Transcript Slide 1

PREVENTION OF CHILDHOOD OBESITY
16th Nordic Congress of General Practice, Friday 15 May 2009
Head of Section, Maria Koch Aabel, National Board of Health, Denmark
Senior Consultant Thomas Skovgaard, Rambøll Management Consulting
WHAT´S THE PROBLEM?
Why target children and adolescents
• Obesity in childhood is associated with health problems and is a
significant early risk factor for the development of i.e. hypertension,
diabetes, cardiovascular diseases, social isolation and psychological
problems
• Overweight children have a much greater chance of becoming/staying
obese as adults
• Food and physical activity related behaviors track from childhood into
later years
• Obesity in adulthood is very difficult to treat
Cali & Cabrio, 2008; Johansen & Due (ed.), 2009
EFFECTIVE INTERVENTIONS
Primary prevention
Structural initiatives at national and local level
Population based initiative: broad based campaigns
Initiatives aimed at groups of children
Initiatives aimed at the individual child and family
Secondary prevention
Early detection of children with problems related to body weight
Tertiary prevention
Hinder relapse
NATIONAL ACTION PLAN AGAINST OBESITY:
THE COMMUNITY LEVEL
National program including 31 local, community based projects
Target group: Children & adolescents – and family
Aim:
• to carry out and assess prevention- and treatment interventions in a number of
communities
• to generate solid knowledge on project performance and results - usable for future
policies and strategies at various levels in connection with obesity prevention among
children and youth
Communities obliged to execute:
General interventions aiming at preventing overweight in children and adolescents
Specific interventions aiming at treating overweight in children and adolescents
A total of 73 million DKK has been provided by the National Board of Health in the period
2005-2008
GP - key person in the community based projects
• Education/qualification of professionals
• Early identification of overweight children and adolescents
• Creation of networks and cross collaboration between GP and
community
• Examination and visitation to community project
• Development of tools and methods for identification and
management of high risk groups
• Clinical Guidelines GP, 2006:
“Early Identification and Treatment of Overweight in
Preschool Children”
THREE PHASED APPROACH
Systematic
review of
available
research
Metaevaluation of
local
programs
Producing
integrative
new
knowledge
EFFECTIVE INTERVENTIONS
BUILDING ON
Cochrane Review
Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T,
Campbell KJ. Interventions for preventing obesity in
children. Cochrane Database of Systematic Reviews 2005
OBJECTIVE
• To review recent evidence on the effectiveness of interventions
aimed at preventing childhood obesity via diet, exercise and social
support/networks
COLLECTING DATA
Review team
Two academic staff (public health science) guided by an expert group
(n=3)
Independent extraction of data and study quality
Joint analysis and formulation of conclusions/findings
SEARCH STRATEGY
Aim: Supplement the Cochrane review
Database: PubMed
Selection criteria: Reviews and meta-analysis
Limits: Humans; Children (0-18 y); English & Danish language
Headings/Search terms: Prevention; Health Promotion; Obesity;
Community; School; Family
Primary outcome measure: Obesity (as defined in the Cochrane
study: weight & height; percent fat content; body mass index;
skin-fold thickness; ponderal index)
RESULTS
80 reviews were indentified.
Main reviewers went through abstracts and excluded studies that did
not apply a systematic appraisal/grading system or that were not
relevant for main focus (such as reviews concerning illness-related
obesity)
Four reviews were selected to be fully read and one study were finally
added to the body of primary studies included in the 2005-Cochrane
publication
OBESITY PREVENTION
Health Education
Communication directed
at individuals, families
and communities to
influence:
Behaviour change
Determinants of
behaviour change:
Awareness/knowledge
Decision-making
Beliefs/attitudes
Empowerment
Community participation
Service
improvement
Improvements in
quality and quantity
of services:
Social marketing
Improvement in
capacity of staff
Development of new
activities
Reorienting existing
activities to make
them more
effective/acceptable
Environmental &
legislative
Changing the
environment in order to
facilitate healthy
behavior:
Recreational facilities
Cafeteria menus
Food pricing & labelling
Product placement
Built environment
Accessibility
LITERATURE REVIEW
EFFECT ON REDUCING OBESITY AMONG
CHILDREN AND ADOLESCENTS
• Only four studies showed significant effects in relation to the primary outcome of
reducing obesity (Gotmarker et al.2008; Robinson,1999; Flores,1995 & Müller, 2001)
• Nearly all studies showed effects on secondary outcomes such as physical activity
and diet
• The majority of studies were short-term
• Only minor involvement of & by GP´s
• In some studies, poor quality of measurements may be the cause of not detecting
changes in the target outcome
• There is still a significant need for knowledge on how to reduce obesity among
children and adolescents.
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