Lauren Lissner, Ending Childhood Obesity in the Nordic Countries workshop, 16-17.11.2016. Nordic Welfare States and Public Health - A Need for Transformative Change? -conference.

1. Childhood Obesity-
from surveillance to
prevention
Lauren Lissner, MPH, PhD,
Department of Epidemiology and Social Medicine (EPSO)
Director of EpiLife Center
University of Gothenburg, Sweden

2. Outline
• Obesity trends in Sweden and
beyond
• The social gradient in childhood
obesity across Europe
• Childhood obesity prevention:
lessons from the IDEFICS
intervention

3. Obesity Reviews 2016

4. Chung et al, 2016
Eligible studies: 42
post-2000: most found overall stability
or decrease but 40% indicated a
widening gap in childhood and
adolescent obesity
(as epidemic slows down inequalities
persist)

5. Outline
• Obesity trends in Sweden and
beyond
• The social gradient in childhood
obesity across Europe
• Childhood obesity prevention:
lessons from the IDEFICS
intervention

6. Early evidence: from US:
Stunkard 1972,JAMA
Cross-sectional evidence:
In 6 year old girls, obesity
was 9 times more prevalent
in lower SES than upper
SES girls.
Similar but less marked
trends seen in boys
”Prevention attempts
should be directed
particularly towards those
at high risk because of low
SES”

7. Ongoing
surveillance in
European
children:
WHO
CHILDHOOD
OBESITY
SURVEILLANCE
INITIATIVE
(COSI)

8. COSI
concept
• Trained personnel
• Standardized field equipment
• Standardized measurement
protocols
• Representative national
sampling
• Family questionnaires

9. Analytical sample: 13,764 children aged 6.5-8.5
In 5 countries with family surveys
Prevalence of overweight/obesity (WHO)
Bulgaria: 29.0/12.5
Czech Republic: 20.5/7.0
Lithuania: 24.0/8.7
Portugal: 37.8/14.4
Sweden: 22.8/5.8
Monitoring Social Inequalities
at baseline survey of
WHO-COSI (2008)

10. Prevalence odds ratio for overweight (including
obesity) with low maternal and paternal
education, compared to reference group with
higher education denoted by grey line adjusted
for sex and age group.

11. Prevalence odds ratio for overweight (including
obesity) with maternal and paternal
unemployment, compared to reference group
with employment, denoted by grey line; adjusted
for sex and age group (Lissner et al 2015)

12. Unexpected heterogeneity in socioeconomic
gradient in childhood obesityacross Europe
Importance of surveillance to track the gap

13. Outline
• Obesity trends in Sweden and
beyond
• The social gradient in childhood
obesity across Europe
• Childhood obesity prevention:
lessons from the IDEFICS
intervention

14. 14
Identification and prevention of
Dietary- and lifestyle-induced health
EFfects In Children and infantS
IDEFICS-
EU´s 6th Framework Programme
Theme 5 Food quality and safety
Area 2 Epidemiology of food-related diseases and allergies
Topic 5.4.2.1 Influences of diet and lifestyle on children’s health
(integrated project)
Coordination, W Ahrens, Bremen

15. 15
Baseline and
2-y followup
surveys
Intervention or control
Design
Survey and intervention, harmonized in 8
countries

16. Funded by the EC, FP 6, Contract No. 016181 (FOOD)
Interac(on
by
country
for
‘primary’
preven(on
Country-­‐specific
+
covariate
adjusted
pooled
results
(Obesity
Research,
2014)
Non-overweight
At baseline
Overweight
At baseline

17. Why such small preventive
effects and so many failures?
• Interventions not early enough
• Too short duration
• Insufficient parental involvement
• Focus on invidividual rather than
environment
• Saturation (messages, predisposition)

18. Reaching the hard-to-reach,
the big challenge
Risk: inreased SES gradient?

19. What types of interventions generate
inequalities? Lorenc et al JECH 2012
I
Intervention-generated
inequalities (IGIs)
Examples: media campaigns,
workplace smoking bans
”downstream”
Reducing inequalities
Examples: structural
workplace interventions,
provision of resources, fiscal
interventions
”upstream”

20. Take home messages
• Need to reach out to vulnerable group
in health promotion
• Targeted and universal prevention not
mutually exclussive
• Surveillance is needed as part of public
health prevention to ensure we reach
our target and don’t do harm
• Need for upstream measures
addressing causes of causes

21. Thank you for your attention
ForteCenter epilife.se
EpiLife Futures
epidemiology CVD
University of Gothenburg
epilife.se
lifecycle
Cognition
Obesity
Acknowledgements: colleagues from IDEFICS (coordinated
by W Ahrens) and COSI (coordinated by J Breda) and,
www.epilife.se