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

2. WHAT´S THE PROBLEM? 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 Why target children and adolescents

3. 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

4. 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

5. 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 andmethods for identification and management of high risk groups Clinical Guidelines GP, 2006: “ Early Identification and Treatment of Overweight in Preschool Children”

6. THREE PHASED APPROACH Systematic review of available research Meta- evaluation of local programs Producing integrative new knowledge

7. EFFECTIVE INTERVENTIONS

8. 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

9. OBJECTIVE To review recent evidence on the effectiveness of interventions aimed at preventing childhood obesity via diet, exercise and social support/networks

10. 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 COLLECTING DATA

11. 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) SEARCH STRATEGY

12. 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 RESULTS

13. 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

14. 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. 14