Technical Paper 1:
Obesity in Australia: a need for urgent action
4.6.2 - The community setting
There is a range of community-wide interventions under way in Australia and Pacific countries that aim to control childhood obesity. One of the controlled intervention demonstration projects, ‘Eat Well Be Active’, recently published results following several years of community implementation in Colac, in regional Victoria. The program was designed to build the community’s capacity to address childhood obesity through the promotion of healthy eating, physical activity and healthy weight in 4–12-year-olds and their families.
The action plan was designed and implemented by local organisations, including schools and parents, and local health, housing and government services. The program used nutrition strategies such as support from school-appointed dietitians, canteen menu changes, training for canteen staff and healthy breakfast days, while physical activity strategies included walking to school programs, sporting club equipment and coach training.
Project objectives included reducing television viewing, sugary drinks and energy-dense snacks, and increasing water and fruit intake, active play out of school and active transport to school.
While overweight and obesity levels in children from both the campaign and the nearby comparison areas did not differ significantly and increased over time, children in the project area gained less weight and had smaller waist circumference measures (about 3cm) after several years of the project. Project results were also promising in reducing obesity-related health inequalities: in Colac, changes in weight and other measures were not related to children’s socio-economic status, while in the comparison group the more disadvantaged children experienced greater unhealthy weight gain.
Ensemble prévenons l’obésité des enfants (EPODE) (‘together, let’s prevent obesity in children’) is a community-based, family-oriented nutrition and lifestyle education program in France. The initiative involves local physical activity and healthy eating initiatives aimed at parents and children, with engagement of influential community groups and individuals, including education and health professionals, retailers and the media. The program was launched in 2004 and involves over 110 French towns in 10 pilot communities, and is now being extended into Belgium and Spain.
The program was launched following the success of a similar campaign in two French towns between 1992 and 1997, which involved a nutritional program intended to change children’s eating habits; 80% of the population participated. The program included a school breakfast program and curriculum changes, and was supported by local doctors and dietitians, including lectures for parents on healthy eating.
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The results indicated significant modification of eating habits (for example, the number of families eating chips weekly fell from 56% to 39%), while childhood obesity did not increase between 1992 and 2000. In comparison, in the rest of the region where childhood obesity doubled. Mothers in the participating towns also gained less weight than those in other towns.
The program is led by an expert committee with the support of the Ministry for Health and Family, with private sector partners (including food and insurance companies) that have committed human and technical resources as well as US$1 million. In the current program, height and weight is monitored in the target group (5–12-year-olds), with feedback provided to parents. Overweight/at-risk children are encouraged to see a doctor, while each town receives suggestions for activities, diets and community initiatives such as safe routes for walking to school, learning about vegetables at school, inviting food professionals to talk in schools and organised games at playtime. While results from the 10 pilot towns will be published in 2009, initial results appear promising; for example, in one town, the prevalence of overweight children decreased markedly between 2004 and 2005 (from 19% to 13.5%).
The North Karelia project is another excellent example of a community-based intervention. (See section 4.2 in this paper).
Implement comprehensive community-based interventions that encourage and support healthy lifestyles among all population groups, particularly in areas of disadvantage and among groups at high risk of unhealthy weight gain.