Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Community interventions—planning for sustainability
large number of stakeholders/key opinion leaders
(public, private) to participate on a voluntary basis;
2. training stakeholders to convey positive messages
and creative solutions guided by international recommendations,
behavioral change theory, and the
experience of trained local experts;
3. implementing actions in schools and towns, using
the developed tools and methodologies, guided by
local initiatives in keeping with EPODE ’ s philosophy
with materials being validated by the national
scientific committee.
4. assessing effectiveness by measuring children ’s
BMI, the level of stakeholders ’ involvement and
the quality of spontaneous actions undertaken.
Financing comes from public - private partnerships,
established at the national and local level.
Representatives from private business (e.g. food
industry, insurance sector), academia, and local and
national politicians are brought together. The private
support is strictly financial and they sign an ethical
charter confirming their intention (supporting a
public health prevention project, independent of their
own agendas).
Evaluation
All EPODE communities measure and weigh children
annually at school and because participation is considered
the norm, the response rates are 90 – 95%. The
data are then a virtual census and statistical tests are
not required to give confidence about what is occurring
in participating communities. There are no comparison
populations being measured and it is,
therefore, difficult to assess the impact of the program
compared to having no program. The costs of obtaining
comparative data and the difficulty of evaluating
the influences of a multi - factorial intervention on
complex behaviors are major evaluation challenges.
The monitoring of actions is an important part of
evaluation. Since its launch in 2004, there have been
more than 1,000 actions per year by local stakeholders
in the first ten EPODE towns. A detailed monitoring
chart of these actions, filled by the project managers,
enables a continuous process evaluation. Economic,
media and sociological aspects are also evaluated.
Sustainability
A number of factors contribute to sustainability of the
project. The strong philosophy of ensuring that no
stigmatization occurs ensures that perceived risks are
minimized. The structure of EPODE maximizes
sustainability by ensuring leadership and commitment
(mayors signing on), the ongoing funding
(private : public, national : local), the program quality
(consistency across all towns/cities through the
National Coordination team), and the local relevance
and engagement (local project manager and steering
committee) are built into the design and processes.
The local stakeholders develop new skills and create
strong partnerships and social ties in their work. This
means that they feel valued and know they are part of
a large positive program for the community. Families
live in an “ ecological niche ” (village/town, neighborhood)
where events of daily life occur (education,
work, shopping, medical care, leisure transport, etc.).
Local stakeholders can have a strong influence in these
settings, supporting families and disseminating
common messages. EPODE involves the whole community
creating mobilization of local resources.
Since 2000, France has had a national strategy to
promote healthy lifestyles and implement supportive
policies such as restricting food advertising practices.
This has created a positive national context, which has
facilitated the implementation of EPODE.
Transferability
The initial ten EPODE towns have created a mayors ’
club to promote the concept among other local
authorities, explore financial, physical and human
resources, extend the network to foster operational
partnerships, and develop political awareness around
childhood obesity. Implementation is successful from
small towns (80 inhabitants) to large cities (Paris,
beginning in four districts). EPODE cuts across political
differences and socio - economic status. The model
has also been adopted and adapted in countries
outside France. Further details can be found on: www.
epode.fr .
Case s tudy 2 Sentinel
s ite for o besity p revention,
V ictoria, A ustralia
Introduction
The Sentinel Site for Obesity Prevention established
three whole - of - community demonstration projects
located in the Barwon - South Western region of
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