EPODE, European Network France

1. Christophe ROY
Deputy Director
EPODE
Preventing childhood obesity

2. From FLVS pilot study to EPODE
2

3. FLVS: Fleurbaix Laventie Ville Santé
Nord
Pas de Calais
Paris
Fleurbaix
Laventie
Lille
Fleurbaix : 2 222 inhabitants
Laventie : 4 444 inhabitants
3

4. 4

5. Children obesity prevalence
data in FLVS and in CT
(Romon & Al., Public Health Nutrition, 2008, Dec 23:1-8)
Childhood obesity
20
rate (%)
17.8
%
15 P<0.0001 / FLVS 2004
14.3
12.6
NS
10 11.4 8.8%
NS; p= 0.7
CT
P<0.012 / FLVS 2000
FLVS
5
From education to education + city involvement
Years
1992 2000 2004
5

6. EPODE in the world, today
France, 2004
226 towns
Spain, 2007
Belgium, 2007
32 towns
15 towns
EPODE
Niños y Niñas OPAL
Mexico, 2010
South Australia, 2009
6 councils
Paideiatrofi
Greece, 2008
5 towns
6

7. EPODE approach
A coordinated, capacity-building approach for
communities to implement effective and sustainable
strategies to prevent childhood obesity.

8. Vision statement
Childhood obesity will be reduce by local environments,
childhood settings and family norms all being strongly
supportive of children enjoying healthy eating, active
play and recreation.

9. EPODE philosophy
 Based on positive messages, prompting a smooth
awareness of the obesity issue, both collectively and
individually
 No stigmatization of any culture, any food habits,
and no stigmatization of any diets, food groups,
behaviours and body image
 A “Step wise” and Experience-based
learning process of healthy diet &
physical activity.
9

10. The EPODE 4 pillars and goal
1 Creating the political commitment
2 Mobilizing resources
3 Coordination and Support services
4 Evidence-based & evaluation
=> Enable community stakeholders to implement effective
and sustainable actions to prevent childhood obesity

11. Target groups
1 Children 0 to 12 years old and their families
2 Stakeholders who can influence childhood
settings, food environments and physical
activity environments, and socio cultural norms

12. EPODE’s Philosophy
 A smooth awareness of the obesity issue with no
stigmatization of any culture, any food habits, and no
stigmatization of overweight and obesity
A positive, concrete and “step wise” process targeting all
socioeconomic groups with adapted levers
A long-term program aimed at changing the environment
and thus behaviors involving all relevant local stakeholders
4
12

13. A federative approach SCIENTIFIC NATIONAL
COMMITTEE INSTITUTIONAL
SUPPORT
Creation of an environment facilitating
the adoption of healthier lifestyles by
the families PRIVATE
PARTNERS
EPODE
NATIONAL
COORDINATION
MAYORS,
Elected
representatives
LOCAL
PROJECT
Environment of MANAGERS
families
LOCAL
STEERING
COMMITTEE

14. The town, at the heart of the system
The town is at the heart
Town Decision of the system
Schools makers
Facilities
School
Catering Health
professionals
Health
organizations
Family Infancy
professionals •Foster multistakeholder
dynamics
Other local Network
stakeholders of
associations
Shop
owners,
Media Extra- local
curricular producers
professionals
EPODE National
• Information
• Training
Coordination • Communication tools
Team • Coaching
14

15. Organization at the local level
Mayor
and
municipal
team
Local team : Education system
• expert GP representative
• dietician
• school GP
• school nurse City
sports & leisure
Sports department
associations
representatives Project School
catering
manager department
Shop keepers
representatives And local steering
committee City school
department
Local NGOs
Stakeholders Welfare
department
Population
15

16. National Coordination role
Overall management of the programme
1. Resources mobilization, Advocacy and mobilization of National /
Regional stakeholders : Experts, Ministries, health professionals,
local authorities, NGOs, economic players…
2. Continuous training and coaching of the local project manager (including
best practices sharing sessions, evaluation of local actions…),
3. Development of Tools:
• Training tools: guidance documents, roadmaps…
• Communication tools related to a theme (twice a year)
4. Monitoring and evaluation
5. Permanent communication

17. Each semester, training session, communication tools and
roadmaps are provided to local project managers
General public Local stakeholders
Poster Leaflet 3 / 12 years-old File for « worksheets » Worksheets «local
Disseminated in the whole Contents : Worksheets adapted to
city
Target : families and children aged 3 to 12 stakeholders »
Contents : Advice and tips, recommendations for different stakeholders to implement Target : local stakeholders:
Target : population as a specific actions
healthier behaviours infancy professionals, shop
whole
owners, NGOs, schools…
THEME
Health professionals
Local Project Managers
and
Local steering committees
Faxed letter:
Contents : Advice and An overall guidance
tips, recommendations for
healthier behaviours
document and
Biannual roadmaps
Contents : objectives, Mobilization worksheets
information and advice for Target : All local stakeholders in the framework of the
the on-going theme “Taste of the Season” plan:
Infancy professionals, shop owners, NGOs,
schools…
17 June 2009 17

18. EPODE themes
Playing is already moving! Fish is all good!
January 08 October 08
18

19. Posters
Displayed all around the city
Target : whole population

20. The 3-12 years old leaflets
Target: families with children aged 3 to 12 years old
Content : advices, tips, consumption benchmarks…

21. Actions sheets Epode
Content : Sheets dedicated by target of actor to implement specific actions

22. Monitoring and Evaluation

23. A multidisciplinary and independent expert board
 Dr Jean-Michel Borys  Dr Sophie Treppoz
 Practitioner in Endocrinology,  Paediatrician, representing the
Diabetology and Nutrition French Association of Ambulatory
Paediatrics, REPOP coordinator
 Natalie Rigal
 Child Psychologist
 Pr Alain Duhamel
 Biostatistician, Faculty of Medicine
 Pr Daniel Rivière and Biostatistics Training Unit, Lille
 Vice-Chairman of the French Society University and Hospital Complex
of Medical Practice and Sport
 Pr Monique Romon  Pr Claude Jaffiol
 Professor of Nutrition, Head of the  Emeritus Professor at Montpellier
Nutrition Dept of Lille University and Academy of Medicine
Hospital Complex, Chairman of
OSEAN network
 Monique Valaize
 Deputy Mayor for Public Health,
 Sandrine Raffin Twinning Committee and
 Social Marketing Expert Decentralised Cooperation
 Dr Desbonnets
 Benoît Dervaux  General Practitioner
 Health economist, CNRS, Lille

24. A role in expertise, advice and
advocacy
 Expertise role for each theme developed
 Discussion and choice of new themes to be developed
 Validation of the approach and main messages to be
communicated
 Expertise role in BMI data collection and results
 Advice about data collection methodology
 Comments on the results
 Advice on other indicators to be collected and communicated
 Presentation of specific studies results
 Studies led by the experts
 Pilot studies led within the EPODE programme
 Epode advocacy
 Participation in congresses and conferences
 Publications

25. BMI Measurements
Framework, Process, Communication,
Difficulties and Challenges

26. BMI measurements
Framework and Process
 At National Level
 Collaboration with the ministry of National Education
 Collaboration with local education administrations
 At Local level
 Part of the initial training of the Local Project Manager
 Collaboration with the National Education GPs and nurses
 Or another solution involving other health professionals
 Data collection yearly / every 2 years :
Pilot towns
Y1 Y2 Y3 Y4 Y5
Nursery school
(5 yo) TO 5th
New recommendation
grade (10-11 yo)
Y1 Y3 Y5
Nursery school Nursery school Nursery school
(5 yo) TO 5th (5 yo) AND 5th (5 yo) TO 5th
grade (10-11 yo) grade (10-11 yo) grade (10-11 yo)

27. BMI measurements
Framework and Process
 At Local level
 Information to school directors and to the parents
 Data collection in the schools, respecting children decency
 Data transfer from Local level -> National level
 A collaboration with a biostatistics centre for data processing
 Underweight (from 2010) / Normal / Overweight / Obese prevalence
 Boys / Girls
 Age
 School location (ZEP/ non ZEP)
 A meeting with the Local Project Manager and the Deputy Mayor to
share the results
 BMI data collection =
Interest in the results
Objectification of for local politicians and
« » the towns results Local organization

28. Evolution of childhood overweight and obesity
prevalence, between 2005 and 2009 in the pilot towns
Evolution of the prevalence of childhood
Overweight+Obesity between 2005 and 2009 in
EPODE pilot towns
30
25
Asnières
Body Mass Index (%)
Beauvais
20
Béziers
Evreux
15
Meyzieu
Roubaix*
10
Royan
Vitré**
5
0
2005 2009
2005 2009
TOTAL towns N % case N total N % case N total p*** % Decrease
Obese 1192 4,81 1051 4,45 0,056
Overw eight 3900 15,76 3397 14,38 <0,0001
Overw eightObese 5092 20,57 24752 4448 18,83 23617 <0.0001 -9,12%
* Roubaix : only the 7 common schools between 2005 and 2009 have been included.
** Vitré : 2008 data. The CP, CE1 and CM1 school grades have not been included in 2009.
***In bold : significant "p".

29. Evolution of childhood overweight and obesity
prevalence, between 2005 and 2009 in the pilot
towns Schools located in deprived areas
 For the children from schools located in deprived areas, a non-
significant (p=0,3845) downward trend is observed in the
prevalence of childhood overweight (including obesity), from
23,7% in 2005 to 23,15% in 2009:
 Overweight: from 16,91% in 2005 to 16,65% in 2009
 Obesity: from 6,78% in 2005 to 6,5% in 2009
2005 2009
TOTAL tow ns -
Schools in deprived
areas N % case N total N % case N total p*** % Decrease
Obese 642 6,78 576 6,5 0,4514
Overw eight 1601 16,91 9466 1474 16,65 8855 0,6287
Overw eightObese 2243 23,7 2050 23,15 0,3845 -2%
***In bold : significant "p".

30. Evolution of childhood overweight and obesity
prevalence, between 2005 and 2009 in the pilot towns
Schools NOT located in deprived areas
 For the children from schools located in non-deprived areas, the
prevalence of childhood overweight (including obesity) decreased
significantly (p<0,0001), from 18,64% in 2005 to 16,24% in 2009:
 Significant decrease (p<0,0001) in overweight prevalence from 15,04% in
2005 to 13,03% in 2009
 Non-significant decrease (0,0694) in obesity prevalence from 3,6% to
3,22% in 2009
2005 2009
TOTAL tow ns -
Schools NOT in
deprived areas N % case N total N % case N total p*** % Decrease
Obese 550 3,6 475 3,22 0,4514
Overw eight 2299 15,04 15286 1923 13,03 14762 0,6287
Overw eightObese 2849 18,64 2398 16,24 0,3845 -13%
***In bold : significant "p".

31. BMI measurements
Positive aspects and Challenges
 Long term collaboration with the ministry of National Education
 Real interest in the results for national, local politicians and
other local actors
<<
 Time and human resources demanding
 Variability of data quality
 Recurrent concern about obesity care plan

32. Complementary Monitoring and
Evaluation and Indicators
Collected
Input, Process and Output indicators

33. Monitoring and Evaluation Framework
4 levels, in compliance with the EEN Evaluation
Committee first recommendations
National organization level
Local organization level
Setting level
Child level BMI Data Collection

34. Tools used to collect or report data
 Interviews with local project managers, at least
annually
 Questionnaires consistently passed out to the
Local Project Managers during meetings
 Via the evaluation of pilot projects
 Via annual reports
 Press Relation Report
 National Coordination reports for FLVS
association, towns and partners
 Via pilot studies results
 « We move and we like it »
 CSO-Sciences Po-INRA Study
 BMI Data collection

35. Data Collected at National Organization Level
Subject / Area Nature of measurement
Amount and type of Ministries and politicians supporting the
Political support
INPUT programme
Amount of meetings organized, experts’ qualifications and
Expert advisory
involvement
Networking / Scientific
Participation in congresses and other events
communication
Human investment Coordination Team human resources
Manpower competence Coordination Team qualifications
Knowledge expertise Experts and Coordination Team expertise
PROCESS
Amount of private partners contacted and supporting the
Private partners recruitment
programme
Press Relation team report: number and type of press releases,
events and clips
Communication advocacy / press
Dissemination indicators: newsletters (number of contacts),
website (traffic)
Funding Evolution of funding
Town commitment to the
OUTUT
Evolution of the amount of towns committing to the programme
programme
Amount of trainings organised per year, perception of their quality
Training of local teams
by the Local Project Managers. Dissemination at local level*
Amount, type and quality (Local Project Managers’ perception) of
Tools developed
tools developed
Organisation commitment to the
* = recent indicator Amount and type of organisations participating to the programme
programme

36. Data Collected at Local Organization Level
Subject / Area Nature of measurement
Kinds of tools developed or used at local level and
Material and methods
methods used to mobilise the general public
INPUT
Type of contract for Local Project Managers (full/part
Time investment
time)
Project Managers’ qualifications Local Project Manager’s qualifications
Assistants to the Local Project Manager (MP, nurse,
Knowledge expertise
dietician…) involvement
Steering committee Detailed qualifications of stakeholders involved*
PROCESS
Structures involved / Fields of Amount and type of structures involved / fields of
intervention intervention
Communication materials Dissemination (amount and type) and satisfaction
Labelling Amount and type of EPODE actions labelled
Development of new Action sheets by Local Project
Action sheets
Managers, use of action sheets*
OUTUT
Utilization at local level of “train the trainer” training
Training of local stakeholders
sessions, perception of efficiency*
Multi stakeholders’ participation in
Type of stakeholders involved in the implementation,
organization/implementation of the
Perception of efficiency by Local Project Managers*
programme
* = recent indicator

37. Data Collected at Setting Level
Subject / Area Nature of measurement
INPUT
Amount and type of potential stakeholders to be
Initial evaluation of potential stakeholders
involved in the EPODE programme
For specific actions : age and SES of participating
Targets of interventions
people
Identification of schools located/not located in priority
PROCESS
Targets of interventions : schools
education areas (ZEP)
Multi stakeholders’ participation in
Type of stakeholders involved in the implementation,
organization/implementation of the
Perception of efficiency by Local Project Managers*
programme
Amount of schools / town implementing the actions “a
Social environment fruit for recreation” and school playgrounds
OUTPUT
development
For specific actions : amount and type of participation,
People participation to the actions
age
Tools dissemination Amount and type of dissemination
* = recent indicator

38. Data Collected at Child Level
Subject / Area Nature of measurement
Amount of schools / town implementing the actions “a
INPUT
Social environment fruit for recreation” and school playgrounds
development
For specific actions : amount and type of participation,
People participation to the actions
PROCESS
age
Tools dissemination Amount and type of dissemination
“We move and we like it“ pilot study : assessment of
Behaviour changes changes in food habits and physical activity of a cohort
OUTUT
of 944 children, primary school aged
Evolution of Body Mass Index of children
aged 4-5 to 10-11 years old / 4-5 and 10- Weight and height measured by a health professional
11 yo
* = recent indicator

39. Evaluation Framework
Positive aspects and challenges
 Some ways to collect data are already efficient
 Experts, politicians and partners have a real interest in the results
<<
 Define the most relevant indicators in compliance with the EEN
Scientific Evaluation and Dissemination Committee recommendations
 Design the appropriate instruments
 Find the incentive to motivate the local teams to collect data
 Produce common international evaluations and publications

40. Staff in charge of data collection or reporting
Profile and time spent
 National organization level
 Data collection : J Mayer (qualifications : sociology, social marketing)
 Estimation of time spent : 4 days per month
 Reporting : EPODE team and PR team
 Estimation of time spent : 2 days per month
 Local organization level
 Data Collection : J Mayer
 Reporting : Local Project Manager (various qualifications)
 Time spent varies according to the LPM
 Setting level
 Data Collection : J Mayer through the Local Project Manager
 Reporting : through the Local Project Manager
 Child level
 Data Collection : Health professionals
 Estimation of time spent : 1/2 day for 3 school classes
 Data processing : CHRU Lille
 Estimation of time spent : from 2h to 1/2 day per town

41. Dissemination of results
Ways and reasons
 Expert committee
 Advice on how to improve ourselves and what to
communicate
 Municipalities : Deputy Mayor and Local Project Manager
 Get advocacy and motivation of local stakeholders
 Valorisation of of the National Coordination work and of the
Local Project Manager
 Communication at local level
 Help targeting specific areas
 Reports to partners
 Get an overview to justify their funding
 National and local press communication
 Linked to the EPODE congress
 Conferences, congresses, publications
 ECO 2009
 EPODE Congress

42. EPODE multistakeholder partnership
17 June 2009 42

43. EPODE :
Multistakeholder Partnership
 A response consistent with the recommendations of the WHO
and the EU, which appeals to a joint mobilisation of all actors in
order to establish a coordinated, integrated and multistakeholder
response.
 A complementary expertise in order to respond to a
multifactorial public health problem
 A response that emphasises the role of the actors at all levels,
in the search of a sustainable solution

44. PPP within EPODE in France
 An Initiator (FLVS NGO) and a National coordination team
 Towns: actors funding the program at the local level
 Institutional partners: ministries, national health prevention institutions,
scientific associations
 Private sponsors:
 A corporate commitment, with a PPP charter

45. EPODE
Public / Not-for profit Partners at local
and national level

46. EPODE public / non-for profit partners
 Local level
- Town
- Local NGOs
- Leisure Centres
- Hospitals
- Health and Infancy professionals
- Schools
-…
 Regional level
- Regional government
- Regional health administration
 National level
- Ministries
- Health Groups (Civil society)
 International level (e.g. EU/DG SANCO, WHO)

47. EPODE
Private / Corporate Partners at local and
national level

48. EPODE
Local Private Partners
 For concrete and and “win-win” collaborations, e.g.:
- With local producers
- Other local actors (town gardener, supermarket & dietician etc.)

49. An example of EPODE local partnership
« From seed to bread », in Saint-Quentin with the supermarket
1 A long term partnership
2 A commitment of the employee
and the manager of the
supermarket => pedagogical
workshops organized with
children either in the classroom or
in the supermarket’s bakery
3 A balanced partnership : get
political recognition in
compensation, and the motivation
of employees

50. A Commitment Charter for
EPODE Local Private Partners
 Limited to the town’s territory
 2 different timeframes
- For specific local actions or projects
- On a continuous basis
 Possible frameworks: financial support, in kind support,
pedagogical workshops with children etc.
 Communication about the partnership only at local level
 No product or brand promotion

51. EPODE
Private partners at national level
 A Coordination entity
 Foundations and Health Institutes
 Insurance companies
 Retailers
 Food and Beverages Industries
 Health Industries
 …

52. Corporate partners involved
 Responsible economic actors:
 Placing CSR at the heart of their core business
 Being part of a sustainable solution: providing financial support to
the EPODE programme on a long term basis
 Involved in health prevention
 Beyond its economical role, the company has a social responsibility
will
 Private entities, companies have an expertise, a view and data
which may be helpful
 Because a company is able to mobilise its employees

53. Corporate partners involved (2)
 Signing a charter of commitment
 Participating to partners meetings
 Well-framed communication charter :
- Encouraging corporate communication about the
programme
- No product or brand promotion
- No intervention in the content of the programme

54. With the support of
EPODE European Network
54

55. Objectives
 Raise political, institutional and scientific awareness of the importance
of local, long-term and multi-stakeholder approaches for childhood
obesity prevention
 Enrich existing methodologies and develop guidelines on the EPODE
key pillars:
 The importance of political involvement for the set up and implementation of similar-
programs
 Good practices for the evaluation of EPODE-similar community-based interventions
 The interest of network expertise and social marketing approaches
 Public/private partnerships
 Identify and follow up relevant teams willing to implement CBIs using
EPODE methodology in other countries

56. EEN Partners

57. EEN organizational scheme

58. EEN Website
www.epode-european-network.eu

59. Contacts and websites
EPODE European Coordination Team
Jean-Michel BORYS, MD, jmborys@proteines.fr
Christophe ROY, croy@proteines.fr
Yann LE BODO, ylebodo@proteines.fr
EPODE existing Websites
www.epode.fr
www.viasano.be
www.thaosalud.com
www.paideiatrofi.gr