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Epode International Network

Dec.10.2014

Scientific background

 

The prevalence of overweight and obesity has increased worldwide during the last 30 years. In the European Region, over 50% of the population is overweight and over 20% is obese1. Childhood obesity is also a major issue in Europe, as up to 27% of 13-year-old adolescents and 33% of 11-year-old-children are overweight2.

The prevention through the promotion of healthier lifestyles is crucial from the early age and has to lean on networks of local actors in order to reach the families in their daily life and on a long-term basis. Programmes and initiatives already exist in order to prevent childhood obesity.

However, recent research findings are sometimes difficult to be applied in the field and a lot of best practices and methodology advice would need to be better shared. Finally, some populations at risk are more difficult to reach.

  1. A need for strengthening and up-scaling existing childhood obesity prevention Community-Based Programmes and Community-Based Interventions
  2. A need for obesity prevention among socio-economic disadvantaged groups, especially adolescents
  3. The EPODE methodology: definition and use within OPEN

 

A need for strengthening and up-scaling existing Community-Based Programmes and Community-Based Initiatives for childhood obesity prevention 

The European Commission has identified the need for an overview of the Community-Based Interventions implemented from 2005-2011 in Europe, as a support to the Health Information Strategy. A survey providing this overview was executed by the Dutch Institute for Public Health and the Environment (RIVM). Among the conclusion of the Final report of the survey, it was stated that for the purpose of comparing CBI (activities), a standardization of evaluation methodology and data collection was needed. Also, that a database facility should become available, accompanied by a search function to locate specific elements of CBIs and the option to download materials, documents, handbooks, and transfer systems3.

The OPEN project will answer these needs providing tools to assess the coordination teams methodology (using WHO good practice appraisal tool (scoring) and qualitative analysis of needs based on the EPODE 4 Pillars), tailored coaching for coordination teams methodology progress, best practice sharing thanks to workshops (during the 2 symposiums) and to an online database which aims to classify and share methodology and communication tools used by the coordination teams.

 

A need for obesity prevention among socio-economic disadvantaged groups, especially adolescents

The social gradient in health increases in most of EU countries4,5. In lower socioeconomic groups, inequalities in mortality from cardiovascular diseases account for about half of the excess mortality. Associated risk factors include overweight and obesity. Surveys conducted in EU States suggest that over 20% to 40% of the obesity found among EU adults is attributable to inequalities in socio economical status.

The EC Communication “Solidarity in health” emphasizes the variations in health-related behaviors, such as quality of nutrition and level of physical activity according to socioeconomic factors within and across countries. The EPODE methodology was referenced in the second edition of the EU report “Focusing on obesity through a health equity lens” among the collection of innovative approaches and promising practices developed to counteract obesity and improve health equity. It is today used in this aim in the EPHE project4.

Within the process of implementing obesity prevention strategies and actions, focus on adolescents’ poverty and inequalities is essential, since it has shown to impact negatively health, inhibiting personal development, education and general well being4.

Finally, lower socioeconomic status not only increases the risk of obesity among adolescents but also may result from obesity. Several studies have noted that obesity increases time off school and reduces the numbers of social relationships among adolescents, perceived popularity among child and adolescent peers, school educational attainment and employment prospects; resulting in a greater likelihood of an occupation with lower income or unemployment. Thus, social isolation, lower education and lower income may exacerbate the relationship between lower socioeconomic status and obesity6.

 

Use of the EPODE methodology

For more information see BIBLIOGRAPHY ON EPODE at the end of this page

Within OPEN, the EPODE methodology is used throughout the project to structure the qualitative appraisal and the capacity building and experience sharing workshops. It is also one of the programmes that is reviewed for giving evidence-based and practical recommendations to the Coordination Teams in the frame of the addressing adolescents from deprived areas.

The EPODE methodology, which will be used for recommending methodology progress to the CTs, is based on the FLVS study results. Results showed that long-term achievements are possible when mobilizing not only schools, but the whole community to touch, not only school-aged children, but the entire family including adolescents. FLVS study results also showed a significant BMI decrease among low-income populations7.

After the positive results of the FLVS study (1992-2004), the EPODE methodology has been launched in 2004 with 10 French pilot towns (who have globally experienced a downward trend in the prevalence of childhood overweight and obesity over the last 5 years) and was up-scaled to more than 500 towns around Europe from 2007.

EPODE is a coordinated, capacity-building approach aimed at reducing childhood obesity through a societal process in which local environments, childhood settings and family norms are directed and encouraged to facilitate the adoption of healthy lifestyles in children (i.e. the enjoyment of healthy eating, active play and recreation) (Figure 1).

 

EPODE wheel

EPODE wheel

EPODE philosophy is based on multiple components, including a positive approach to tackling obesity, with no cultural or societal stigmatisation; step-by-step learning and an experience of healthy lifestyle habits, tailored to the needs of all socio-economic groups.

 

EPODE target groups are children, families and local stakeholders. Through initiatives and a long-term programme, stakeholders foster and promote healthy lifestyles in families in a sustainable manner.

 

The EPODE four pillars – a strong political commitment, support services inspired from social marketing techniques, Mobilization of resources including Public-Private Partnerships and Evidence including a multidisciplinary Evaluation – have been sub-divided into ten EPODE implementation principles, which describe the EPODE methodology. Each country (or region) commits to a central coordination support/capacity:

 

1- Each local community has a formal political commitment for several years from the outset;

2- Each local community has a dedicated local project manager with sufficient capacity and cross-sectoral mandate for action;

3- A multistakeholder approach is integral to the central and local structures and processes;

4- An approach to action is planned and coordinated using social marketing. This is specifically to define a series of themed messages and actions, informed by evidence, from a wide variety of sources, and in line with official recommendations;

5- Local stakeholders are involved in the planning processes and are trusted with sufficient flexibility to adapt actions to local context;

6- The “right message” is defined for the whole community. However, getting the message “right” means tailoring for different stakeholders and audiences;

7- Messages and actions are solution-oriented and designed to motivate positive changes and not to stigmatise any culture or behaviours;

8- Strategies and support services are designed to be sustainable and backed by policies and environmental changes.

9- Evaluation and monitoring are implemented at various levels. This is achieved through the collection of information on process, output and outcomes indicators, and informs the future development of the programme.

 

 

BIBLIOGRAPHY

  • 1. http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity
  • 2. WHO Euro (2013). Country profiles on nutrition, physical activity and obesity in the 53 WHO European Region Member States. Methodology and summary.
  • 3. Bemelmans WJE. Verschuuren M. Dale van D. Savelkoul M. Wendel-Vos GCW. Raaij van J. (2011). Final report. An EU-wide overview of community-based initiatives to reduce childhood obesity. RIVM.
  • 4. ephestory.eu
  • 5. Mackenbach (2006). Health inequalities: Europe in Profile.
  • 6. Jusot, F. (2010). Les interventions de réduction des inégalités sociales de santé en Europe in Potvin L., Moquet M.-J., Jones C. (sous la dir.). Réduire les inégalités sociales en santé. Saint-Denis : INPES, coll. Santé en action, 2010 : 380 p.
  • 7. Finkelstein E et al. (2005). Economic causes and consequences of obesity. Annual Review of Public Health, 26:239–257.2005.

 

BIBLIOGRAPHY ON EPODE

Obesity Reviews, 2011. EPODE approach for childhood obesity prevention: methods, progress and international development.

Lavoisier, 2011. Preventing childhood obesity, EPODE European Network Recommendations.

Public Health Nutrition, 2008. Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes.