system The town is at the heart Town Decision of the system Schools makers Facilities School Catering Health professionals Health organizations Family Infancy professionals •Foster multistakeholder dynamics Other local Network stakeholders of associations Shop owners, Media Extra- local curricular producers professionals EPODE National • Information • Training Coordination • Communication tools Team • Coaching 14
Organization at the local level Mayor and municipal team Local team : Education system • expert GP representative • dietician • school GP • school nurse City sports & leisure Sports department associations representatives Project School catering manager department Shop keepers representatives And local steering committee City school department Local NGOs Stakeholders Welfare department Population 15
National Coordination role Overall management of the programme 1. Resources mobilization, Advocacy and mobilization of National / Regional stakeholders : Experts, Ministries, health professionals, local authorities, NGOs, economic players… 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) 4. Monitoring and evaluation 5. Permanent communication
Each semester, training session, communication tools and roadmaps are provided to local project managers General public Local stakeholders Poster Leaflet 3 / 12 years-old File for « worksheets » Worksheets «local Disseminated in the whole Contents : Worksheets adapted to city Target : families and children aged 3 to 12 stakeholders » Contents : Advice and tips, recommendations for different stakeholders to implement Target : local stakeholders: Target : population as a specific actions healthier behaviours infancy professionals, shop whole owners, NGOs, schools… THEME Health professionals Local Project Managers and Local steering committees Faxed letter: Contents : Advice and An overall guidance tips, recommendations for healthier behaviours document and Biannual roadmaps Contents : objectives, Mobilization worksheets information and advice for Target : All local stakeholders in the framework of the the on-going theme “Taste of the Season” plan: Infancy professionals, shop owners, NGOs, schools… 17 June 2009 17
EPODE themes Playing is already moving! Fish is all good! January 08 October 08 18
Posters Displayed all around the city Target : whole population
The 3-12 years old leaflets Target: families with children aged 3 to 12 years old Content : advices, tips, consumption benchmarks…
Actions sheets Epode Content : Sheets dedicated by target of actor to implement specific actions
Monitoring and Evaluation
A multidisciplinary and independent expert board  Dr Jean-Michel Borys  Dr Sophie Treppoz  Practitioner in Endocrinology,  Paediatrician, representing the Diabetology and Nutrition French Association of Ambulatory Paediatrics, REPOP coordinator  Natalie Rigal  Child Psychologist  Pr Alain Duhamel  Biostatistician, Faculty of Medicine  Pr Daniel Rivière and Biostatistics Training Unit, Lille  Vice-Chairman of the French Society University and Hospital Complex of Medical Practice and Sport  Pr Monique Romon  Pr Claude Jaffiol  Professor of Nutrition, Head of the  Emeritus Professor at Montpellier Nutrition Dept of Lille University and Academy of Medicine Hospital Complex, Chairman of OSEAN network  Monique Valaize  Deputy Mayor for Public Health,  Sandrine Raffin Twinning Committee and  Social Marketing Expert Decentralised Cooperation  Dr Desbonnets  Benoît Dervaux  General Practitioner  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 Measurements Framework, Process, Communication, Difficulties and Challenges
BMI measurements Framework 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 : Pilot towns Y1 Y2 Y3 Y4 Y5 Nursery school (5 yo) TO 5th New recommendation grade (10-11 yo) Y1 Y3 Y5 Nursery school Nursery school Nursery school (5 yo) TO 5th (5 yo) AND 5th (5 yo) TO 5th grade (10-11 yo) grade (10-11 yo) grade (10-11 yo)
BMI measurements Framework 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 = Interest in the results Objectification of for local politicians and « » the towns results Local organization
Evolution of childhood overweight and obesity prevalence, between 2005 and 2009 in the pilot towns Evolution of the prevalence of childhood Overweight+Obesity between 2005 and 2009 in EPODE pilot towns 30 25 Asnières Body Mass Index (%) Beauvais 20 Béziers Evreux 15 Meyzieu Roubaix* 10 Royan Vitré** 5 0 2005 2009 2005 2009 TOTAL towns N % case N total N % case N total p*** % Decrease Obese 1192 4,81 1051 4,45 0,056 Overw eight 3900 15,76 3397 14,38 <0,0001 Overw eightObese 5092 20,57 24752 4448 18,83 23617 <0.0001 -9,12% * 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".
Evolution of childhood overweight and obesity prevalence, between 2005 and 2009 in the pilot towns Schools located in deprived areas  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 2005 2009 TOTAL tow ns - Schools in deprived areas N % case N total N % case N total p*** % Decrease Obese 642 6,78 576 6,5 0,4514 Overw eight 1601 16,91 9466 1474 16,65 8855 0,6287 Overw eightObese 2243 23,7 2050 23,15 0,3845 -2% ***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  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 2005 2009 TOTAL tow ns - Schools NOT in deprived areas N % case N total N % case N total p*** % Decrease Obese 550 3,6 475 3,22 0,4514 Overw eight 2299 15,04 15286 1923 13,03 14762 0,6287 Overw eightObese 2849 18,64 2398 16,24 0,3845 -13% ***In bold : significant "p".
BMI measurements Positive 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 Collected Input, Process and Output indicators
Monitoring and Evaluation Framework 4 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  Interviews with local project managers, at least annually  Questionnaires consistently passed out to the Local Project Managers during meetings  Via the evaluation of pilot projects  Via annual reports  Press Relation Report  National Coordination reports for FLVS association, towns and partners  Via pilot studies results  « We move and we like it »  CSO-Sciences Po-INRA Study  BMI Data collection
Data Collected at National Organization Level Subject / Area Nature of measurement Amount and type of Ministries and politicians supporting the Political support INPUT programme Amount of meetings organized, experts’ qualifications and Expert advisory involvement Networking / Scientific Participation in congresses and other events communication Human investment Coordination Team human resources Manpower competence Coordination Team qualifications Knowledge expertise Experts and Coordination Team expertise PROCESS Amount of private partners contacted and supporting the Private partners recruitment programme Press Relation team report: number and type of press releases, events and clips Communication advocacy / press Dissemination indicators: newsletters (number of contacts), website (traffic) Funding Evolution of funding Town commitment to the OUTUT Evolution of the amount of towns committing to the programme programme Amount of trainings organised per year, perception of their quality Training of local teams by the Local Project Managers. Dissemination at local level* Amount, type and quality (Local Project Managers’ perception) of Tools developed tools developed Organisation commitment to the * = recent indicator Amount and type of organisations participating to the programme programme
Data Collected at Local Organization Level Subject / Area Nature of measurement Kinds of tools developed or used at local level and Material and methods methods used to mobilise the general public INPUT Type of contract for Local Project Managers (full/part Time investment time) Project Managers’ qualifications Local Project Manager’s qualifications Assistants to the Local Project Manager (MP, nurse, Knowledge expertise dietician…) involvement Steering committee Detailed qualifications of stakeholders involved* PROCESS Structures involved / Fields of Amount and type of structures involved / fields of intervention intervention Communication materials Dissemination (amount and type) and satisfaction Labelling Amount and type of EPODE actions labelled Development of new Action sheets by Local Project Action sheets Managers, use of action sheets* OUTUT Utilization at local level of “train the trainer” training Training of local stakeholders sessions, perception of efficiency* Multi stakeholders’ participation in Type of stakeholders involved in the implementation, organization/implementation of the Perception of efficiency by Local Project Managers* programme * = recent indicator
Data Collected at Setting Level Subject / Area Nature of measurement INPUT Amount and type of potential stakeholders to be Initial evaluation of potential stakeholders involved in the EPODE programme For specific actions : age and SES of participating Targets of interventions people Identification of schools located/not located in priority PROCESS Targets of interventions : schools education areas (ZEP) Multi stakeholders’ participation in Type of stakeholders involved in the implementation, organization/implementation of the Perception of efficiency by Local Project Managers* programme Amount of schools / town implementing the actions “a Social environment fruit for recreation” and school playgrounds OUTPUT development For specific actions : amount and type of participation, People participation to the actions age Tools dissemination Amount and type of dissemination * = recent indicator
Data Collected at Child Level Subject / Area Nature of measurement Amount of schools / town implementing the actions “a INPUT Social environment fruit for recreation” and school playgrounds development For specific actions : amount and type of participation, People participation to the actions PROCESS age Tools dissemination Amount and type of dissemination “We move and we like it“ pilot study : assessment of Behaviour changes changes in food habits and physical activity of a cohort OUTUT 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- Weight and height measured by a health professional 11 yo * = recent indicator
Evaluation Framework Positive 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 reporting Profile 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 results Ways 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
EPODE multistakeholder partnership 17 June 2009 42
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
Corporate partners involved (2)  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
With the support of EPODE European Network 54
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

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EPODE - Preventing childhood obesity in communities - Mr Christophe Roy

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    Christophe ROY Deputy Director EPODE Preventing childhood obesity
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    From FLVS pilotstudy to EPODE 2
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    FLVS: Fleurbaix LaventieVille Santé Nord Pas de Calais Paris Fleurbaix Laventie Lille Fleurbaix : 2 222 inhabitants Laventie : 4 444 inhabitants 3
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    Children obesity prevalence data in FLVS and in CT (Romon & Al., Public Health Nutrition, 2008, Dec 23:1-8) Childhood obesity 20 rate (%) 17.8 % 15 P<0.0001 / FLVS 2004 14.3 12.6 NS 10 11.4 8.8% NS; p= 0.7 CT P<0.012 / FLVS 2000 FLVS 5 From education to education + city involvement Years 1992 2000 2004 5
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    EPODE in theworld, today France, 2004 226 towns Spain, 2007 Belgium, 2007 32 towns 15 towns EPODE Niños y Niñas OPAL Mexico, 2010 South Australia, 2009 6 councils Paideiatrofi Greece, 2008 5 towns 6
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    EPODE approach A coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity.
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    Vision statement Childhood obesitywill be reduce by local environments, childhood settings and family norms all being strongly supportive of children enjoying healthy eating, active play and recreation.
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    EPODE philosophy  Basedon 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-based learning process of healthy diet & physical activity. 9
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    The EPODE 4pillars and goal 1 Creating the political commitment 2 Mobilizing resources 3 Coordination and Support services 4 Evidence-based & evaluation => Enable community stakeholders to implement effective and sustainable actions to prevent childhood obesity
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    Target groups 1 Children0 to 12 years old and their families 2 Stakeholders who can influence childhood settings, food environments and physical activity environments, and socio cultural norms
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    EPODE’s Philosophy  Asmooth 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 environment and thus behaviors involving all relevant local stakeholders 4 12
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    A federative approach SCIENTIFIC NATIONAL COMMITTEE INSTITUTIONAL SUPPORT Creation of an environment facilitating the adoption of healthier lifestyles by the families PRIVATE PARTNERS EPODE NATIONAL COORDINATION MAYORS, Elected representatives LOCAL PROJECT Environment of MANAGERS families LOCAL STEERING COMMITTEE
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    The town, atthe heart of the system The town is at the heart Town Decision of the system Schools makers Facilities School Catering Health professionals Health organizations Family Infancy professionals •Foster multistakeholder dynamics Other local Network stakeholders of associations Shop owners, Media Extra- local curricular producers professionals EPODE National • Information • Training Coordination • Communication tools Team • Coaching 14
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    Organization at thelocal level Mayor and municipal team Local team : Education system • expert GP representative • dietician • school GP • school nurse City sports & leisure Sports department associations representatives Project School catering manager department Shop keepers representatives And local steering committee City school department Local NGOs Stakeholders Welfare department Population 15
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    National Coordination role Overall management of the programme 1. Resources mobilization, Advocacy and mobilization of National / Regional stakeholders : Experts, Ministries, health professionals, local authorities, NGOs, economic players… 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) 4. Monitoring and evaluation 5. Permanent communication
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    Each semester, trainingsession, communication tools and roadmaps are provided to local project managers General public Local stakeholders Poster Leaflet 3 / 12 years-old File for « worksheets » Worksheets «local Disseminated in the whole Contents : Worksheets adapted to city Target : families and children aged 3 to 12 stakeholders » Contents : Advice and tips, recommendations for different stakeholders to implement Target : local stakeholders: Target : population as a specific actions healthier behaviours infancy professionals, shop whole owners, NGOs, schools… THEME Health professionals Local Project Managers and Local steering committees Faxed letter: Contents : Advice and An overall guidance tips, recommendations for healthier behaviours document and Biannual roadmaps Contents : objectives, Mobilization worksheets information and advice for Target : All local stakeholders in the framework of the the on-going theme “Taste of the Season” plan: Infancy professionals, shop owners, NGOs, schools… 17 June 2009 17
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    EPODE themes Playing is already moving! Fish is all good! January 08 October 08 18
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    Posters Displayed all aroundthe city Target : whole population
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    The 3-12 yearsold leaflets Target: families with children aged 3 to 12 years old Content : advices, tips, consumption benchmarks…
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    Actions sheets Epode Content: Sheets dedicated by target of actor to implement specific actions
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    A multidisciplinary andindependent expert board  Dr Jean-Michel Borys  Dr Sophie Treppoz  Practitioner in Endocrinology,  Paediatrician, representing the Diabetology and Nutrition French Association of Ambulatory Paediatrics, REPOP coordinator  Natalie Rigal  Child Psychologist  Pr Alain Duhamel  Biostatistician, Faculty of Medicine  Pr Daniel Rivière and Biostatistics Training Unit, Lille  Vice-Chairman of the French Society University and Hospital Complex of Medical Practice and Sport  Pr Monique Romon  Pr Claude Jaffiol  Professor of Nutrition, Head of the  Emeritus Professor at Montpellier Nutrition Dept of Lille University and Academy of Medicine Hospital Complex, Chairman of OSEAN network  Monique Valaize  Deputy Mayor for Public Health,  Sandrine Raffin Twinning Committee and  Social Marketing Expert Decentralised Cooperation  Dr Desbonnets  Benoît Dervaux  General Practitioner  Health economist, CNRS, Lille
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    A role inexpertise, 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
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    BMI Measurements Framework, Process,Communication, Difficulties and Challenges
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    BMI measurements Framework 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 : Pilot towns Y1 Y2 Y3 Y4 Y5 Nursery school (5 yo) TO 5th New recommendation grade (10-11 yo) Y1 Y3 Y5 Nursery school Nursery school Nursery school (5 yo) TO 5th (5 yo) AND 5th (5 yo) TO 5th grade (10-11 yo) grade (10-11 yo) grade (10-11 yo)
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    BMI measurements Framework 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 = Interest in the results Objectification of for local politicians and « » the towns results Local organization
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    Evolution of childhoodoverweight and obesity prevalence, between 2005 and 2009 in the pilot towns Evolution of the prevalence of childhood Overweight+Obesity between 2005 and 2009 in EPODE pilot towns 30 25 Asnières Body Mass Index (%) Beauvais 20 Béziers Evreux 15 Meyzieu Roubaix* 10 Royan Vitré** 5 0 2005 2009 2005 2009 TOTAL towns N % case N total N % case N total p*** % Decrease Obese 1192 4,81 1051 4,45 0,056 Overw eight 3900 15,76 3397 14,38 <0,0001 Overw eightObese 5092 20,57 24752 4448 18,83 23617 <0.0001 -9,12% * 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".
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    Evolution of childhoodoverweight and obesity prevalence, between 2005 and 2009 in the pilot towns Schools located in deprived areas  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 2005 2009 TOTAL tow ns - Schools in deprived areas N % case N total N % case N total p*** % Decrease Obese 642 6,78 576 6,5 0,4514 Overw eight 1601 16,91 9466 1474 16,65 8855 0,6287 Overw eightObese 2243 23,7 2050 23,15 0,3845 -2% ***In bold : significant "p".
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    Evolution of childhoodoverweight and obesity prevalence, between 2005 and 2009 in the pilot towns Schools NOT located in deprived areas  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 2005 2009 TOTAL tow ns - Schools NOT in deprived areas N % case N total N % case N total p*** % Decrease Obese 550 3,6 475 3,22 0,4514 Overw eight 2299 15,04 15286 1923 13,03 14762 0,6287 Overw eightObese 2849 18,64 2398 16,24 0,3845 -13% ***In bold : significant "p".
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    BMI measurements Positive 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
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    Complementary Monitoring and Evaluation and Indicators Collected Input, Process and Output indicators
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    Monitoring and EvaluationFramework 4 levels, in compliance with the EEN Evaluation Committee first recommendations National organization level Local organization level Setting level Child level BMI Data Collection
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    Tools used tocollect or report data  Interviews with local project managers, at least annually  Questionnaires consistently passed out to the Local Project Managers during meetings  Via the evaluation of pilot projects  Via annual reports  Press Relation Report  National Coordination reports for FLVS association, towns and partners  Via pilot studies results  « We move and we like it »  CSO-Sciences Po-INRA Study  BMI Data collection
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    Data Collected atNational Organization Level Subject / Area Nature of measurement Amount and type of Ministries and politicians supporting the Political support INPUT programme Amount of meetings organized, experts’ qualifications and Expert advisory involvement Networking / Scientific Participation in congresses and other events communication Human investment Coordination Team human resources Manpower competence Coordination Team qualifications Knowledge expertise Experts and Coordination Team expertise PROCESS Amount of private partners contacted and supporting the Private partners recruitment programme Press Relation team report: number and type of press releases, events and clips Communication advocacy / press Dissemination indicators: newsletters (number of contacts), website (traffic) Funding Evolution of funding Town commitment to the OUTUT Evolution of the amount of towns committing to the programme programme Amount of trainings organised per year, perception of their quality Training of local teams by the Local Project Managers. Dissemination at local level* Amount, type and quality (Local Project Managers’ perception) of Tools developed tools developed Organisation commitment to the * = recent indicator Amount and type of organisations participating to the programme programme
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    Data Collected atLocal Organization Level Subject / Area Nature of measurement Kinds of tools developed or used at local level and Material and methods methods used to mobilise the general public INPUT Type of contract for Local Project Managers (full/part Time investment time) Project Managers’ qualifications Local Project Manager’s qualifications Assistants to the Local Project Manager (MP, nurse, Knowledge expertise dietician…) involvement Steering committee Detailed qualifications of stakeholders involved* PROCESS Structures involved / Fields of Amount and type of structures involved / fields of intervention intervention Communication materials Dissemination (amount and type) and satisfaction Labelling Amount and type of EPODE actions labelled Development of new Action sheets by Local Project Action sheets Managers, use of action sheets* OUTUT Utilization at local level of “train the trainer” training Training of local stakeholders sessions, perception of efficiency* Multi stakeholders’ participation in Type of stakeholders involved in the implementation, organization/implementation of the Perception of efficiency by Local Project Managers* programme * = recent indicator
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    Data Collected atSetting Level Subject / Area Nature of measurement INPUT Amount and type of potential stakeholders to be Initial evaluation of potential stakeholders involved in the EPODE programme For specific actions : age and SES of participating Targets of interventions people Identification of schools located/not located in priority PROCESS Targets of interventions : schools education areas (ZEP) Multi stakeholders’ participation in Type of stakeholders involved in the implementation, organization/implementation of the Perception of efficiency by Local Project Managers* programme Amount of schools / town implementing the actions “a Social environment fruit for recreation” and school playgrounds OUTPUT development For specific actions : amount and type of participation, People participation to the actions age Tools dissemination Amount and type of dissemination * = recent indicator
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    Data Collected atChild Level Subject / Area Nature of measurement Amount of schools / town implementing the actions “a INPUT Social environment fruit for recreation” and school playgrounds development For specific actions : amount and type of participation, People participation to the actions PROCESS age Tools dissemination Amount and type of dissemination “We move and we like it“ pilot study : assessment of Behaviour changes changes in food habits and physical activity of a cohort OUTUT 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- Weight and height measured by a health professional 11 yo * = recent indicator
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    Evaluation Framework Positive 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
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    Staff in chargeof data collection or reporting Profile 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
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    Dissemination of results Ways 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
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    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
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    PPP within EPODEin 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
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    EPODE Public / Not-forprofit Partners at local and national level
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    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)
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    EPODE Private / CorporatePartners at local and national level
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    EPODE Local Private Partners  For concrete and and “win-win” collaborations, e.g.: - With local producers - Other local actors (town gardener, supermarket & dietician etc.)
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    An example ofEPODE 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
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    A Commitment Charterfor 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
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    EPODE Private partners at national level  A Coordination entity  Foundations and Health Institutes  Insurance companies  Retailers  Food and Beverages Industries  Health Industries  …
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    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
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    Corporate partners involved(2)  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
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    With the supportof EPODE European Network 54
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    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
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    Contacts and websites EPODEEuropean 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