school and community interventions for preventing obesity ...€¦ · de craemer m., et al....

Yannis Manios, ProfessorDepartment of Nutrition and DieteticsSchool of Health Science & EducationHarokopio University, Athens, Greece

School and community interventions for preventing obesity and NCDs in Europe: ToyBox-Study & Feel4Diabetes-study

Tracking of childhood overweight and obesity into adulthood

The Bogalusa Heart StudyFollow-up: 17.6 years

59% obese

68% obese

77% obese

Freedman et al.; Pediatrics 2005

Prevalence of iron deficiency by weight status in primary schoolchildren in Greece

Manios Y., et al., The double burden of obesity and iron deficiency in children and adolescents in Greece: the Healthy Growth Study. J Hum Nutr Diet, 2013. 26(5): p. 470-8.

14.1

1.4

17.4

2.8

23.3

5.30%

5%

10%

15%

20%

25%Male p<0.001

12.42

153.3

20.6

8.20%5%

10%15%20%25%

Iron deficiency(TS<16%)

Iron deficiency anemia(TS<16% andHgb<12g/dl)

Female p=0.001

Normal weight

Overweight

Obese

2010 2011 2012 2013 2014

What is the prevalence of overweight/ obesity at preschool age in Europe?

How can we prevent early childhood overweight/ obesity?

EU funded project: Number 245200, FP7-KBBE-2009-3)

Prevalence of overweight/obesity among preschool children in Europe

14.912 11.5 10.4 9.4 8.6

5.7

2.8 3.72.3

21.4

0%

5%

10%

15%

20%

25%

Greece Spain Bulgaria Poland Belgium Germany

Overweight Obesity

P<0.001

P<0.001P<0.001

Manios Y., et al. "Prevalence and sociodemographic correlates of overweight and obesity in a large Pan-European cohort of preschool children and their families. The ToyBox-study." Nutrition (2018).

Prevalence of overweight/obesity among preschool children in Europe by socioeconomic status

14.5% 12.7% 10.9% 10.0% 8.9% 8.1%

9.3%

7.2%

3.5%3.1%

2.0% 1.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Low SES Mid/High SES Low SES Mid/High SES Low SES Mid/High SES

South(Greece, Spain)

East(Bulgaria, Poland)

Central/North(Belgium, Germany)

Overweight Obesity

P = 0.040

Manios Y., et al. "Prevalence and sociodemographic correlates of overweight and obesity in a large Pan-European cohort of preschool children and their families. The ToyBox-study." Nutrition (2018).

2010 2011 2012 2013 2014

What is the prevalence of overweight/ obesity at preschool age in Europe?

How can we prevent early childhood overweight/ obesity?

EU funded project: Number 245200, FP7-KBBE-2009-3)

2010 2011 2012 2013 2014

What is the prevalence of overweight/ obesity at preschool age in Europe?

How can we prevent early childhood overweight/ obesity?

EU funded project: Number 245200, FP7-KBBE-2009-3)

By developing and implementing a kindergarten-based, family-involved intervention

2010 2011 2012-2013 2014

• Systematic reviews

• Secondary analysis

• Focus groups

Key-behaviours& their

determinants

IM Table Targeted behaviours• Water consumption

• Snacking• Physical activity

• Sedentary behaviour

ToyBox-study

Aiming to:Change kindergarten environment

Implement the behavioursTarget & involve parents via newsletters/daily activities

Training of teachers

1st Behaviour: Water consumption

Change of kindergarten environment

Implementation of behaviour

2nd Behaviour: Snacking

Change of kindergarten environment

Implementation of behaviour

3rd Behaviour: Physical activity

Change of kindergarten environment

Implementation of behaviour

4th Behaviour: Sedentary behaviour

Change of kindergarten environment

Implementation of behaviour

Intervention at home

Oct Nov Dec Jan Feb Mar Apr May Jun

Water consumption

NewsletterTip-cardPoster

Physical activity

NewsletterTip-cardPoster

Snacking

NewsletterTip-cardPoster

Sedentary behaviour

NewsletterTip-cardPoster

Water consumption

NewsletterTip-cardPoster

Physical activity

NewsletterTip-cardPoster

Snacking

NewsletterTip-cardPoster

Sedentary behaviour

NewsletterTip-cardPoster

All behaviours

NewsletterTip-cardPoster

• 9 Newsletters

• 8 Tip-cards

• 4 Posters

ToyBox Programme was implemented in 6 countries during school year 2012-2013

GERMANY

GREECE

BULGARIA

POLAND

SPAIN

BELGIUM

April 2010 2011 2012 2013 2014

ToyBox Programme was implemented:• by more than 700

kindergarten teachers • in 309 kindergartens • reaching more than 17,000

children and their families

ToyBox Programme was implemented in 6 countries during school year 2012-2013

GERMANY

GREECE

BULGARIA

POLAND

SPAIN

BELGIUM

April 2010 2011 2012 2013 2014

Country Kindergartens Children/Parents

Belgium 26 1032

Bulgaria 19 792

Germany 55 954

Greece 92 854

Poland 49 1065

Spain 30 853

Total 271 5550

Summary of findings after one year of intervention:

Positive changes were found for IG vs. CG for:• Children’s screen time• Children’s water consumption• Children’s and parents’ sweet consumption• Children’s and parents’ snack choices

De Craemer M., et al. "Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four-to six-year-old children’s steps per day: the ToyBox-study." International Journal of Behavioral Nutrition and Physical Activity 14.1 (2017): 116.

Pinket A., et al. "Multibehavioural interventions with a focus on specific energy balance-related behaviours can affect diet quality in preschoolers from six european countries: The toybox-study." Nutrients 9.5 (2017): 479.

Latomme J., et al. "Effect and process evaluation of a kindergarten-based, family-involved intervention with a randomized cluster design on sedentary behaviour in 4-to 6-year old European preschool children: The ToyBox-study." PloS one 12.4 (2017): e0172730.

Summary of findings after one year of intervention:

Positive changes were found for IG vs. CG for:• Children’s screen time• Children’s water consumption• Children’s and parents’ sweet consumption• Children’s and parents’ snack choices

De Craemer M., et al. "Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four-to six-year-old children’s steps per day: the ToyBox-study." International Journal of Behavioral Nutrition and Physical Activity 14.1 (2017): 116.

Pinket A., et al. "Multibehavioural interventions with a focus on specific energy balance-related behaviours can affect diet quality in preschoolers from six european countries: The toybox-study." Nutrients 9.5 (2017): 479.

Latomme J., et al. "Effect and process evaluation of a kindergarten-based, family-involved intervention with a randomized cluster design on sedentary behaviour in 4-to 6-year old European preschool children: The ToyBox-study." PloS one 12.4 (2017): e0172730.

% overweight/ obesity from baseline to follow up:• No changes between IG vs. CG

Factors associated with change observed in preschool children’s BMI over the 1-year intervention period

Linear Mixed Model†

Dependent variable: Increase in BMI (kg*m-2)

Independent variables B 95 % C.IChildren’s age at follow-up (years) 0.134 0.081 0.188Sex (Girls vs. Boys) -0.064 -0.106 -0.022Children’s BMI at baseline (kg*m-2) -0.011 -0.028 0.006Treatment arm (Intervention vs. Control) -0.033 -0.128 0.061Region (Belgium/Germany vs. Greece/Spain) -0.320 -0.227 -0.023Region (Bulgaria and Poland vs. Greece/Spain) -0.125 -0.423 -0.217Maternal misperception of child’s weight status(Underestimation vs. correct estimation) 0.390 0.173 0.607

Maternal pre-pregnancy BMI(Overweight/obese vs. Normal-weight) 0.181 0.123 0.238

Paternal BMI (Overweight/obese vs. Normal-weight) 0.082 0.038 0.127†: Three level logistic model adjusting for the random effects of socio-economic status and school.

Androutsos O., et al. "Perinatal and lifestyle factors mediate the association between maternal education and preschool children's weight status: the ToyBox study." Nutrition 48 (2018): 6-12.

School-based, family-involved intervention

2010 2011 2012 2013 2014

School-based, family-involved intervention

2010 2011 2012 2013 2014

School-based, family-involved intervention

2015 2016 2017 2018 20192010 2011 2012 2013 2014

Targeting High Risk Families

Feel4Diabetes-study was implemented in 6 countries during school years 2016-2017 & 2017-2018

Feel4Diabetes-study was implemented:• in 221 schools• reaching more than 30,309

children and their families

Finland

Greece

Bulgaria

HungaryBelgium

Spain

2015 2016 2017 2018 2019

EU-funded project: Horizon 2020 / Grant agreement n° 643708

Manios Y., et al. "A school-and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study." Public Health Nutrition (2018): 1-10.

For evaluation purposes data obtained at:Spring 2016, 2017 & 2018

Country Schools Families

Belgium 60 1278

Bulgaria 20 2196

Finland 30 1305

Greece 56 1744

Hungary 14 1309

Spain 41 1326

Total 221 9,158

Finland

Greece

Bulgaria

HungaryBelgium

Spain

2015 2016 2017 2018 2019

1st year Intervention results (IG vs. CG):

School & Community-based component: 6 countries (n= 9,158 families)

Favorable changes for parents:↑ Physical Activity↓ Screentime↓ Father’s BMI

Favorable changes for children:↑ Fruits & Vegetables↓ Sweets & Salty snacks↑ Physical Activity

1st year Intervention results (IG vs. CG):

School & Community-based component: 6 countries (n= 9,158 families)

Favorable changes for parents:↑ Physical Activity↓ Screentime↓ Father’s BMI

High-Risk Families component: for Greece (n=432 families)

Favorable changes for parents:↓ Waist circumference↓ Total cholesterol35% of the pre-diabetic parents turned to normal glucose levels

Favorable changes for children:↑ Fruits & Vegetables↓ Sweets & Salty snacks↑ Physical Activity

Favorable changes for children:↓ BMI↓ BMI-z scores in girls

ToyBox is scaling up around the globe: www.toybox-study.eu

ToyBox is scaling up around the globe: www.toybox-study.eufeel4diabetes-study is still on going: www.feel4diabetes-study.eu

ToyBox is scaling up around the globe: www.toybox-study.eufeel4diabetes-study is still on going: www.feel4diabetes-study.euYannis Manios: manios@hua.gr

THANK YOU!