"Together,"Together, wewe cancan preventprevent obesityobesity inin children"children"
A major issue for the future of the children of today and the adults of tomorrow
1 > Fleurbaix-Laventie Ville Santé: how children can educate their parents
> EPODE: ten cities against children obesity
2 FleurbaixFleurbaix LaventieLaventie VilleVille SantéSanté
A scientific study A public health operation
3 FleurbaixFleurbaix etet LaventieLaventie
Nord Pas de Calais
Fleurbaix Laventie Lille
Fleurbaix: 2,222 inhabitants Laventie: 4,444 inhabitants
4 FleurbaixFleurbaix LaventieLaventie VilleVille SantéSanté 11
1992 - 1997 Can giving nutritional information to children change the eating habits of the whole family?
5 PrinciplesPrinciples andand objectivesobjectives
> Objective Assess whether the integration of nutritional education into the school curriculum can change the dietary behaviour of children and their families
> Methodology 2 "intervention" towns and 2 "control" towns
6 PlanPlan ofof thethe studystudy
Fleurbaix- Control Laventie towns 1992 Food surveys (children-parents)
Nutritional information 1997
Food surveys + educational assessment 7 NutritionalNutritional informationinformation
> Included in general lessons: biology, mathematics, French, history, sports education > Educational programmes Drawn up by an educational committee: teachers, scientists, doctors, nutritionists, school doctors, in collaboration with the teacher training college in Arras and the school inspectorate of Pas-de-Calais Adapted to each cycle Validated on the ground > Nutritional and educational training of teachers
8 FromFrom theory…theory…
The meal Food categories
9 …… toto practicepractice
> Practical lessons in and outside of schools
Cookery courses Visits to the market and supermarkets Visit from manufacturing or agricultural food production units
Visite d’un verger
10 An educational programme integrated into school curricula by teachers
92/93 93/94 94/95 95/96 96/97
Children 826 940 1,118 1,401 1,819 concerned
Number of classes 56 65 74 83 92 concerned
Nursery Nursery Nursery Nursery Nursery Classes school school school school school concerned CM2 6th 5th 4th 3rd
11 FleurbaixFleurbaix LaventieLaventie VilleVille SantéSanté 11
Some results
12 TripleTriple assessmentassessment
> 1) Do the children have better nutritional knowledge?
> 2) If yes, has this changed family food habits?
> 3) If yes, wich consequences on health markers?
13 1)1) DoDo thethe childrenchildren havehave betterbetter nutritionalnutritional knowledge?knowledge?
> Tests carried out under the control of National Education
> Biology acted as a control
> Questions on nutrition Evaluation of the nutritional balance of a meal Nutritional analysis of certain foods Making a balanced meal Eating foods before physical activity
14 1)1) DoDo thethe childrenchildren havehave betterbetter nutritionalnutritional knowledge?knowledge?
> Rate of correct answers (%) to nutrition tests
Fleurbaix Laventie Control towns
Biology tests 44.30 % 43.20 %
Nutrition tests 53.10 % 42.20 %
15 FirstFirst conclusionconclusion
Compared with children from the control towns, the children of Fleurbaix and Laventie have better nutritional knowledge
16 2)2) HasHas thisthis changedchanged familyfamily eatingeating habits?habits?
> Some family eating habits have been changed, moving towards the direction of PNNS (National Nutrition and Health Programme) recommendations. > Some changes are significant: More frequent and structured breakfasts Better quality of fats Increase in the number of consumers of pulses
Lafay L, Vray M, Boute D, Basdevant A; Rev Epidemiol Santé Publique 1998; 46 : 263-275
17 2)2) HasHas thisthis changedchanged familyfamily eatingeating habits?habits?
Fewer calories: Reduction in total energy content and fats, especially in girls
Feurbaix Control towns Significance Laventie
Energy 1,768 1,888 p < 0.03 (K cal/d)
Lipids 75 81 p < 0.05
Proteins 66 70 p < 0.05
18 SecondSecond conclusionconclusion
Families in Fleurbaix and Laventie whose children have received nutritional information have changed their lifestyle habits towards current PNNS recommendations
19 3)3) TheThe weight’sweight’s consequencesconsequences
> In women: a lower BMI Fleurbaix Laventie: 23 kg/m2 Control town: 24.1 kg/m2
> Same trend but no statistically significant difference in men
Int J Obes 1997; 21 : 567-73; Lafay L, Basdevant A, Charles M-A et al
20 3)3) TheThe weight’sweight’s consequencesconsequences
> In children No significant increase of obesity or excess weight between 1992 and 2000 No control in a strict scientific sense but double the prevalence of obesity in children of the same age during the same period in the region
Heude B, LafaLafayy L, Borys J.M, Thibult N, Lommez A, Romon M, et al.; Diabetes Metab 2003; 29(3) :235-40
21 GeneralGeneral conclusionsconclusions ofof FleurbaixFleurbaix LaventieLaventie VilleVille SantéSanté 11
> Nutritional information can change the status of knowledge
> Through the intermediary of children, the family can change its eating habits
> These changes have a positive effect on health, specially on weight gain
22 FLVS:FLVS: strengthsstrengths andand weaknessesweaknesses
23 KeyKey toto successsuccess
> Concrete actions > Local actions
> Visible actions
> Lasting actions
> Actions accentuated by regular communication
> Involvement of all the players
24 InvolvementInvolvement ofof allall locallocal playersplayers
> The people > Teachers > Health professionals: treating pathologies, follow-up, informing patients > The municipalities Availability of resources Regular communication with the people > Associations
25 RegularRegular communicationcommunication
> Information bulletin on the Study
> Posters in public places
> 3 > Information from doctors
> Publications in the press
> Website: www.villesante.com
26 WeaknessesWeaknesses
> Financing
> Perpetuation of the project
27 TheThe costscosts
> Intervention 2 euros per year per inhabitant
> Scientific research and assessment 75 euros per year per inhabitant
28 Funding…Funding… > 20% from public funds Towns Regional Council National education Research and Health Departments
> 80% from private funds From 1992 to 1997 From 1997 to 2002 From 2002 to 2007 Boerhinger Mannheim Cedus Cedus diagnostics Groupe Fournier Laboratoire Fournier Eridania Béghin Say Knoll BASF Pharma Go Sport Groupe Fournier Lesieur Lesieur Lesieur Nestlé France Nestlé France Nestlé France Roche Roche Tepral
29 SupportSupport fromfrom partnerspartners
30 FleurbaixFleurbaix--LaventieLaventie VilleVille SantéSanté
12 years later…
31 ExpectationsExpectations ofof thethe peoplepeople
> Appropriation by the people > Appropriation by local players: teachers continue educational programmes > 10 years later, almost complete involvement by the people: 90% participation in the study
32 OnOn thethe basisbasis ofof actionsactions takentaken asas partpart ofof thethe FleurbaixFleurbaix--LaventieLaventie VilleVille SantéSanté study,study, extensionextension toto aa selectionselection ofof pilotpilot townstowns
"Together,"Together, wewe cancan preventprevent obesityobesity inin children"children" campaigncampaign
33 EPODEEPODE
Campaign for the prevention of childhood obesity in ten towns; Objective: Stop the increase in childhood obesity by an intervention plan over 5 years
34 > Prevention based on:
Advocating a varied, balanced, pleasant diet as well as regular practice of physical activity
Community actions which are implemented on a long-term basis
Concrete and visible actions
35 This will involve: • 440,000 inhabitants • 48,000 primary school pupils • 2,000 teachers • 300 primary schools
36 TheThe towns,towns, planplan ofof actionaction requirementsrequirements
> Strong political will of the mayor and the local authorities: Approval of the project’s philosophy of public health implemented on a long-term basis Commitment to applying all the necessary means to carry out the minimum of actions and communication > Appointment of a local project leader as a key intermediary between the actions devised by the Research Institute for Dietary Habits and Weight (OHAP) and their local implementation > An EPODE referring doctor > A school doctor > A school nurse > A dietician Arousing the interest of local participants 37 SupportSupport fromfrom institutionsinstitutions
SFP (French Society of Paediatrics) APOP (Association for the Prevention and Control of Obesity in Children) AFPA (French Association of Ambulatory Paediatrics) Association of the Mayors of France
Under the patronage of the: Ministry of Health, the Family and Handicapped Persons Ministry of Youth, National Education and Research Ministry of Sport Ministry of Towns Ministry of Agriculture, Food, Fishing and Rural Affairs Ministry of Small and Medium-sized Companies, Trade, the Craft Industry, the Professions and Consumption
38 TheThe economiceconomic playersplayers
> Solution to the difficulties of financing the towns for public health actions
> Private partners: Assureurs Prévention Santé (French health insurers group)
(partner of Fleurbaix Laventie Ville Santé since 1992)
> Who undertake (signing of a charter): Not to promote product brands Not to modify the content of the programme To only communicate with the institutions concerning the campaign
39 Curb the increase in childhood obesity. Which strategy?
1/1/ AvoidAvoid excessiveexcessive weightweight gaingain inin childrenchildren
(Primary prevention)
40 ActionsActions inin schoolsschools andand townstowns
>>PromotionPromotion ofof aa varied,varied, balancedbalanced andand pleasantpleasant dietdiet
>> IncentiveIncentive toto regularlyregularly practicepractice recreationalrecreational physicalphysical activitiesactivities
Village Sports - Evreux 2004
41 PromotionPromotion ofof aa balancedbalanced andand variedvaried dietdiet
42 AA crosscross--disciplinarydisciplinary actionaction forfor aa balancedbalanced diet:diet: "The"The specialityspeciality ofof thethe season"season"
Each season, the spotlight is put on a different food group October-December 2004: vegetables
Doctors Parents/children Teachers Town Restaurants & Local Medical / "The speciality of Educational tools Local newspaper, canteens producers nutritional news the season is…" posters Adapted menus Distributors sheet
A synergy of the effects shown 43 ActionsActions inin schoolsschools (1)(1)
> Educational workshops conducted by volunteer teachers: Develop the concepts of nutrition and dietary variation throughout the year Familiarise the children with all of the food groups (fruits, vegetables, cereal products, etc.) from nursery school Encourage gustative assessment of foods Encourage real discovery of foods and the principles of a balanced diet: method of learning by experience
44 ActionsActions inin schoolsschools (2)(2)
> Working with school caterers Creating menus that specifically emphasise the food group of "The speciality of the season".
Creating and setting up thematic, recreational / educational activities in cooperation with the dieticians to educate the children Learning to cook Taste workshops: discovery of local products …
45 ActionsActions inin thethe TownTown
> Involving local players in the food industry: Producers Distributors Businesses Restaurants Markets … > Circulation of the thematic sheet "The speciality of the season is… " Practical advice for following nutritional recommendations on a day-to- day basis… and enjoying food Tips Easy and delicious recipe ideas
46 IncentiveIncentive toto regularlyregularly practicepractice recreationalrecreational physicalphysical activitiesactivities
Village Sports -Evreux 2004
47 Village Sports - Evreux 2004 > Actions at school Adapting recreational lessons to the practice of a physical activity in cooperation with the town Rediscovering physical activity games Organising inter-class and inter-school challenges …
> Actions in the town Setting up family actions such as "Walking to school together", a "walking school bus" managed by parents who take turns in walking a group of children to school
48 AA federativefederative aannualnnual eventevent
> Nutrition and Physical and Sporting Activity Week (SNAPS) Activities based on themes of a balanced and varied diet and physical activity: Discovery of physical and sporting activities Taste workshops Inter-class, inter-school, inter-generational challenges
Information talks
…
49 Curb the increase in childhood obesity. Which strategy?
2/ Involvement of the medical profession in cases of children with an excess weight problem (in collaboration with APOP and AFPA)
(Secondary prevention)
50 EachEach yearyear measuremeasure andand weighweigh thethe childrenchildren inin schoolsschools
> Recording of weight/height data from 48,000 primary school children once a year, organised by the school doctors and nurses.
51 ForFor testedtested childrenchildren
> 13 to 20% of children
> Incentive for parents to see their doctor
> Control by the doctors of the town-hospital network where it exists
> Personalised family coaching (diet and physical activity) conducted by telephone by registered dieticians
52 ActionAction byby locallocal doctorsdoctors
> Training of volunteer doctors by the EPODE referring doctor > Making tools available to control obesity
CD de FMC 53 AssessmentAssessment ofof thethe programmeprogramme
> Final assessment after 5 years of the prevalence of obesity in school children (BMI)
> Annual intermediary extrapolations
54 "Together,"Together, wewe cancan preventprevent obesityobesity inin children"children"
A concrete solution to a major public health problem
55 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.