school and community interventions for preventing obesity ...€¦ · de craemer m., et al....
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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: [email protected]
THANK YOU!