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A review of the evidence: School-based

interventions to address obesity in children 6-12

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Q&A

Participant Side Panel in WebEx

Maureen Dobbins Scientific Director Tel: 905 525-9140 ext 22481 E-mail: dobbinsm@mcmaster.ca

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Robyn Traynor Research Coordinator

The Health Evidence Team

Heather Husson Project Manager

Jennifer Yost Guest Presenter

What is www.health-evidence.ca?

Evidence

Decision Making

inform

Why use www.health-evidence.ca?

1. Saves you time

2. Relevant & current evidence

3. Transparent process

4. Supports for EIDM available

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Knowledge Translation

Supplement Project

CIHR-funded KTB-112487

A Review of the Evidence: School-based Interventions to Address Obesity in Children 6-12 Years of Age

• Julie Charlebois Health Promotion Consultant

• Paula Waddell Health Promotion Consultant

Overview

• Partnerships for Health System Improvement Project Goal

• Introduction to Evidence-Informed Decision Making

• A Review of the Evidence • Recommendations

• Next Steps

Partnerships for Health System Improvement

• Health Evidence was awarded a CIHR grant

• Health Evidence is partnering with three Ontario public health units

• Exploring how to best enhance capacity for and facilitate contexts conducive to EIDM in public health

What is Evidence-Informed Decision Making?

The process of distilling and disseminating the best available evidence from research, practice and experience and using that

evidence to inform and improve public health policy and practice

National Collaborating Centre for Methods and Tools (NCCMT)

Stages of Evidence-Informed Decision Making

Step 1: Define Step 2: Search Step 3: Appraise Step 4: Synthesize Step 5: Adapt Step 6: Implement Step 7: Evaluate

Source: National Collaborating Centre for Methods and Tools (NCCMT)

Community Health Issues, Local Context

Research Evidence

Public Health Resources

Community and Political

Preferences and Actions

Public Health

Expertise

Model of EIDM in Public Health

National Collaborating Centre for Methods and Tools DiCenso, A., Ciliska D., Haynes B., & Guyatt, G. 2005

Step 1: Define

P (Population): Low-income Communities I (Intervention): Best Intervention C (Comparison): N/A O (Outcome): Factors influencing healthy weights and obesity

prevention

Research Question 1: What interventions or strategies are most effective in low-income communities/neighbourhoods to address

risk factors related to obesity?

Step 1: Define

Research Question 2: What school-based programs are effective in

increasing physical activity participation in higher needs elementary schools?

P (Population): Children in higher needs elementary schools

I (Intervention): School-based physical activity programs C (Comparison): N/A O (Outcome): Increasing participation in physical activity

Step 2: Search

START HERE

Step 2: Search (Search Terms)

Research Question #1: “obesity; obesity and low income; obesity and

low income and program; obesity and low income and physical activity and nutrition"

Research Question #2: "school and physical activity programs; school and physical activity and programs and high

risk"

Step 2: Search (Tracking Tool)

Step 2: Search (Databases and Timeframe)

Guidelines and Systematic Reviews Electronic Databases:

• Guideline Advisory Committee (GAC) • National Guidelines Clearinghouse (NGC) • Turning Research into Practice (TRIP) Database

(Guidelines and Systematic Reviews) • Health Evidence • Centre for Reviews and Dissemination (CRD) • Eppi-Centre • Cochrane Collaboration • PubMed Clinical Queries

Time Frame:

• Searched from 2007 to May 2012

Step 3: Appraise

Quality

Assessment Tool for Systematic

Reviews:

Appraise

Quality Assessment Tool for Guidelines:

Quality Assessment Summary (Appendix B)

Total: 9 Systematic Reviews & 2 Guidelines

New PICO Question

What school-based programs are effective in low-income communities/neighbourhoods to address risk factors related to obesity in children ages 6-12?

Step 4: Synthesize

Characteristics: (Appendix C) - Author, Date, Place of Publication

- # of Primary Studies, Type of Studies

- Theoretical Basis - Settings - Target Audience - Intervention Length - Mode of Delivery - Provider - Parent/Guardian Involvement

Outcomes: (Appendix D) - Author, Year, Place of Publication - Outcome Measures - Results - General Implications - Comments/Limitations

Step 4: Synthesize (Results)

Results were synthesized from 410 articles describing 364 separate interventions Results analyzed according to categories:

√ Physical Health Status Measures (5 Reviews) √ Physical Activity Measures (4 Reviews) √ Dietary Measures (3 Reviews) √ Psychosocial Measures (2 Reviews)

Step 4: Synthesize (Results)

The categories were further sub-divided into one or more of the following topics:

√ Dietary-based Interventions √ Physical Activity-based Interventions √ Psychosocial/psychoeducational Variables √ Duration √ Family and Community Involvement √ Intervention Delivery Based on Setting and Provider √ Tailored Programs √ Education Only Interventions √ Multi-component Interventions √ Environmental or Policy-based Interventions √ Peer Leaders and Incentives

Step 4: Synthesize (Recommendations)

Setting and Audience: TPH should implement obesity prevention interventions in the school setting.

TPH should implement obesity prevention interventions targeting children ages 6–12 (elementary school aged).

TPH should deliver obesity prevention interventions to mixed gender groups.

TPH should implement obesity prevention interventions in schools in lower socio-economic neighbourhoods to increase physical activity levels and improve dietary intake.

TPH should implement obesity prevention interventions that target all children versus interventions that target high risk populations who are already overweight or have risk factors of becoming overweight.

Step 4: Synthesize (Recommendations)

Dietary-based Interventions: TPH should not implement dietary-based interventions alone to improve anthropometric measures.

TPH should implement dietary-based interventions to improve dietary intake and/or behaviour (vs. anthropometric measures alone).

TPH should implement environmental or policy-based interventions such as breakfast and/or fruit and vegetable distribution programs to improve dietary intake.

TPH should not implement environmental or policy-based interventions focussing on system-wide nutritional change to improve anthropometric measures.

Step 4: Synthesize (Recommendations)

Physical Activity-based Interventions: TPH should implement physical activity-based interventions that decrease sedentary behaviours to improve anthropometric measures.

TPH should implement physical activity-based interventions that focus on extended physical education classes and activity breaks to improve anthropometric measures.

TPH should not implement physical activity-based interventions involving fitness enhancement to improve anthropometric measures.

TPH should implement physical activity-based interventions to increase physical activity measures including physical activity and /or sedentary levels. The use of activity breaks is one intervention that has been shown to be successful.

Step 4: Synthesize (Recommendations)

Physical Activity-based Interventions: (continued)

TPH should not implement physical activity curriculum alone to increase physical activity levels.

TPH should implement environmental or policy-based interventions to increase physical activity levels (e.g., playground game equipment and activity cards provided, playground painted with florescent marking designs and games by students).

Step 4: Synthesize (Recommendations)

Multi-risk Approach: TPH should implement a combination of physical activity and dietary-based interventions to improve anthropometric measures as well as physical and dietary behaviours.

Step 4: Synthesize (Recommendations)

Multi-component Approach: TPH should incorporate a multi-component approach to obesity prevention including behavioral, environmental, and educational components including health education, enhanced physical education, and promotion of healthy food options. In particular, the education component should be multi-risk.

TPH should not implement either physical activity or dietary-based education in isolation due to its limited impact as an obesity prevention intervention.

Step 4: Synthesize (Recommendations)

Other Intervention Components: TPH should include psychosocial/psychoeducational components in physical activity and dietary-based interventions (e.g. activities increasing knowledge/attitudes/preferences, self-esteem, well-being and/or quality of life). TPH should implement physical activity and/ or dietary-based interventions lasting at least 3 months. TPH should incorporate a family component into all obesity prevention interventions. TPH should aim for a high level of parental involvement in obesity prevention interventions (e.g. behaviour change goal for parents).

Step 4: Synthesize (Recommendations)

Other Intervention Components: (continued) TPH should use peer leaders in interventions focussing on obesity prevention. TPH should use incentives in interventions focussing on increasing fruit and vegetables consumption (e.g. rewards provided when fruit and vegetable servings are eaten at school). TPH should continue to partner with school staff and intervention specialists in the school setting in order to maximize the impacts of obesity prevention interventions. Overall, TPH should address harm or unintended effects when planning, implementing and evaluating obesity prevention interventions.

Step 5: Adapt

Assessment of Applicability and Transferability

Next Steps

• Applicability and transferability tool • Examine current TPH programs for gaps and

opportunities • Develop pilot project Ongoing: Knowledge Brokering within Toronto Public Health

• CDIP Consultants, Healthy Communities Consultants • CDIP child staff • Healthy Communities school youth team staff • Other TPH PHSI project staff

Thank you

Julie Charlebois Health Promotion Consultant Toronto Public Health jcharle@toronto.ca Paula Waddell Health Promotion Consultant Toronto Public Health pwaddell@toronto.ca Health Evidence info@health-evidence.ca

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